The Effectiveness of Treating Migraine Headaches Using Tuina to Address Patterns of Organ Disharmony

Emillie Ferreira

Research Case Report June 29, 2009

International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

The author wishes to acknowledge and thank Skip Kanester for his feedback on the initial client notes and treatment protocol developed for this case report study.

ABSTRACT
Objective: To determine if using Tuina to address organ disharmony is beneficial in achieving a reduction in the intensity and frequency of migraine headaches.

Methods: 20 year old male presenting with chronic headaches. Client recorded intensity and frequency of headaches and stress levels daily in a logbook for 4 weeks prior and 4 weeks during the study. Stress level, blood pressure and heart rate were taken before and after each session. One-hour sessions were conducted weekly over 5 weeks.

Results: Headache intensity and frequency show slight increase. Overall stress levels shows slight increase. Post-session stress levels show decrease while pain levels increase slightly. After every session the client’s heart rate decreased however his blood pressure rose after the first two sessions and decreased after the next three. Reduction in secondary symptoms related to organ disharmony.

Conclusion: Tuina is bodywork that can require a longer period of time to achieve results when the practitioner is working to balance organ disharmonies rather than working to address a specific complaint.

Key Words: Tuina, Migraine Headache, Organ disharmony, Chinese Medicine

INTRODUCTION

Migraine headaches affect more than 29.5 million Americans. These headaches are vascular in nature and occur when excited brain cells trigger the trigeminal nerve to release chemicals causing swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem (National Headache Foundation, 2009). According to the International Headache Society (IHS) there are two primary types of migraine headaches, those presenting with aura and those without. General symptoms of migraine headaches include unilateral pain, pulsating quality to the pain, moderate or severe pain intensity, aggravation by physical activity, headaches lasting 4- 72 hours, nausea and/or vomiting, photophobia and phonophobia. Migraines presenting with aura will also have visual, sensory or speech disturbances (International Headache Society, 2004/2005). Since there are no tests to confirm migraine headaches, diagnosis is made by establishing the history of the migraine-related symptoms and eliminating any underlying cause for headaches (National Headache Foundation, 2009).

The traditional method of treating migraines is pharmacological. There are three main methods of treatment. The first is abortive or acute treatments. These are medications which are designed to be taken during a migraine to reverse attacks and hopefully stop the pain and symptoms once they have started. Currently there are over 40 different prescribed medications for use in stopping migraines once they start, however not all have been scientifically proven. Examples of acute/abortive treatments include: simple analgesics, combination analgesics, nonsteroidal anti-inflammatory agents (NSAIDs), Opiate analgesics, Ergot alkaloids, Triptans and Corticosteroids.

The second category is preventative medications which are designed to be taken regularly, with most being taken daily, to reduce the frequency and severity of migraines. Included in this category are antidepressants, beta-blockers, calcium channel blockers, anticonvulsants and monoamine oxidase inhibitors (MAOIs).

The last category is alternative therapies. Included here are relaxation training, thermal biofeedback with relaxation training, electromyographic biofeedback, cognitive- behavioral therapy and herbal/vitamins therapies including the use of Feverfew, Petasites Hybridus, Magnesium, Riboflavin, Coenzyme Q 10, and Melatonin (Rapoport, 2008; Migraine Resource Network). Although the first two categories are the more traditional methods of treating migraines, this last category shows a willingness to try alternative therapies for migraine headaches.

Another type of alternative therapy that has shown success in treating headaches is massage therapy. Studies have been done on the efficacy of different types of massage therapy and the various types of headaches (Launso, Brendstrup & Arnberg, 1999; Lipton, 1986; Foster, et al., 2004; Lawler & Cameron; Piovesan, et al., 2007). While these studies were successful, a review of the literature showed only one study that included Tuina as part of an acupuncture protocol to relieve migraine headaches (Hu, Xu & Zhong, 2004). Studies done in China show that Tuina has been used to treat a myriad of conditions such as Fatigue Syndrome (Zhang & Lin, 2003), Constipation (Ruan, 2008), Ankle Sprain (Feng, 2004), Myofascial pain syndrome (Zhang & Wu, 2008) and Cervical Spondylosis (Guo, 2009). In the United States, Tuina has been used to treat back pain, sciatic pain, headache, muscle tightness, frozen shoulder, neck pain, tennis elbow, insomnia, fatigue, constipation, diarrhea, stroke recovery, joint dislocation, poor childhood appetite and even the common cold (Seattle Post-Intelligencer 2007).

Tuina (pronounced “twee-NAA”) is a form of bodywork that has been used in traditional medicine clinics and hospitals in China as well as in many other Asian countries for thousands of years. It is commonly used to prevent and treat injuries and illness by removing obstructions and increasing vital energy, called Qi (“chee”), in the body through manual methods and other techniques (Apichai, 2007). Chinese medical theory recognizes a network of important Organs which work together to achieve equilibrium in the body. Chinese medicine bases its logic on organizing symptoms and signs into patterns of disharmony. These patterns of disharmony provide the framework for designing the treatments. The therapy and treatments then attempt to bring the patterns of disharmony back into balance and restore harmony to the individual. When the body is in equilibrium then the person is considered healthy. This theory of health is the Chinese medical attempt to make sense out of the practice of treating illness (Kapptchuk, 2000).

There are three Organs which are relevant to this client’s disharmony and are thought to contribute to his primary complaint. These are the Liver, the Spleen and the Kidneys. According to Chinese theory each Organ in the body is associated with specific responsibilities such as flowing and spreading, transforming and transporting, absorbing and eliminating, ascending and descending, activating and quieting. Chinese organ theory is determined by the dynamic functional activity of the Organ rather than the fixed somatic structure that performs the activity. Therefore the Chinese Liver is defined first by the activities associated with it and not by its physical structure. The Liver is said to rule flowing and spreading and is most closely connected with the Blood. At the same time it calms the Qi and keeps it pliable. The Liver’s Blood is essential to balance the Spleen and Liver Qi and all activity that depends on Qi also depends on the Liver. When the Liver becomes imbalanced it can influence the circulation of Qi and Blood. This causes the blood to stagnate (Kaptchuck, 2000; Tyme, 2001). It can also cause the Qi to become rebellious and flow in a counter productive direction. For the Liver this would lead directly to the head and cause headaches.

The emotion associated with the Liver is anger. Anger often affects the Spleen and Stomach as well as the Liver. This is usually caused by stagnant Liver Qi invading the Stomach and Spleen. Symptoms from anger are mostly felt in the head and neck areas and include migraine headaches, tinnitus, dizziness, red blotches on the front of the neck, red face, thirst and red tongue (Tyme, 2001).

Chronic headaches experienced by the client possibly stem from Liver Qi Stagnation. Assessment also indicated a possible Spleen and Kidney Yang Deficiency as another pattern of disharmony and a contributing factor to his chronic headaches. The Spleen is most closely associated with Qi. It is the Organ by which food is transformed into Qi and Blood and for the Chinese it is the primary Organ of digestion. The Spleen directs “ascending” movement and rules transformation and transportation. Disharmony in the Spleen may lead to Deficient Qi or Blood in either the whole body or in some part of it. The Spleen is the origin of Qi and Blood, helps to create the Blood and controls the Blood by keeping it flowing in its proper paths. The Spleen is the ruler of the muscles, flesh, and the four limbs, and also transports Qi and Blood to them. Muscle tone or the appearance of the limbs can often indicate the relative strength or weakness of the Spleen. The Spleen Qi needs a balanced and calm Liver. If the Liver starts to become stagnate, it can “invade” causing an imbalance of the Spleen.

Kidneys store the Essence (Jing) and rule reproduction, growth and development. The entire body and all the Organs of the body need Essence in order to thrive. Thus, the Kidneys are considered the “root of life.” Kidneys have both Yin and Yang aspects. The Yin of the Kidneys is called either Jing or Water. The Yang of the Kidneys is called Ming-men huo or Gate Life Fire. The Kidneys rule Water through their Yang aspect. This Fire transforms Water into a “mist” so the Fluids can ascend or circulate. The Spleen also vaporizes pure Fluids but its vaporization power is ultimately dependent on the Kidney Fire, which acts as kind of a “pilot light.” Because the Kidneys store the Essence they are the foundation of each Organ’s Yin and Yang or life activity. Each Organ depends on the Yin and Yang of the Kidneys. Without the Kidneys being in harmony the other Organs cannot do their specific functions (Kaptchuk, 2000; Tyme, 2001).

The objective of this study is to determine if using Tuina to address Organ disharmony is beneficial in achieving a reduction in the intensity and frequency of migraine headaches. Therefore a treatment protocol was developed to move Liver Qi stagnation and tonify the Spleen and Kidneys. The treatment protocol was divided into three distinct parts: Client Supine, Client Prone and Client Seated. Points and techniques were chosen for their ability to strengthen and tonify the affected Organs while addressing the primary complaint of chronic headaches. Prior to the study the client was instructed to keep track of frequency and intensity of his headaches. Frequency of headaches was documented in a daily headache log. Intensity of headaches and daily stress levels were documented in a log and measured using a numerical rating scale (NRS).

METHODS

Client Profile
The client is a single 20 year old Caucasian male with no children, experiencing

chronic headaches. He is 5′ 6″ weighing 150 pounds. He works for the U.S. Marine Corps as part of the Motor Transportation Company driving vehicles. Chronic headaches began after a minor concussion owing to a fall at age 7 and began to worsen at age 10 or 11 following the divorce of the client’s parents. At age 12 a doctor suggested taking Advil Migraine. This was discontinued after approximately one year as it had very little effect on relieving pain. Excedrin Extra Strength currently provides relief but is only effective if taken during very early stages of a headache. Headaches reached their peak of severity while in high school causing enough pain to induce vomiting then requiring him to be sent home. Pain intensity began to decrease around age 17 and now the average pain of his headaches reach about a 7 on a scale of 1-10, and no longer cause vomiting.

