Craniosacral Therapy

Intro to Craniosacral Therapy

you struggling with emotional stress, pain, chronic health conditions, or other disorders? The physiological, psychological, and energetic stressors of everyday life can create deeply held patterns of tension, compression, and restriction in the body. This can negatively impact your nervous system and brain, resulting in further stress, pain, or illness. If you seek a greater sense of ease or wholeness in your body or mind, or relief from particular symptoms or health conditions, then you might find Craniosacral Therapy (CST) to be beneficial. CST is a form of therapeutic bodywork designed to correct imbalances with the systems of the body. Through gentle hands-on manipulation of the structures and tissues of the body, Craniosacral Therapy treatment seeks to manually release these debilitating patterns and restore the body’s innate ability to self-heal. This, in turn, allows it to return to a state of health, wholeness, and balance.

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Craniosacral Therapy (CST) has been used to treat a variety of conditions, both physical and psychological. The Upledger Institute lists the following disorders as suitable for treatment with CST:

Origins of CST

CST is rooted in osteopathy and cranial osteopathy. Osteopathy, founded by American physician Andrew Taylor Still, M.D., D.O. (1828–1917), is a holistic medical practice that seeks to restore the healthy function of the joints and body through physical manipulation of muscle tissue and bones. Cranial osteopathy was later founded by Still’s student, American osteopath William Garner Sutherland, D.O. (1873–1954). Sutherland was the first in his field to conceptualize and teach a cranial approach to osteopathy. He pioneered our modern-day understanding of the craniosacral system and its role in maintaining health, which now forms the basis of CST.

In 1899, while studying osteopathy under Still, Sutherland developed a particular interest in the cranium (i.e., the skull). He believed that the skull structures implied an ability to shift and “breathe” and that the principles of osteopathy could also be applied to the head. This was an unorthodox theory at the time that is still disputed today because the commonly held understanding in mainstream medicine is that the bone structures of the skull become fused by adolescence. However, through extensive research and testing, Sutherland began experiencing rhythmic shape changes in the skull. The discovery of these micromovements and rhythms led him to extend his research beyond the musculoskeletal system to the central nervous system and the movement of fluids in the body. Sutherland eventually demonstrated a connection between cranial bone movement and other tissues of the body through the circulation (or what he called “tides”) of the cerebrospinal fluid that maintains the nervous system and, as such, is inextricably linked to the individual’s mental and emotional health. 

Sutherland’s early work focused on this purely “biomechanical” approach. His theory that an individual’s health and wellbeing is influenced by the biomechanical connection between micro-movements of the skull and the circulation of cerebrospinal fluid remains the bedrock and common focus of the varying approaches of CST today. However, in the later stages of his life, Sutherland’s work evolved beyond the biomechanical to the “biodynamic.” He developed theories of deeper, intelligent, and self-organizing energetic forces in the human body. He formulated a concept called “Breath of Life” (i.e., an innate creative intelligence that he believed makes, organizes, and heals the human body and generates the body’s rhythmic tides). It is the adherence to these two distinct aspects of Sutherland’s work that distinguish the varying approaches of CST from one another. Amongst the numerous forms of CST, there are three main branches: Biomechanical CST, founded by Dr. John Upledger (1932–2012); Biodynamic CST, founded by Franklyn Sills (1947– ); and Visionary CST, founded by Dr. Hugh Milne (1948– ).

In the 1970s, Dr. John Upledger developed Sutherland’s early work and created his own system, which takes a purely biomechanical approach. Upledger named this system “Craniosacral Therapy” to differentiate his work from Sutherland’s cranial osteopathy. Moreover, Upledger was the first to conceptualize the “craniosacral system” and helped to inspire a new generation of practitioners by being the first to teach his methods to individuals beyond the field of osteopathy (e.g., nurses and massage therapists). In 1985, he founded the Upledger Institute, which is now one of the leading CST training and education organizations. 

Although both Sills and Milne later adopted Upledger’s term craniosacral therapy to describe their own respective practices, they differ from Upledger in their approaches, which are more informed by Sutherland’s later life teachings and work. 

*See the Summary section for more information on the distinctions between CST approaches.

The CST model of today has been influenced by:

Osteopathy | Cranial Osteopathy | Cranial Therapy | Holistic Medicine  

Summary of Craniosacral Therapy: What is Craniosacral Therapy?

The Premise of Craniosacral Therapy 

Craniosacral therapy is a bodywork therapy rooted in the principles of osteopathy (i.e., the therapeutic physical manipulation of the body’s muscle tissue and bones) and cranial osteopathy. CST is a simplified version of these practices designed to heal the body’s systems, particularly the central nervous system, through non-invasive, hands-on treatment.

There are several different approaches to CST and many independent training schools. Although their approaches may vary, they are all are based on the common foundational theoretical principles that subtle motions within the body are an expression of the individual’s health and wellbeing, and that by listening to the body through touch and using gentle manual techniques, dysfunctional restriction and tension within the body can be released, thereby restoring the body’s innate harmony and balance.

