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

_MG_6818Emillie 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.

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

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

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CranioSacral Therapy Reduces Chronic Back Pain and Improves Structural Balance

man-massageBy, 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.

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