Chronic headaches prevent him from engaging in any strenuous physical activities such as lifting anything over forty pounds or running. However, these actions are performed if they are required for work. Headaches occur once or twice a week. Headaches can be brought on or made worse by stress. Extreme heat, such as the conditions experienced in Iraq, and sudden variations in temperature such as from hot to cold or cold to hot make existing headaches worse but are not a cause. Light, sound and sudden movement may also aggravate existing headaches. Pain starts in the frontal and/or vertex region of the head and then radiates towards the center of the head as the intensity and duration increase. Pain continues in the original locations even once it starts to radiate. Pressure/pain in the eyes and occipital/sub- occipital region is occasionally felt. Client is unsure whether pain is aggravated or relieved by pressure. The client does not start the day with a headache. Headaches start midday and then progressively get worse. On the Brief Pain Inventory completed by the client, words used to describe the pain were throbbing, shooting, stabbing, gnawing, sharp, tiring, penetrating, nagging, miserable and unbearable. The client expressed a desire to reduce the frequency of chronic headaches and thus agreed to participate in a 5 week study to determine the effects of Tuina on chronic headaches.

Client Assessment
The client is nearsighted and wears contacts daily. Vision was last checked in February of 2009. He exercises three or four times weekly. He does not perspire spontaneously but only after heavy exertion. He smokes one pack of cigarettes a day and has been smoking for five years. He consumes approximately one twelve pack of beer on the weekend which is defined as Friday, Saturday and Sunday. He consumes between three and four coffee drinks per day with each serving being approximately sixteen ounces, and between three and six twenty ounce sodas a day. He eats fast food approximately one to two times a week. He states that he does not drink any water daily. His usual diet consists of eating in the chow hall at the barracks where he lives. He describes his appetite as being “moderately hungry” and says he is thirsty often. He has no preference for either hot or cold drinks. He has no food cravings. He tends to belch often. He did not report any unusual tastes in his mouth but reported a feeling of fullness in his stomach after meals.

The client states that he has been experiencing diarrhea at least once a week and that it occurs at random times during the day. This has been going on for at least three or four months and started when he returned home from deployment in Iraq. He does not suffer from any fever or chills and has no aversion to either hot, cold or wind. He urinates between 4-6 times per day and has a bowel movement once or twice a day. He describes his urine as medium to slightly dark yellow. There is no pain or difficulty with urination or defecation. He states that the consistency of his stool is “regular” with no undigested food, mucous or blood present.

The client sleeps between 6-8 hours and has no trouble getting to sleep or staying asleep. He claims that he sleeps well, does not suffer from any night sweats and has no dreams or nightmares. Client has a tan, slightly orange-colored complexion with ruddy cheeks. It is undetermined if this is due to him being out in the sun or if this is his normal coloring. His hair is shiny and thick with no dryness, although perhaps very slightly on the oily side. It was noticed that the skin along the tops of his ears was red but the lobes were not. His ear lobes were medium in size and not very thick. His eyes were not very bright and his contacts seem to bother him quite a bit, and they cause him to blink and rub his eyes a lot although it does not cause any redness in the eyes. The client claims they are not dry and he does not need or use eye drops to moisten his eyes. His lips were very slightly more red than normal, like he was wearing lip gloss but not glossy. They also seemed a bit dry. He has a wide gap in between his two front teeth which he says is due to a structural defect in his jaw. He has a slightly narrow jaw and somewhat weak looking chin with a cleft in it. His skin is unblemished and smooth. Overall he appears soft and his muscles are not well defined. He is not overweight but he could be described as having “baby fat.” He tends to slouch or hunch while standing or sitting and he looks down while walking. He moves and speaks somewhat slowly. He is quiet with his speech. He is very passive in his mannerism.

Ridges were observed on the fingernails. Socks were worn through the entire assessment. When removed it was found that his feet were very cold to the touch. This is the usual state of his feet although they do not feel cold to him. The temperature of his hands was checked and found to be very warm. This is also normal for him. While observing breathing it was noted that the diaphragm area does not rise very much and that his breathing seems shallow but not in the chest. Palpation of his abdomen reveals it to be soft and resilient. The areas above and to the left of the umbilicus are cool to the touch. The areas below and to the right of the umbilicus are slightly warmer.

The client tends to make a lot of exaggerated facial expressions when sharing information but does not use hand gestures. Facial expressions included alternately raising one eyebrow then the other, grimacing, exaggerated eye movements and silly faces that seem out of place. The client was willing to cooperate and answer all questions and seems to have no problem with any questions. The client stated he “feels like he’s ADD” and has trouble concentrating. Further questioning revealed that he has a poor memory for faces, names, and everyday things, but can remember facts. The client did not seem to have a problem concentrating in general. Subsequent conversations with the client uncovered an underlying emotional constitution of anger. It should be noted that in this context “anger” includes such emotions as resentment, irritability, repressed anger, frustration, rage, anxiety, depression, jealousy and animosity.

Palpation revealed that the sternocleidomastoid (SCM) was hypertonic on both sides from attachment to insertion causing this muscle to appear flexed while the client was supine. The left side was much worse than the right. This was the only muscle that was noticeably tense upon visual assessment. Tenderness was found in the following points while briefly palpating the body: Tai yang, GB21, GB30, UB36, UB40, UB39, UB57, K10, GB20, LI9, LI10, LI11, LI4, Lu1, Lu2, Lu5, P3, H3, GB29, GB34, Li3, UB60, ST36, ST40 and ST41.

Study Overview
To establish baseline headache measures, four weeks prior to starting the 5-week study the client was instructed to record frequency, duration and intensity of headaches using a daily logbook. The time and date of each headache was recorded. A numeric rating scale (NRS) was used to determine the intensity of the headaches. The client rated the intensity of the headaches on a NRS ranging from 0-10, with 0 indicating no pain and 10 indicating worst/incapacitating pain. The client was also asked to track stress levels using the NRS with 0 indicating no stress and 10 indicating most stressed. Blood pressure and heart rate were taken before and after each treatment for comparison. A NRS measuring pain and stress levels were taken before and after each treatment. The client was asked to abstain from smoking, eating and drinking anything other than water for 2 1⁄2 hours before each session.

Treatment Plan

The following treatment plan was designed to address the primary complaint of chronic headaches based on the Organ disharmony of Liver Qi Stagnation. This treatment plan has a secondary purpose of tonifying the Spleen and Kidneys.

Client Supine:

1. Press/Release (An) Du 20 (5 times)
2. Divergent push (Tui) forehead (7 times)
3. Press/release (An) the Yintang (5 times)
4. Divergent push (Tui) from the sides of the nose along the zygomatic arch out tothe jawbone (5 times)
5. Press/release (An) Tai Yang (5 times)
6. Grasp (Na) down the neck and shoulders on each side (3 times)
7. Grasp (Na) down arm (3 times)
8. Press rub (Chien) LI11, LI10, LI9, LI4 (5 times each point)
9. Repeat steps 7 and 8 on other side
10. Press/release (An) abdomen to regulate breathing (5 minutes)
11. Grasp (Na) lower abdomen (5 minutes)
12. Grasp (Na) abdomen along rib margins (5 minutes)
13. Grasp (Na) down legs GB/Lv channels (3 times)
14. Press rub (Chien) GB34, ST36, GB35, GB38, SP6, ST41, GB40, Lv2, Lv3 (5times each point)
15. Brush (Mot) down body
16. Ask client to turn prone

17.

Client Prone:
18. Push (Tui) down back from shoulders to hips using forearms (3 times each side) 19. Moderately knead back with emphasis on Lv/GB area (2 minutes)
20. Press rub (Chien) UB18, UB19, UB20, UB21, DU4 (5 times each point)
21. Penetrate (Tien) Ahshi points in area using elbow (10 minutes)
22. Roll back, low back and legs (10 minutes)
23. Press rub (Chien) GB30, UB40, K10, UB60 (5 times each point)
24. Grasp(Na) down legs (3 times)
25. Brush (Mot) down body
26. Ask client to sit up either in a chair or with legs over the edge of the table

Client Seated:
27. Roll neck and tops of shoulders with passive movement (10 minutes) 28. Press/release (An) GB20, GB21, UB10 (5 times)
29. Chafe (Tsa) bottom of ribs over organs to warm area (2-3 minutes) 30. Brush (Mot) down back and arms

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Report of Clinical Visits

RESULTS

Session 1

The client began the session with a slight headache and had trouble relaxing. He kept his eyes open for the duration of the treatment. His breathing was shallow and deep breathing was difficult. Breathing from the diaphragm needed to be explained before beginning the abdominal work. He laughed while having the lower abdomen grasped although he claimed he was not ticklish and felt irritated when the grasping was moved to the upper abdomen. He swore a lot during the session in response to his points being worked and grasping along the rib margins. The client’s points were difficult to locate because of slight edema in the legs. Only one Ahshi (tender) point on his back located medial to the inferior angle of the right scapula was found. At the end of the session client reported the last point (UB10) caused the pain inside his head to rise. He stated, “It feels like the pain I get with my normal headaches but in a different location.”

Session 2

The client consumed large amounts of alcohol over the 4 day holiday prior to treatment session. He has noticed an increase in his irritability level and has had bouts of diarrhea following the last session. Swearing has ceased this session and he tried to concentrate on getting through the point work by holding his breath which caused him to turn very red in the face. Practitioner softened the abdominal area by placing a bolster under his knees which made the grasping easier but did not change the client’s initial reaction. There was an increase in the amount of edema in the client’s lower extremities.