The Theory of Craniosacral Therapy 

CST aims to treat the craniosacral system as a means to heal the body. The craniosacral system consists of the bones of the skull, spine, sacrum, fascia, and cerebrospinal fluid. The cerebrospinal fluid protects and maintains the nervous system. Since the nervous system processes and responds to everything that happens in the body, it is, therefore, inextricably linked to our mental and emotional health. When the craniosacral system is aligned, cerebrospinal fluid can flow functionally around the body, thereby maintaining the individual’s health. However, if the craniosacral system becomes tense or compressed due to injury or other stressors, the movement of the cerebrospinal fluid becomes restricted. This can create dysfunction within the systems of the body.

The cerebrospinal fluid produces subtle rhythmic pulsations (referred to as tides) in the body. The craniosacral rhythm (CSR) is a pattern of tides at different places in the body. It can be felt or “read” by the CST therapist to evaluate any buildup of tension or compression within the body that may be impeding the flow of the cerebrospinal fluid and, therefore, causing imbalance or dysfunction in the nervous system. By mobilizing the cranium, spine, sacrum, and fascia joints, the therapist can clear the craniosacral system to restore the fluidity. This, in turn, rebalances the nervous system, alleviates any symptoms of dysfunction in the body, reduces stress and promotes deep relaxation, returns the body to its natural state of vitality and wholeness, and improves mental, emotional, and physical health.

Process of Treatment

CST’s core processes and objectives are essentially the same across the various branches, regardless of any conceptual differences in their approach. 

The CST treatment method uses non-invasive, gentle, hands-on techniques across the whole body. The CST practitioner starts by placing their hands above and below the various parts of the body (primarily the head, shoulders, neck, legs, feet, and sacrum) to read the pulses of the craniosacral rhythm. These pulses guide them to the parts of the body that are blocked or restricted. The therapist will then use delicate manual techniques to release those areas, thereby restoring the functional flow of cerebrospinal fluid around the nervous system.

During treatment, the client may experience certain sensations, such as tingling, heat, floating, or deep relaxation as their body responds to the therapist’s touch and begins to release held patterns that were inhibiting the natural flow of energy within the body.

*See the Seeker Experience section for more information.

The 3 Main Branches of CST

Biomechanical Craniosacral Therapy (BST). BST, pioneered by Dr. John Upledger in the 1970s, is the most widely practiced form of CST. It takes a purely biomechanical approach toward treating the musculoskeletal system, working with the concepts of craniosacral rhythm and primary respiration to alleviate tension and constrictions in the body.

Biodynamic Craniosacral Therapy (BCST). Founded by Dr. Franklyn Sills (of the Karuna Institute) in 1986, BCST is based upon the concept of what William Sutherland called the Breath of Life (as previously defined in the Origins of Craniosacral Therapy section). This concept teaches that human beings are an expression of the wholeness of life and that we are part of the energetic forces of the universe. The focus of the BCST therapist is to perceive this Breath of Life and restore its movement through the body in order to restore one’s original “blueprint” of health.

Visionary Craniosacral Work® (VSCW). Founded by Dr. Hugh Milne (of the Milne Institute) in the 1980s, VSCW combines BST with shamanic and eastern healing practices, meditation, and intuitive perception skills. The VSCW therapist has four main aims during treatment: to read an individual’s anatomy and physiology; to perceive the parts that have become disconnected from the whole; to perceive the client’s spiritual, energetic, and emotional state; to simultaneously perceive their own spiritual, emotional, and energetic state.

Uses & Conditions

CST is a gentle therapy that is claimed to be effective for people of all ages, including newborns and the elderly. Its core objective is to release tension, heal the nervous, and facilitate the body’s innate healing processes, so it can be used to treat a wide range of healthcare conditions. Due to CST’s reinforcement of the body’s natural healing processes, it can be used to correct existing dysfunction and health issues. It can also be used as a preventative health measure to maintain a healthy nervous system and bolster immunity.

CST is primarily used to alleviate the symptoms of physiological compression, pain, and injury, particularly with issues of the head, neck, spine, back, and nerves. In addition, it works to restore cranial mobility and release any restrictions from these areas of the body. It can, therefore, be used to treat conditions such as migraines and headaches, chronic pain, temporomandibular joint disorders (TMJ), earaches, tinnitus, proprioception issues, visual disorders, nerve pain, scoliosis, orthopedic issues, and motor-coordination impairments.

Due to CST’s soothing release of tension in the body, the nervous system and the body’s self-correcting potential can be restored. It is claimed that this restoration can then resolve several conditions such as emotional or mental stress, anxiety, and depression, PTSD, ADHD sleep disorders, digestion disorders, asthma, chronic fatigue, fibromyalgia, hormonal issues, infertility, immune system conditions, and irritable bowel syndrome. 