Session 3

In contrast to the previous weekend the client did not drink alcohol over this weekend, felt less stressed and believed he was having fewer headaches. Over the last two sessions UB10 seemed to give the client a headache so the first half of the seated protocol was moved to the beginning of the treatment to see if this would lessen the discomfort. Chafing and brushing remain at the end of the treatment. His breathing is deeper and

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slower than in past sessions and he now closes his eyes and appears more relaxed during the abdominal work. Grasping of the abdomen was done from the left side of the body instead of the right side as it has been done is previous sessions, and this has resolved the client’s desire to laugh during the treatment. His Ahshi point has moved from the right side of his body to the left side in the same location. His edema has decreased slightly in the lower extremities. The client fell asleep during hand rolling on the back of body which is the first indication of him being truly relaxed. There was no change in post- session pain seen with change in protocol but client requested to keep the new protocol.

Session 4

Unlike before the previous sessions the client smoked 1⁄2 hour prior to the beginning his treatment. He consumed more alcohol over the weekend than in previous weekends and he was exposed to 2-chlorobenzalmalononitrile or CS gas over the previous week. He no longer has the digestive problems he complained about prior to starting the sessions and following the first session, however his sleep has been disturbed making him more tired than usual. He experienced more discomfort during the session than in previous sessions. He was advised to keep his eyes closed and concentrate on his breathing. As a result the abdominal work was deeper and easier this session than any other. There was an increase in edema in his lower extremities. Post-session client requested information on how drinking water and improving lifestyle could change the quality of the treatment sessions.

Session 5

The most notable difference this session is that the client did not consume any alcohol this weekend but opted instead to drink a bottle of water and abstained from smoking the day of his treatment. Since last session he has been sleeping more soundly but has been feeling irritable and getting mad for no apparent reason. He was relaxed throughout the session, breathing deeply without coaching. No Ahshi points were found on the back. No edema was seen in the lower extremities. Post-session the client requested to continue bodywork sessions after termination of the study.

Stress Levels

Pain Levels

Before Treatment After Treatment

10 9 8

6

5

4

3

2

1

0
Figure 21. Stress l2evels be3fore and4after trea5tment

Before Treatment After Treatment

4 3.5 73

2.5

2

1.5

1

0.5

0

12345

International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

Figure 3. Pain levels before and after treatment

8 6 4 2 0

4/20/2009

4/27/2009

5/4/2009

5/11/2009

5/18/2009

5/25/2009

6/1/2009

6/8/2009

Headache Intensity

10 8 6 4 2 0

4/20/2009

4/27/2009

5/4/2009

5/11/2009

5/18/2009

5/25/2009

6/1/2009

6/8/2009

Figure 4. Headache intensity was recorded for 4 weeks prior to treatment and for 4 weeks during the study.

Stress Levels

Figure 5. Stress levels recorded for 4 weeks prior to treatment and for 4 weeks during the study

Report of Clinical Data
The data shows no reduction in headache frequency or intensity and no long term

reduction in stress (Figs. 1, 4 & 5). Post-session data shows a decrease in stress upon completion of a session and a slight increase in pain after a session (Figs. 2 & 3). After every session the client’s heart rate decreased, however his blood pressure rose after the first two sessions and decreased after the next three (Fig. 6). It is interesting to note that despite the weekends of heavy drinking and exposure to CS gas during the study period the frequency of headaches remains relatively consistent.

Although the data suggests little to no improvement the client reported feeling more relaxed throughout the study. He no longer had the problems with his digestion that were reported when he first started the study. His feet were warmer and no longer felt cold to the touch. He started drinking water and sleeping more soundly. He experienced irritability throughout the study which is an emotion associated with the liver and which you would expect to see while working to balance this Organ (Kapptchuk, 2000).

Blood Pressure & Heart Rate

Figure 6. Blood Pressure and Heart Rate measurements taken before and after each session.

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Session Before Session After Session

1 127/68 (66) 137/58 (58)

2 121/60 (81) 127/76 (64)

3 128/63 (66) 127/66 (60)

4 135/61 (68) 122/79 (65)

5 128/65 (76) 124/69 (66)

DISCUSSION

At first glance the results of this study might imply that treating migraine headaches by addressing a client’s Organ disharmony or disharmonies via Tuina is ineffective. However based on the client’s other physical improvements and the manifestation of specific emotions during this study such as improved digestion, improved sleep, warmer extremities, reduction of edema and the feelings of irritability, it appears the treatments were addressing the correct Organ disharmonies. The protocol was designed to address disharmonies of the liver, spleen and kidneys. Improved digestion and the reduction of edema could be seen as a result of tonifying the spleen while warmer extremities could be seen as a result of strengthening the kidneys. Feelings of irritability are not unusual while working on the liver and would be expected to manifest during the course of treatment. Lifestyle and diet are important factors in Chinese medicine and ideally a client would adopt a healthier way of living during and after receiving treatments (Kaptchuk, 2000).

It is probable that this client’s lifestyle choices during the treatment period contributed to his symptoms. A review of the literature reveals most Tuina protocols are administered over a much longer period of time than was given in this study (Zhang & Lin, 2003; Zhang & Wu, 2008; Zhang, 2003). It is suggested a longer study period be used in determining the efficacy of Tuina on migraine headaches and Organ disharmonies.

Conclusion
Tuina is bodywork that can require a longer period of time to achieve results

when the practitioner is working to balance Organ disharmonies rather than working to address a specific complaint. Elimination or relief of the primary complaint may not be immediate however secondary symptoms may be relieved. While the objective of the study was not achieved, the protocol was working to address the correct Organ disharmonies.

References

Apichai, B. (2/8/2007). Alternative medicine: Tuina: ancient pain relief meets modern life. Seattle Post-Intelligencer. Retrieved April 29, 2009, from http://www.seattlepi.com/health/302749_altmed08.html.

Feng, G. (2004). Treatment of 20 cases of ankle sprain with tuina combined with physical therapy. Journal of acupuncture and tuina science, 2(2), 51-52.

Foster, K. A., Liskin, J., Cen, S., Abbott, A., Armisen, V., Globe, D., et al. (Sept/Oct 2004). The trager approach in the treatment of chronic headache: A pilot study. Alternative Therapies, 10(5), 40-46.

Guo, Y. (2009). Treatment of 157 cases of cervical spondylosis of vertebral artery type by tuina therapy. Journal of acupuncture and tuina science, 7(2), 113-115.

International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

Hu, W., Xu, s., & Zhong, L. (2004). Observations on the effect of tuina plus acupuncture for cervical migraine. Journal of acupuncture and tuina science, 2(4), 50-52.

International Headache Society (Comp.). (2004/2005). The International classification of headache disorders. Oxford: Blackwell Publishing. (2nd Edition).

Kapptchuk, Ted J. (2000). The web that has no weaver (2nd ed.). New York: McGraw- Hill.

Launso, L., Brendstrup, E., & Arnberg, S. (1999). An exploratory study of reflexological treatment for headache. Alternative therapies, 5(3), 57-65.

Lawler, S. P., & Cameron, L. D. (2006). A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med, 32(1), 50-59.

Lipton, S. (1986). Prevention of classic migraine headache by digital massage of the superficial temporal arteries during visual aura. Ann Neurol, 19, 515-516.

Migraine Resource Network. (2009). Retrieved April 29, 2009, from MediCom Worldwide, Inc. Web site: http://www.migraineresoursenetwork.com

National Headache Foundation. (2009). Retrieved April 29, 2009, from National Headache Foundation Web site: http://www.headaches.org/education/Headache_Topic_Sheets/Migraine

Piovesan, E. J., Di Stani, F, Kowacs, PA, Mulinari, RA, Radunz, VH, Utiumi, M, et al. (2007). Massaging over the greater occipital nerve reduces the intensity of migraine attacks: Evidence for inhibitory trigemino-cervical convergence mechanisms. Arquivos de Neuro-Psiquiatria, 65(3). Retrieved April 30, 2009, from http://www.scielo.br.

Rapoport, A. M. (2008). Acute and prophylactic treatments for migraine: present and future. Neurological Sciences, 29(Suppl.), 110-122.

Ruan, Y. (2008). Summarization of constipation treated with tuina therapeutics. Journal of acupuncture and tuina science, 6(1), 62-64.

Student manual of the fundamentals of oriental medicine (4th ed.). (2001). In Tyme (Comp.). La Mesa, CA: Living Earth.

Zhang, J. (2003). Treatment of fatigue syndrome by tuina: A report of 79 cases. Journal of acupuncture and tuina science, 1(4), 51-52.

Zhang, J., & Wu, Y. (2008). Clinical study on treatment of myofascial pain syndrome with ashi points. Journal of acupuncture and tuina science, 6(6), 347-351.

Zhang, J., & Lin, Q. (2003). Treatment of fatigue syndrome by tuina: A report of 79 cases. Journal of acupuncture and tuina science, 1(4), 51-52.

International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

CranioSacral Therapy Reduces Chronic Back Pain and Improves Structural Balance

By, Abby McKenna

Research Case Report June 29, 2009

International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

The author wishes to acknowledge Dorothy Mahrie for her guidance and helpful advice given throughout this case report project.

Abstract


Objective: This study investigated the effects of CranioSacral Therapy (CST) on structural imbalance and the reduction of chronic pain.

Method: A 23 year old male experiencing chronic pain from the mid-back shooting up the spine, and radiating out through the upper girdle region. Five CST sessions were given once a week for five weeks, each treatment lasted for 1 hour. Each bodywork session began with three initial check-in phases to determine where to begin the specific CST holds. The client recorded his pain daily on a number scale and the practitioner measured his structural alignment.

Results: The client experienced a significant reduction in pain following the first session, and stayed at that level throughout the rest of the treatments. There was no measurable change in the clients physical structure, although many of the inner structures shifted and aligned to create ease.

Conclusion: This case study has shown that Craniosacral Therapy improves inner body awareness, decreases chronic pain, and creates a feeling of balance and alignment throughout one’s being.

Key Words: CranioSacral Therapy, Chronic Back Pain, Alignment, Upledger, Osteopathy

Introduction

Chronic pain has been defined by the International Association for the Study of Pain (IASP) as continuous or recurrent pain that persists for longer than the normal time of healing, generally about three months (Merskey, 1994). Chronic pain can range from mild tissue irritation to intense suffering and disability affecting an individual’s entire body, psyche and life. The perception of pain often persists long after the injured tissue has healed. This can cause compensatory patterns that continue to maintain the sensation of pain, eventually leading to abnormal somatic and visceral changes that frequently mask the primary cause of the chronic pain (Wanveer, 2006).

An estimated two-thirds of American adults suffer from back pain — a condition almost as prevalent as the common cold. When the pain lingers, making it hard to get comfortable or do simple activities, this is chronic pain. Acute or Chronic, the causes of back pain are sometimes unknown (Deyo, 2007). Precipitating factors that can cause back pain include mechanical problems, such as the way the spine moves or the way you feel when your spine moves a certain way. Spasms, muscle tension, and ruptured or herniated discs can cause chronic pain. Injuries can cause back pain and muscle strains or ligament sprains; they can occur from twisting or lifting improperly. Acquired conditions and diseases such as arthritis, osteoarthritis, scoliosis, also lead to chronic back pain. Although the many causes of back pain are usually physical, emotional stress can play a role in how severe pain is and how long it lasts. Most back pain, acute or chronic, is treated with a wide range of medications available over the counter, or by a doctor’s prescription. In more extreme cases corsets and braces are used, injections of anesthetic or steroid medications are used and sometimes even surgery is needed (NIAMS, 2005).

Webster’s Dictionary defines alignment as an “arrangement in a straight line.” When referring to the body we look at the way the bones fit in relationship to one another. Ideal alignment creates an easy feeling throughout the musculoskeletal system. A balanced posture is one in which positioning is centered and relaxed for all the joints of the body. With joints in non-awkward positions, muscles relax, and unnecessary tension can be released. Tension can lead to pain, discomfort, lack of range of motion along with other uncomfortable situations. The mid-line is an imaginary line down the center of the body which provides a reference for viewing the positions of the ears, shoulders, spine, hips, knees, ankles, feet, and the very specific cranial bones. Looking to the midline shows one the relationship between theses structures, and gives information on where imbalances exist. When all is in line with the midline, alignment is improved and therefore tension is reduced and systems flow freely on the straight line known as alignment.

Craniosacral therapy (CST) is a gentle, non-invasive, hands-on alternative medicine procedure for evaluating and enhancing the body’s own natural healing mechanism. The focus of this work is on the craniosacral system, a physiological system which consists of the membranes and cerebrospinal fluid that surround the brain and spinal cord. This system extends from the bones of the skull, face and mouth, which make up the cranium, down the spine to the sacrum and coccyx, our tail bone (Mahrie, 2004). The craniosacral system is a very important system in our body and directly influences the performance of the brain and spinal cord, having a direct affect on the central nervous system. Imbalances or restrictions anywhere in this system could cause any number of sensory, motor or neurological challenges. Balancing the craniosacral system frees the movement of the cerebrospinal fluid, improving brain and spinal cord function along with improvement of the other body systems (Mahrie, 2004). CST has addressed many symptoms, such as musculoskeletal imbalance, myofascial dysfunction, chronic fatigue, immune system dysfunction, autonomic nervous system dysfunction, elevated heart rate, high blood pressure, endocrine system dysfunction, stress, anxiety, brain and spinal cord injuries, sleep difficulties and chronic neck and back pain (Wanveer, 2006).

Wanveer (a LMT specializing in Craniosacral therapy) explains chronic pain and how it relates to the brain and spinal cord, showing that there is a need for balance of this system. In this article, Wanveer shows that CranioSacral Therapy can be used to identify and help the body change core patterns contributing to chronic pain. Describing that with chronic pain the sensitivity does not decrease, thus abnormal changes in the structure and function of the tissue innervated by the area of the affected spinal cord neurons maintain the sensation of chronic pain (Wanveer, 2006).

Tan et al. (2007) provides a review on the efficacy of selected Complementary Alternative Medicine (CAM) modalities in the management of chronic pain, reported pain relief from the use of some modalities. Massage therapy was found to be useful for pain relief in numerous chronic pain conditions, particularly low back pain and shoulder pain. The use of Cranial Electrotherapy Stimulation (CES) was tested showing that there is considerable promise as both a complementary modality to other forms of therapeutic interventions to treat particular types of pain. CST and the CV-4 technique were examined for tension-type headaches. Patients who received the CST treatments reported less pain intensity, however additional large scale trials were recommended.

Upledger (1977) examined statistical analysis from 50 craniosacral examinations on 25 schoolchildren to help determine cranial rhythmic impulse, showing how its motion may display dysfunction/damage and whether cranial osteopathic treatment can bring any change to dysfunction. He also examined a collection of photographic evidence supporting the craniosacral examination. A systematic review of 33 studies by Green et al (1999) showed that only seven were based on the effectiveness of the treatment. No other systematic review was found, and relevant, reliable primary data research based on the effectiveness of craniosacral treatment was not found either. Research into clinically measurable patient outcomes after craniosacral therapy treatments is still lacking (Green et al 1999).

The objective of this study is to determine if Craniosacral Therapy (CST) can improve structural alignment to reduce chronic back pain. In CST, the practitioner is taught to be a therapeutic facilitator, not deciding what must be done, rather following the lead of the body. Practitioners are taught that the client’s body has within it the wisdom to solve its own problems. Primarily, all that is asked of the CST practitioner is a supportive presence that offers assistance in the forms of light touch, energy and intention (Upledger, 1996). This study’s treatment protocol is established around this point of view, beginning with three initial check-in phases to determine where to begin treatment on the body. Measurements are made objectively by the practitioner before and after each session using a ruler and a level to assess the clients structure, measuring the structural alignment of the client’s shoulder girdle where the chronic pain begins. The subjective measurement of pain is recorded by the client every day during the study to track changes in the intensity of his chronic pain.

Methods

Profile of Client: A 23 year old male bodywork practitioner and student has been experiencing chronic pain from the mid-back, shooting up the spine and radiating out through the upper girdle region (shoulders). Client has a history of rotator cuff tears and dislocations in both right and left shoulders due to many falls and crashes throughout childhood. He broke metatarsal bones of the right foot twice, once in 1999 and again in 2005. He has had rhinoplasty to improve breathing, and his wisdom teeth have been removed. The client does not currently take prescription medications however, he does smoke 2 cigarettes a day, consumes alcohol 2-3 times a week and often self medicates with THC.

The client feels as though he can not stand up straight, and after measuring using a plumb line, this was confirmed. This initial structural assessment using the plumb line revealed that the client has a prominent kyphotic thoracic curve and lordotic cervical curve. His right shoulder is significantly higher than the left, his clavicles do not line up. When lifting arms over his head the shooting pain from the mid-back up the spine increases. Client experiences slightly less than moderate pain on a consistent basis.

The client recently sought chiropractic work, and discovered from x-rays that two cervical vertebrae were fused. He has not returned to the chiropractor since, believing the treatment did not help aside from the x-rays. He has tried acupuncture, physical therapy, osteopathy, and many types of massage and bodywork. Currently, he is receiving massage two to three times a month, and feels that these sessions help relieve pain and discomfort for a short time. He was instructed not to receive other massage and bodywork while involved in this study.

The client’s desired outcome for this treatment is to feel a straightening in the spine; he would like to lessen the degree of kyphosis in the thoracic region and lordosis in the cervical area. The client feels that with balance in that area, the pain will decrease. He would also like to feel a reduction in the shooting pain from mid-back out to the shoulders.

Treatment Plan: To begin each session, there is an initial intake of how the client is feeling today, a check in of how much pain has been experienced on this day and throughout the past week. Next, the therapist measures alignment — tools for measurement and the procedure are described in the assessment tools section. Next, the client lies supine on the table fully clothed with relaxation music playing. The therapist begins with three initial check-in phases to determine where to begin treatment on the body.

First phase, vector searching, where the therapist looks and feels for energetic misalignments in the structure of the body, feeling for vectors from the feet to the cranium, and then from the cranium to the feet, not yet placing hands on the body. Energetic vectors should be in alignment with the midline of the body. When vectors go off in directions off of the midline this shows imbalances from the energetic body to the physical body. Looking for vectors to show misalignment will help the therapist to determine where to begin the session.

Second phase, feeling through the body for relations of certain areas and systems. The therapist’s position for this phase is having her hands supine cradling the occiput. The therapist is feeling through the body for relationships between certain bones, muscles, the brain and spinal cord, specifically the cranium and pelvis relation, occiput and sacrum relation, specific cranial bones, movement, or lack of movement throughout.

The therapist is also checking for the balance of the inter-cranial membranes, horizontally and vertically. Feeling for these key check-in points and how they relate helps to bring focus to those areas that are not in alignment. The therapist facilitates a neutral space where the body feels comfort and can then find balance and begin to align.

Third phase: feeling for the flow, listening to the body. The therapist in this phase has one hand supine under the sacrum and the other hand supine under the occiput. In this position the therapist can feel the flow of the Cerebrospinal Fluid (CSF), which is the core of our being. CSF is always producing fluid that runs along our brain and spinal cord, constantly pulsating an exchange of information throughout our bodies. In this same phase, the therapist can also feel the craniosacral rhythm (CSR) which is its own unique rhythm in the body. When feeling the CSR, the therapist will gain more information about the flexion and extension of the sacrum, and therefore a better understanding of the relationship of many of the bones that were mentioned in phase two.

After sorting and becoming aware of the information given in these three phases, the therapist then proceeds to the place of the body where they feel a need for more focus. More focus and attention to certain areas, along with hand position, will create comfort and support for the body to begin to unwind and restore itself to a state of balance and flow. Specific hand positions are performed upon the discovery of where the body directs the therapist.

Assessment Tools: The client will record on a 1 to 10 visual analog scale (VAS) the intensity of his pain every day. This charting began one week prior to bodywork sessions and continues throughout the five week study, including days with treatment. On the scale, the left end of the line indicates no pain at all, and the right end indicates worst possible pain. There has been a chart created with the specific amount of scales needed, the start date, dates of treatment, and end date have been indicated. The average of each week was then graphed on a chart to show change.

Using a level and a ruler as tools, the practitioner will determine the differences in shoulder height to measure and record the clients structural alignment. Before and after each session, the therapist uses a level and a ruler to measure the distance from the level to the clavicle. The end of the level is focused at the sternoclavicular notch, and is level (bubble in the middle of center line), the measurements with a ruler are made from the level to the clavicle from this focus point. This will show the differences in alignment of the clavicles, and therefore shoulder alignment.

Report of Client Visits

Session 1: The client arrived reporting a number three on the pain scale, feeling less pain than recorded the week earlier. During the three initial check-in phases, described in the treatment plan, a plethora of information was obtained. The practitioner found vectors branching out to the left, the right shoulder was significantly higher than the left. When feeling from the occiput down through the body she found that the sacrum and occiput were also elevated on the right. The CSF seemed to be flowing at a wonderful pace up until T-5 where it then takes slow circular motions to make its way through the cervical region, and into the cranium.

Once this information was obtained, the practitioner continued to more focused hand positioning. First, she began with the left hand supine under the sacrum and the right supine under the T-5 to T-6 region. The sacrum shifted from a tilting up to the right position to a more balanced, even rocking of flexion and extension (head-to-toe movement). The CSF then began to flow more freely up to the point of T-5, where the flow seemed stuck. The practitioner continued up the spine with the right hand supine under T-4, 3, 2 and left hand resting, (no more than 5 grams of pressure) on the sternum with fingers branching out toward the clavicles. Finding a blockage with this hold, the awareness of the practitioner began to open, and lead her on to a new area.

The practitioner’s attention was drawn to the arms: they may be forming the blockage in the sternum and T-4-2 area. First, the left arm was held allowing for an unwinding of the humerus in its socket. Having the right hand supine under T-1, and the left hand and arm supporting the clients left arm, the humerus went through slow internal movements that occasionally branched out to look physical. The practitioner then moved to the right arm using the same hand positioning as the left, yet opposite. The right arm began much bigger movements than the left, going in circles, flexing down, extending up, and unrolling. After this the shoulders had significantly relaxed and lowered down to the table.

Next, the therapist at the head of the table held both hands supine between scapulas with arms close together so the client could then rest his head on her forearms comfortably. This allowed the shoulders to open laterally and release to the table even more. This position also gave a connection into the cervical vertebrae and the cranium. The next hold was the left hand under the occiput and the right supine under C-7 and T-1 the head began to unwind rolling from left to right to left again. During this hold the practitioner and the client both felt a large pressure which then turned into an immense pain shooting down the arm. The pain got stronger and more intense, the client was asked to stay with that pain and feel it, and he did. He breathed deeply, and stayed with the pain and eventually, after quite a few minutes, the pain subsided. The practitioner then held the occiput to feel new balances and let the neck unwind a little more, finding that everything felt a lot more centered and flowing, with much less pressure and torque throughout the left side.

The session ended with the balancing position of one hand on the sacrum and the other on the occipital bone to balance and clear the core. Client reported feeling much loser and more expanded after the session.

Session 2: The client arrived reporting a number three on the pain scale, feeling much less pain following the first session. During the three check-in phases the practitioner obtained much information about the same area of blockage discovered in the first session. This area began at the bottom right rib cage, went to the left heart center, then back to the right stopping behind the sternum to turn at an angle to the left shoulder, and then back right into the cranium shifting back upward to the left to the center of the sphenoid bone. Finding this vector and flow of CSF lead the practitioner to a wonderful starting point. She was drawn to the lungs, feeling that both the right and left lobes where turning in towards the heart, perhaps causing the zigzaging feeling throughout the upper girdle, and into the cranium.

The practitioner first placed hands on the sacrum and T-12, feeling the lower body, hips and legs and their connection into the torso. This flow felt wonderful, and she moved onto the zigzag above, beginning at the bottom right lung, one hand under the rib cage, the other on top. Being drawn into this lung, the practitioner and client noticed movement, the lung began to shift and roll down and away from the midline that it had been hugging. This brought attention to the liver, which was also being affected by the roll to the midline. The liver then shifted in this hold along with the bottom of the right lung. The diaphragm was also being affected by the lungs and their roll into the midline, making breathing a challenge for the client. The client and practitioner placed focus on the diaphragm and its relation to the lungs, and it too shifted, moving towards the table and down toward the feet, making room. The practitioner then moved her top hand to the top of the lung just under the top of the left scapula. This allowed the lung to completely unroll, and open up.

Next the left lung drew her in, and felt much different than the right, with much more of a roll to the midline almost suffocating the heart and its circulation. When tuning in to the bottom of the left lung, with one hand under the rib cage and the other on top, the lung shifted and rolled out and down, similar to the right side. As this was happening, the client began to go deeper into an altered state, almost asleep and snoring but could still hear the practitioners words. The lung began to pull the practitioner deeper as well. In this deep space was silence, heavy breathe from the client, and much space holding from the practitioner, leading to a big spontaneous breathe releasing tension in the lung and heart area. After this release the client still in an altered state, the practitioner moved to the thoracic inlet hold, one hand under C-7 through T-2 the other hand with index finger and thumb at the sternoclavicular joints. This structure felt much more open and movable than before, the right clavicle shifted slightly up then down, and the clients breathing pattern changed dramatically. Finding this movement was satisfying and showed that the respiratory system was much involved in the restriction of the upper girdle.

To end the session the practitioner allowed the neck to unwind, connecting the new respiratory flow into the cranium. Finally, a hold for the balancing of movement between the viscerocranium and the neurocranium created space between those two areas, and they found their relation to the midline.

Session 3: The client arrived reporting a number four on the pain scale; feeling a little fatigue today. During the initial check-in phases, the practitioner found a vector going from the mid-back around T-12 up to the right shoulder, the right shoulder is higher than the left. The CSF flow maintained the same pattern, feeling like a roll to the right. The occiput, sacrum, scapulas and spheniod bones made the same upward movement to the right.

The practitioner started with the right hand supine under the sacrum, and the left under T-12 and the lower part of the rib cage. The sacrum rocked up and down, and right to left a few times with a big connection into the ribs, rolling from right to left and slightly down. She then moved to the right rib cage, one hand on behind and the other in front, allowing space for the rib cage to shift down and slightly out away from it’s close hug to the spine. This lead the practitioner to the right arm which felt locked into the shoulder girdle. She lead the arm to it’s vector and it began to unwind and release finding its place of stillness and comfort.

Next, the therapist at the head of the table held both hands supine between scapulas with arms close together so the client could then rest his head on her forearms comfortably. This allowed the shoulders to open laterally, and release to the table even more. This position also gave a connection into the cervical vertebrae and the cranium. She then held the occiput to allow the neck to unwind, during which she was draw to the cranial bones, mainly the sphenoid bone. Feeling a torsion and twist to the left, the right wing of the bone felt much higher and very stuck between the other cranial bones. This being the case the practitioner then held and released the temporal bones, parietals and frontal, opening space for the sphenoid to move more freely. Lastly, holding space for the viscerocranium and nuerocranium, which involves holding the sphenoid to separate the neurocranium, and the zygoma bones as the viscerocranium, allowing for separation between these two structures gave her and the client a balanced feeling in the cranium.

Session 4: The client arrived reporting a four on the pain scale feeling much better since the previous session. He is feeling a lot more open in the upper girdle region where the pain resides, and he has noticed a large connection between the right side of the neck and his right arm. This wonderful piece of awareness brought by the client gave the practitioner a sense that CST creates body awareness. In the check-in phases the practitioner noticed the vector to the right not feeling as strong as before. During the feeling of CSF, she found the flow to be more of a turn and roll to the right, rather than the ridged flow as in the prior sessions. The client agreed on this information feeling a much less rigid flow himself.

The practitioner began with one hand supine under the sacrum, and the other under the mid-back around T-12 and the last rib area. This allowed the sacrum to shift into a neutral place and guided the practitioner to where the flow rolls to the right. This started the next position being at the T-12 area, and the other hand at C-7 T-1, allowing the roll to move left quite a bit.

Next, she moved to the neck, allowing it to unwind in big, slow movements, left to right for about 15 minutes. These shifts gave the client great relief, and created connection for the practitioner into the cranium, mainly the cranial membranes feeling them in the same roll-to-the-right pattern. The client found a connection into his rib cage, around to T-11-12 area, feeling that this area was very stuck and painful; when his neck moved to the right the sensation increased. Following this information the practitioner moved one hand to that thoracic area and the other to the occiput. The ribs then rolled out and up and back down as the occiput followed the movements, this lead to a still point and large release, a subtle, silent pop and click into relaxation.

Moving to the cranium, she held the cranial membranes; first the tentorium to balance it with the new flow coming up the spine, and then the falx cerebri. These structures also felt as if they rolled to the right. This hold allowed the membranes to match the rib cage and spine feeling much more balanced. The practitioner ended holding the sacrum and occiput, feeling much less of a roll to the right, and a great balance between all the structures.

Session 5: The client arrived reporting a six on the pain scale, the week was long and he was feeling tired. The past few days had brought him awareness and pain to the right lower portion of the rib cage however, on this day it felt better. In the check-in phases the practitioner noticed a new feeling, the right shoulder seemed relaxed and lower and the left pressing down. The cranial bones and sacrum felt pressed downward on the left feeling, as did the vector. In the flow phase the CSF felt still like a roll to the right, but not as intense as the past sessions. The check-ins lead the practitioner to the cranium, but before going right to the skull, the thoracic outlet felt a need for release. She held this position for quite some time feeling a great opening across the chest.

Then, she began the cranial work. She started with holding the occiput and sphenoid, feeling them shift left to right and down to the left quite a few times, sometimes even moving towards each other. Eventually, the two bones went into a flexion and extension pattern to begin to match the sacrum in the same pattern. She then felt a connection into the left arm/side body, rib cage area. The client agreed with this connection. Feeling like the left side wanted to come up to meet the right side, she went to the arm and put it into its vector, held space for that and a stillness occurred and then let her go.

She was then draw back to the cranium, first releasing the parietal bones and then the temporal bones and tentorium membrane. Holding the temporals and then the temporal ear pull, when thumbs are inserted into the ear at the auditory meatus. This allowed for a wonderful horizontal release in the skull connecting down to the shoulders/scapulas and pelvis. After much release and balance of the larger bones of the skull she was drawn to the inner structures of the ethmoid and vomer bones, feeling their pressure on the sphenoid, creating some of the downward pressure on the left side. The practitioner held the vomer and ethmoid and then the vomer and atlanto-occipital area, finding a great drop of the vomer down and back in the roof of the mouth. Creating lots of space and allowing the left side to open and feel more free.

Again, holding the viscerocranium and nuerocranium to feel the relation between these structures after much of the cranium had released. She and the client felt a wonderful balance between these two areas with much relief in the surrounding, inner structures. To finish the cranium work she held interlocked fingers of both hands over the midline of the frontal bone. Allowing for midline alignment of the cranial bones, brain and membrane system. When this aligned and balanced, the client felt a great connection to his thoracic area, feeling clarity and alignment throughout his structure.

Results, Discussion and Conclusion

After receiving Craniosacral Therapy once a week for five weeks, chronic pain has been slightly reduced. An average rate of pain on a weekly basis (as shown in figure 1) was taken from the clients records, recorded on a visual analog scale daily throughout the bodywork sessions.

The pain was recorded starting the week before session one and ending after the last session was completed. The client reported the largest change following the first session. With a baseline average of 6.3 for the week prior to treatment, a significant decrease after session 1 brought the clients report to a four, and then in the second week, and a 3.8 for the third. The average increased at week four, and then back to a decrease following the fifth session. After much consideration of daily activities and everyday habits, the practitioner believes that everyday movements may be causing the majority of the pain and structural imbalances. Further acknowledgement and awareness to shift these habits may have an impact in the reduction of pain in the future. The client reported feeling much less pain and discomfort than before the bodywork sessions.

The measurement of structural alignment did not show a significant change, however, this does not mean that nothing changed at all. The height of the left and right clavicles did not show a measurable change (as shown in figure 2).

In craniosacral therapy, the outside structural changes are so subtle that a large visual change is challenging to see through physical measurement. The subtle shifts on the inside are what made the client report feeling more aligned and balanced. The shifts in the inner structures, such as the organs, the brain, membranes of the brain and dural tube surrounding the spinal cord, created a balance throughout the body. As explained in the report of client sessions, many of the sessions lead the practitioner into the organs and membrane systems rather than to the outside structures of bone and muscle. CST deals with the energetic vectors and their alignment to the physical being. In the treatment protocol the practitioner begins by looking for the energetic vectors of the body, vectors cannot be measured with a ruler. By assisting the body into it’s energetic vector and allowing it to feel comfort and release held patterns, the client will feel a result of relief and balance. Creating alignment of the inner-most structures, though not visually measurable on the outside, things did shift and result in comfort on the inside projecting out.

These results show that CST can reduce chronic pain and improve the alignment of the inner structures of the body. How does the inner structure affects the outer physical structural alignment? This question needs further investigation. The practitioner may have needed pictures to see physical changes in the shoulder girdle of this client. Or, perhaps a better tool for measurement of this particular structure.

This case study has shown that Craniosacral Therapy improves inner body awareness, decreases chronic pain and creates a wonderful feeling of balance and alignment throughout one’s being. By holding a space of neutral energy, the practitioner was able to facilitate a comfortable space for the body to unwind and realign it’s inner structures, thus, reflecting out to the client’s outside physical movements, and an improved overall well-being.

References

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Green, C., C.W. Martin, K. Bassett, & A. Kazanjian “A systematic Review of Craniosacal Therapy: Biological Plausibility, Assessment Reliabilty and Clinical Effectiveness,” Complementary Therapies in Medicine 7: 201-207, 1999

Johnston, Laurence. “Craniosacral Therapy” Healing Therapies. URL:

http://www.healingtherapies.info/craniosacral_therapy.htm

Mahrie, Dorothy. (2004) Craniosacral Therapy 1- The Healing Power of a Gentle Touch. San Diego: Self-published.

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2005, September). Back Pain. Retrieved May 6,2009. from http://www.niams.nih.gov/Health_Info/Back_Pain/

St. Denis, L. Johnston, S. L. “Craniosacral Therapy and Spinal Cord Injury” Massage & Bodywork Magazine, February/March 2000. http://www.massagetherapy.com/articles

Tan, G., Craine, M. H., Bair, M. J., Garcia, M. K., Giordano, J., Jensen, M. P., McDonald, S. M., Patterson, D., Sherman, R. A., Williams, W., Tsao, J. (2007). Efficacy of selected Complementary and Alternative Medicine interventions for chronic pain. Journal of Rehabilitation Research & Development 44:195-222.

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Upledger, J.E. “The Reproducibility of Craniosacral Examination Findings: a Statistical Analysis,” Journal of American Osteopathic Association 76(12): 890-899.

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International Professional School of Bodywork http://www.ipsb.edu, info@ipsb.edu, (858) 505-1100

Somato-Emotional Integration Reduces Frequency and Intensity of Tension-type Headaches and Alleviates Low Back Pain in a Female Subject

Casie L. Bennett June 23, 2008

Research Case Report
Case Report Supervisors: Jack Baker & Joanne Odenthal Clinical Supervisor: Carole Osborne-Sheets

The author wishes to acknowledge Carole Osborne-Sheets for masterminding the Somato-Emotional Integration Modality that was used in this study. She also wishes to show appreciation for the efforts of Jack Baker and Joanne Odenthal for their tireless guidance and much needed assistance with the creation and completion of this study.

Abstract

Objective: This study investigated the efficacy of a specific massage therapy procedure on alleviating the frequency, intensity and duration of tension-type headaches and the chronic low back pain of a test subject.

Methods: The subject reported experiencing 5+ headaches per week and almost daily lower back pain for the previous six months. Frequency, intensity and duration of headaches and back pain was recorded in a daily pain journal for a baseline period of two weeks prior to the five weeks of massage treatment. Manual therapy was administered once weekly; each session lasted sixty minutes and consisted of a structured protocol directed toward integration of the physical body and the conscious mind.

Results: During baseline, the headache frequency was established at an average of 5.6 incidences per week and low back pain occurred at an average rate of 3 days per week. After the first week of treatment headache incidence was reduced to and remained at an average of 1.5 incidences per weeks and back pain decreased to an average of 1 incident per week. During the treatment period there was a decrease in the intensity of headaches from a level 7 to a level 2 and the use of NSAID pharmacological intervention decreased from 4 pills per week to 0.

Conclusion: The somato-emotional integration massage therapy techniques used in this study have the potential to be a functional, non-pharmacological intervention for reducing the incidence of tension headaches and chronic low back pain.

Key Words: Somato-Emotional Integration, tension headache, chronic back pain, emotional release, massage, body-mind.

Introduction

Throughout time touch has been implemented in an effort to comfort, heal and to relieve pain. Touch triggers both metabolic and chemical changes in the body that promote healing (Davis, 1991). Many researchers have discovered that massage therapy shows promising results with regards to chronic pain management (Tsao, 2007). Nearly a quarter of all adult Americans (twenty four percent) had a massage at least once in the last 12 months, and more than a third (thirty four percent) have received a massage in the last five years, according to a survey sponsored by the American Massage Therapy Association® While use of massage is growing, the reasons people are turning to massage therapy are also expanding. More and more, people recognize massage as an important element of their overall health and wellness. There is a clear trend in America today: more people than ever are turning to massage therapy for pain relief. Nearly one-third of adult Americans say they’ve used massage therapy at least one time for pain relief. Of the people who had at least one massage in the last five years, 30 percent report that they did so for health conditions such as pain management, injury rehabilitation, migraine control, or overall wellness (2007 Massage therapy consumer fact sheet).

Emotional tensions are often the main source of physical tension (Kurtz, 1990). Traditionally, emotional release has been achieved through the practice of psychotherapy. In Western civilization, psychologists have predominantly used talk therapy to help their patients release emotional distress. However, some psychotherapists are turning to alternative therapies to complement talk therapy and possibly enhance the overall therapeutic result (Collinge, 2005).

Somatic authors have observed that many of the most important discoveries in psychology have increased relevance when grounded in the experience of the body (Maupin, 2000). Emotional reality and biological ground are the same and cannot, in any way, be separated or distinguished (Keleman, 1985). Our thoughts and feelings influence the body via two mechanisms: the nervous system and the circulatory system. These are the pathways of communication between the brain and the rest of the body (Collinge, 1996). Over two thousand studies regarding mind-body medicine have been published in the last twenty five years. These studies demonstrate through the use of measurable diagnostic tests, that mind-body interactions are real and can be measured (Jacobs, 2001). As Collinge notes, this fact is being recognized in the medical establishment. As evidence he quotes Dr. Kolk, director of the TraumaCenter in Boston: “Current research concludes that traumatic experiences involve the whole person’s emotions and feelings (mind, body and spirit). It is believed that traumatic experience is evidenced at the biochemical/neuromuscular levels and that treatment must integrate cognitive- based narrative therapy (psychotherapy/counseling) with somatic body memory treatment” (Collinge, 2005).

Through the process of receiving massage, many clients discover unconscious tensions, recall memories of past events, or release suppressed emotions (Davis, 1991). Emotional trauma sustained in accidents, loss of loved ones, violent natural or interpersonal experiences and repeated abuse or deprivation often profoundly impact the body’s soft tissue. Through mindful and respectful bodywork, a client is allowed to express these deeply rooted emotions and in doing so, the client’s current stresses and their associated psychological traumas can melt from the body’s soft tissues with a resulting sense of relief and resolution (Osborne-Sheets, 1990).

The clients physical body responds to mind/body therapy rapidly by manifesting positive changes in his or her mood, pain level, or other physiological body functions (Collinge, 1996).

Somato-Emotional Integration is a bodywork modality that promotes body awareness through deep tissue sculpting and various other massage therapy techniques with the intention of interfering with the client’s long held physical and intellectual defenses, thereby allowing deeply rooted emotions to emerge from the body. Through massage techniques, awareness, breath work and guided imagery, Somato-Emotional body work promotes integration of the client’s physical, emotional and intellectual experience of her being (Osborne-Sheets, 1990).

One of the areas where massage has proven effective is in treating chronic pain, and two chronic pain conditions are addressed in study: tension headaches and low back pain. Chronic pain is a serious health condition that approximately fifty million Americans live with daily (Menard & Piltch, 2008). Chronic pain is characterized by pain that continues a month or more beyond the usual recovery period for its cause, or pain that goes on for months or years because of a chronic condition (Goodrich-Dunn, & Greene, 2004). Often, no initial cause for the pain is identifiable. When there is no obvious physical injury, muscle tightness due to stress, anxiety and/or depression is often believed to be the source of the pain (Goodrich-Dunn, & Greene, 2004). Chronic pain is a major cause of absenteeism in the workplace.

One common chronic condition is tension headaches. Tension headaches are defined as headaches that are triggered by mechanical stresses that initiate central nervous system changes in serotonin levels and blood vessel dilation (Werner, 2005). Any kind of ongoing mental or physical stress can change postural and movement patterns, which will lead to muscle spasm. These sustained muscle contractions are often the culprit behind chronic tension headaches (Werner, 2005). Since chronically constricted muscles may reflect chronically constricted emotions (Osborne-Sheets, 1990), it is reasonable to assume that somato-emotional bodywork could provide relief from tension headaches. It has been observed that relaxing from the inside out, rather than from the outside in seems to be important to headache prevention and relief (On the Mark, 1996).

The most common type of chronic pain is back pain (Menard & Piltch, 2008). Massage therapy has been shown to effectively reduced the symptoms of chronic lower back pain (Field, Hernandez-Reif, Krasnegor, & Theakston, 2001). Interventions such as relaxation techniques, stress reduction and conflict management have all been used to help alleviate back pain in direct patient care-givers with great success (Williams, 2007). Therefore, low back pain that has no obvious physical cause may be relieved through somato-emotional bodywork.

Researchers have identified how the ways that we cope with emotions and stressful situations can influence our physical health (Collinge,1996). There is growing evidence that massage and other forms of bodywork beneficially complement traditional medicine. A rising number of conventional healthcare companies now offer complementary alternative medicine to their subscribers (Vanderbilt, 2006). Although there have been many studies done to support the relevance of massage therapy, most have focused on the efficacy of massage for treating medical conditions (Moyer, 2004). Virtually no scientifically based research has studied Somato-Emotional Integration as a specific modality. More research is needed to explore the full potential of psychologically based bodywork.

The objective of this study was to determine if a specific massage therapy program could have beneficial effects on the frequency and intensity of tension headaches and chronic low back pain. A two-week measurement period prior to treatment was used to establish baseline measures. Following the baseline period, a five week treatment program that incorporated somato-emotional body awareness techniques and full-body therapeutic massage was initiated. Post session measurements continued for one week following the treatment program.

Methods

Profile of the client: A thirty year old, married mother of two had been experiencing at least four tension headaches episodes per week for the past six months. She had also been experiencing chronic pain in her lower back. A visit with her regular physician determined that the subject’s pain was not the result of any physical ailments. The subject reported occasional use of over the counter non-steroidal anti-inflammatory drugs (NSAID) in conjunction with a microwaveable heating pad and stretching exercises to alleviate her lower back pain as recommended by her physician. She was instructed to continue with pharmacological treatment as necessary, but not to begin new pharmacological intervention related to headaches or the back pain during the course of this study. It is interesting to note that the client was a body worker who had a very strong body-awareness and was able to give the practitioner very anatomically specific feedback throughout the course of this study.

Study Overview: The eight-week study consisted of baseline headache and back pain measures recorded during the first two weeks, followed by once weekly, one-hour Somato- Emotional Integration, massage therapy sessions for the remaining five weeks of the study. Beginning two weeks prior to the first session and continuing one week beyond the final session, a daily log book was completed by the subject each evening before retiring for sleep and each morning upon waking. The logbook recorded the frequency and intensity of the day’s headaches, as well as the frequency, intensity and location of the day’s back pain. The duration of the subjects sleep hours and any pain related interruptions of the subject’s sleep patterns were also noted. In addition, the subject made note of any pharmacological intervention that was used to alleviate pain on the occasions that she resorted to using them. Headache and backache intensity was determined by the subject drawing a mark along a visual analog scale ranging from 0-10 centimeters, with descriptors at each end. The left side (or zero station) indicating no pain and at the right side (or ten station) indicating the worst possible pain. The distance from the zero point to the subjects mark was measured in centimeters. The subject noted the location of her back pain by drawing mark that corresponded with her own body on a pain diagram that consists of two sketches of the human body, both in anatomical position, one prone and one supine.

Treatment Plan: In this study, the client received a total of five, one-hour Somato- Emotional Integration sessions. The bodywork sessions were conducted once a week for five weeks consecutively and were separated by at least 120 hours and no more than 168 hours.

Manual therapy and guided imagery and breath work was conducted by a Holistic Health Practitioner with over 1800 hours of combined classroom time and clinical treatment experience. A one-hour treatment protocol was designed and typically consisted of four distinct phases within the sixty-minute time frame. The descriptions of each phase are as follows. (Note: The subject’s position on the table varied according to the changing needs of the client.)

Each session begins with greetings and a preliminary intake that consists of verbal interaction as well as visual observations. The therapist orients the client to the procedures and obtains permission to touch. At this stage the frame of mind that the client is in is defined as “Ordinary Awareness.” This term is used to describe a person who is behaving as they normally would, in an outwardly oriented, goal directed manner. Their awareness is usually narrowly focused and ruled by habits and routines in space and time (Barstow & Johanson, n.d.).

The second phase of the session begins with breathing exercises and light effleurage as the parasympathetic nervous system are stimulated and the client settles into a more relaxed state and begins to have more body awareness. The massage therapist makes contact over the heart chakra, and may lead the client in a breathing meditation. At this point the client is entering what is referred to as the “Witness State,” which is defined as the client experiencing a mindful consciousness that can simply stand back and observe the inner experience without being caught up in it (Barstow & Johanson, n.d.).

During the third phase, which constitutes the bulk of the session, the client is usually completely in witness state. At this time the massage therapist incorporates bodywork techniques such as deep tissue compressions, sensory repatterning, and passive joint movements as she sees fit, directed by the emotional and physical cues expressed by the client. The massage therapist listens attentively and asks open ended questions to promote the client’s thought process and possible emotional release. The therapist may also use visualizations, past incident processing or body part dialogue as a tool to further explore an area of interest in the clients body. During this phase the therapist may observe the client express his/her “Inner Child,” a state of consciousness in which the client is aware of their current adult status and at the same time is experiencing the memories, feelings, thought modes and speech patterns of childhood (Barstow & Johanson, n.d.). During this phase the client is most likely to experience emotional processing or what is known as “riding the rapids,” a state of consciousness characterized by the loss of mindfulness, uncontrollable emotional release, spontaneous movements and tensions, waves of memory and feeling, and the use of tension and posture to control the flow of feeling (Barstow & Johanson, n.d.). The massage therapist is present as a non-judgmental support system, to assist with the client’s processing and to keep the client safe on the table.

The last phase of a somato-emotional session is closure. The client is told that their time has come to an end, and the massage therapist will check-in to be certain that the client is ready to move on from the subject matter that they were working with. Closing the session involves making tactile contact with the whole of the body with the intention of grounding the client and helping the client return to ordinary awareness. This contact may include effleurage, palm presses, passive movement or zone therapy reflexology on the feet with an emphasis on bringing the client’s attention back to the present and their awareness and their breath back throughout their entire body from head to toe. Finally the therapist will make contact with the three center (head, heart and lower abdomen) in a final act of integrating the entire body. When the bodywork session is complete, the client is left alone to get up off the table and to dress. Once they are ready, the massage therapist discusses any revelations that occurred during the session. The client is often asked what they would like to remember from the day’s work and to speak it aloud. Then the massage therapist will repeat that back to the client in order to solidify the memory. Finally, pleasantries and goodbyes are exchanged and the client leaves. The massage therapist then documents the client’s progress using a Somato-Emotional Integration specific log, in order to record what occurred before, during and after each session.

Report of Client Visits

Session 1: The client arrived reporting pain and discomfort in the gluteal region due to increased physical fitness training. After the initial greetings and touching-in described in phases one and two, the practitioner focused on releasing the muscles in the gluteal region using a combination of deep tissue compressions and passive joint movements. During the course of these compressions the subject experienced visual images that she connected to a source of emotional stress in her life, in addition to muscular release in the area. While processing the manifestation of stress in the gluteal region, the client’s shoulders became tight and her right shoulder became noticeably elevated. The client confirmed that she was experiencing pain in that area. After treating both shoulders with deep tissue compressions and skin rolling, the client reported that the discomfort was moving down her arms, so the therapist continued the deep tissue work down each of the subject’s arms and out to the ends of her finger tips. As a result, the client noticed a searing pain in her IT band near where her hand was laying at her side. In this area the therapist used deep tissue compress-and-follow style strokes combined with gentle rocking of the hips to release the IT band beginning at the greater trochanter and ending just lateral to the knee. This resulted in a strong physical release down the entire right side of her body accompanied by vivid, colorful imagery. This was the end of the bodywork processing segment of this session. The practitioner then proceeded with closure as described in the last phase of the treatment plan, and the practitioner prompted the client to verbalize the connections that she had made during the session before leaving.

Session 2: The client arrived reporting that she had a stiff neck after sleeping poorly the previous night. After the initial greetings and touching-in described in phases one and two, the practitioner began with passive joint movement of the head and neck, followed by traction applied at the occipital ridge. After applying Shiatsu compressions along the sagittal suture of the skull, the therapist used deep tissue compressions to release the frontalis muscle of the forehead as well as the masseter muscle of the jaw. While working in both of these locations the client experienced intense emotional release consisting of clenching of her hands followed by loud sighing and vocalizations of anger and frustration. The client noticed that the anger seemed to be “trying to escape” down her neck toward her right arm and so the therapist skin-rolled down the right side of the neck, across the shoulder and down the right arm, resulting in yet another loud sigh and a visualization of the anger leaving her body. In order to maintain balance in the client’s body, the same pattern was performed on her left side. At this juncture, the client reported a heaviness that had settled in the area over her heart. As a response to this observation, the practitioner responded by addressing the pectoral muscles. The therapist released both sides of the client’s chest using deep tissue compressions and skin rolling techniques. While doing so, the client’s lips began to quiver and several tears escaped as she talked about the feelings that were coming to the surface as a result of work in that area. Work on the pectoral muscles led to a feeling of tension in the client’s abdominal muscles. The therapist performed a few circulatory style effleurage strokes in a clockwise direction over the subject’s abdominal area, followed by several deep Shiatsu style compressions, combined with deep breathing to further enhance the release of the muscles in the area. This was the end of the bodywork processing segment of this session. The practitioner then proceeded with closure as described in the last phase of the treatment plan, and the practitioner prompted the client to verbalize the connections that she had made during the session before leaving.

Session 3: The client arrived reporting tension in her lower back and shoulder girdle. After the initial greetings and touching-in described in phases one and two, the practitioner began with passive joint movement of the hips and traction of the legs. This was followed by passive joint movement at the shoulder joints and traction of the arms, and finally with passive joint movement of the neck followed by traction at the head. The client noticed that she was clenching her teeth together and she requested that further attention be paid to her jaw muscles. The therapist complied to her request by performing deep tissue compressions in the muscles that were displaying obvious tension, and by guiding the client in a few stretching exercises that consisted of opening the jaw wide and moving the mandible from side to side. As the client moved her jaw, she was compelled to make throat-clearing noises and to cough repeatedly. As she did so, the client visualized images of symbols that she connected to events that had been causing her grief in her life. The client experienced a tightening of her gluteal muscles and noticed that her back had begun to ache again as she thought about the stressful events. The subject was then asked to move into the prone position on the table, where the therapist focused on the gluteal muscles using deep tissue compressions and rhythmic rocking motions to facilitate release. After completing both sides of the body, the therapist followed up with deep tissue compressions into the sacro-iliac joints. The work in this location was accompanied by loud sighs and exclamations of relief. Next, at the client’s request, the therapist concentrated on releasing both the right and left quadratus lumborum muscles. The softening of these muscles led to a feeling of tension in the area of the thoracic vertebrae. The therapist responded to this observation by first skin rolling the entire back and then using deep tissue compressions to work down the client’s erector muscles from cervical vertebra seven to the iliac crest. The sudden release of muscular tension in this area led the client into a fit of child-like giggles. When the giggles subsided, she reported feeling “warm and safe.” The practitioner then proceeded with closure as described in the last phase of the treatment plan, and the practitioner prompted the client to verbalize the connections that she had made during the session before leaving.

Session 4: The client arrived and expressed a need for release in the area of her hamstrings. After the initial greetings and touching-in described in phases one and two, the practitioner began the fourth session with the subject in the prone position on the table. The therapist started with Thai- style palm presses up the subject’s legs and over her entire back. Next, she combined passive stretching of the quadriceps with deep compressions into the gluteal muscles to achieve release. The therapist then focused on the hamstrings using deep tissue compressions combined with breathing exercises and a brief body-part dialogue. The client made several emotional connections, linking the tension in her hamstrings to the pain in her low back. Work on the client’s hamstrings led to a feeling of achiness in her left IT band. The therapist once again addressed the IT band with deep tissue compressions and the rhythmic rocking of the hips. Again, the client experienced vivid imagery and a rush of emotion as the therapist reached the end of the compression, just lateral to the knee. At this time the client reported a feeling that her quadriceps were “stuck to the table.” The practitioner asked the client to move into the supine position, and then addressed the subject’s thighs by rhythmically rolling the quadriceps back and forth across the femur before finishing with deep tissue compressions into the bellies of the muscles. The practitioner then proceeded with closure as described in the last phase of the treatment plan, and the practitioner prompted the client to verbalize the connections that she had made during the session before leaving.

Session 5: The client arrived and reported that at that time, she was not experiencing pain or stiffness in any particular region of her body. After the initial greetings and touching-in described in phases one and two, the practitioner began with guided imagery and a breathing meditation with the intention of bringing the subject’s awareness to the areas of her body that were in need of attention. During this time the client visualized many images that led her to new revelations about how her body was being affected by her current life situations. The new connections that she made brought tears to her eyes and a full body shudder. These exercises led the client to express a need for more work on her head, neck and jaw. With the subject in the supine position on the table, the therapist began with deep tissue compressions into the upper trapezius on both sides of the body. Continuing with deep tissue compressions, the therapist addressed the attachments of the levator scapula, the sternocleidomastoid and the scalene muscles. Next, the therapist used deep compressions to release the muscle attachments at the occipital ridge. In this area, the client experienced images that affected her profoundly. As she spoke about her thoughts and feelings regarding these images, her voice took on a very strong and assertive quality. The therapist then performed passive stretching of the subject’s neck muscles before employing passive joint movement of the head and neck, after which the client reported a feeling of floating. While massaging the muscles of the face, the temporalis muscle and the masseter both triggered emotional release in the form of a large sighs and groaning. The therapist completed the work with a circulatory-style scalp massage and gentle stroking of the subject’s hair. The practitioner then proceeded with closure as described in the last phase of the treatment plan, and the practitioner prompted the client to verbalize the connections that she had made during the session before leaving.

Results/Discussion

Headache, experienced almost daily prior to manual therapy, was reduced to an average of 1.5 incidences per week after the first week of treatment. The reduction in headache frequency was maintained through the course of treatment. The intensity of the headaches that the subject experienced was reduced from an average intensity level of 7 prior to treatment to an average intensity level of 2 after the first session and continuing on throughout the following five weeks. These results represent a remarkable change in the subject’s life, gifting her with substantially more productive hours in each week.

The average number of days that the subject reported back pain that was severe enough to interfere with her daily activities was reduced from an average number of 3 incidences per week before treatment to an average of 1 incidence per week after the first week of treatment. Over- the-counter medications are commonly used to treat tension headaches as well as low back pain. During the course of this study, the subject decreased her consumption of over-the-counter analgesic medications by 100%. Prior to receiving somato-emotional bodywork sessions, the subject ingested an average of 6 NSAID tablets per week to help alleviate her pain. In the 5 weeks that followed the first session, the subject did not need to use any sort of pharmacological intervention.

It should be noted that the subject suffered from a head cold during the final week of treatment. The headaches that were reported during that week could have been a result of the virus that she had contracted as opposed to tension. Since the subject did not specify what type of headaches she had that week, all three headaches were included in and calculated into the totals for that week. If they had not been included, the average number representing the reduction in headache pain would have been dramatically lower.

The somato-emotional integration bodywork treatment protocol used in this study was successful in reducing pain associated with tension headaches and the subject’s low back pain. However, components other than massage could be responsible for or may have contributed to the overall effect. For example, the subject was following a regular regimen of specific stretches each morning, as directed by her regular physician in an attempt to alleviate low back tension. This may have contributed to the success of this study in the area of chronic low back pain. It would prove interesting to stage a case study based solely on the effects of stretching on chronic low back pain. The subject in this study observed a meaningful reduction in headache and low back pain frequency and intensity. These findings suggest that a larger, more thorough study that includes a non-headache control group is warranted. Further investigation into the role of somato-emotional integration therapy for alleviating other types of chronic pain is called for as well.

The results of this study suggest that somato-emotional integration therapy is effective at reducing the frequency and intensity of tension headaches in this subject. The reduction in headache frequency and intensity was noted during the first week of treatment, which suggests that SEI therapy may exhibit an effect with as few as one or two treatments. The results of this study also suggest that somato-emotional integration therapy is effective at reducing the occurrence of chronic low back pain.

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