CST also claims to be beneficial in supporting prenatal and postnatal issues, including birth trauma, pediatric disorders, and recurrent ear infections or colic in infants.

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Research & Science supporting CST


The efficacy of CST is still widely disputed due to a dearth of research to support its claims. To date, the majority of support for the claims of CST is anecdotal. However, there have been a few studies conducted that claim to demonstrate the success of CST in alleviating the symptoms of several different health conditions, including the following:

CST for General Pain: Complementary Therapies In Medicine A Systematic Review To Evaluate The Clinical Benefits Of Craniosacral Therapy, by Anne Jäkel, Philip von Hauenschild (published Dec 2012).

CST for Chronic Pain: Craniosacral Therapy For Chronic Pain: A Systematic Review And Meta-analysis Of Randomized Controlled Trials, by Heidemarie Haller, Romy Lauche, Tobias Sundberg, Gustav Dobos & Holger Cramer (published Dec 31, 2019).

CST for Lower Back Pain: Utility of craniosacral therapy in treatment of patients with non-specific low back pain, Dariusz Białoszewski, Marcin Bebelski, Monika Lewandowska, Anna Słupik (published Nov-Dec 2014).

CST for Fibromyalgia: Influence of Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia, by Guillermo A. Matarán-Peñarrocha (published Jun 15, 2011).

CST for Migraine: Craniosacral Therapy For Migraine: A Feasibility Study, by J Mann, S Gaylord, K Faurot, C Suchindran, R Coeytaux, L Wilkinson, R Coble, and P Curtis (published Jun 12, 2012).

Conversely, several studies argue that the purported benefits of CST are not adequately supported and that the studies that demonstrate its effectiveness are flawed. Here are a few of these studies:

A Systematic Review Of Craniosacral Therapy: Biological Plausibility, Assessment Reliability And Clinical Effectiveness, by C.Green, C.W.Martin, K.Bassett, A.Kazanjian (published Jan 11, 2005).

Craniosacral Therapy: A Systematic Review Of The Clinical Evidence, by Edzard Ernst MD, PhD (published Oct 18, 2012).

A Review Of Craniosacral Therapy Science, Fads, And Applied Behavior Analysis, by Thomas Zane Ph.D., Newsletter of the Cambridge Center for Behavioral Studies (published Fall 2011).

Potential Drawbacks/Criticisms

Although CST is suitable for all age groups and can be used to treat a broad range of health conditions, as with other healing modalities, this practice may not be for everyone.

The following are some potential drawbacks and criticisms of CST that should be noted before treatment:

Contraindications of CST

  • CST is not suitable for individuals who have had any acute head injury or cerebral vascular condition such as a stroke, cerebral hemorrhage, aneurysm, or any brain condition with an active bleed. It is also to be avoided if an individual has had an epidural leak, recent skull fracture, or acute traumatic brain injury, brain herniations, tumors, or conditions in which changes in intracranial fluid pressure could be harmful. 

  • Although CST is recommended for children and infants, The American Cancer Society advises against CST treatment on children under two years old. Medical pediatricians have warned against potential harm to children and infants as their brain, skull, and spine are still developing. 

  • The anatomical theories of CST (and cranial osteopathy) are considered inconsistent with the mainstream medical understanding of the anatomy and physiology of the spine, skull, and brain.

  • Although CST is considered effective for relieving emotional and physical stress and tension, there is currently no scientific evidence to support any claim that the skull manipulation techniques used in CST directly aid recovery from cancer or any other disease or health condition. 
  • There is currently no research or evidence demonstrating that the anecdotal benefits of CST are more than the placebo effect of the modality’s hands-on, therapeutic relaxation techniques. 

  • The concept of craniosacral rhythm has also been disputed as there is no objective evidence of a craniosacral pulse. Moreover, while under observation, practitioners have been known to produce conflicting assessments of the same patient; thus, pulse readings have been dismissed as subjective.

The Seeker Experience

A typical CST session will begin with the practitioner taking the client’s personal and medical history prior to treatment to build an understanding of their health and lifestyle and the issues that need addressing. Then, during the treatment, the client lies face-up on a massage table. At the same time, the practitioner uses light and gentle touch (with the client’s permission) and manual holds (primarily at the head, shoulders, neck, legs, feet, and sacrum) to treat the areas of the body that need releasing. The client is fully clothed throughout this procedure (comfortable, loose clothing is recommended).

Establishing the client’s comfort during a session is of primary importance so they can fully relax. Therefore, treatment is conducted in a quiet, private space. There will likely be some dialogue at the start of the session to make any necessary adjustments before and during treatment. The practitioner also will encourage the client to articulate any sensations they experience during treatment (such as tingling, warmth, floating, or the arising of repressed or conscious memories). The conversation is otherwise minimal during treatment as the practitioner focuses on listening to and being guided by impulses in the client’s body rather than the client’s verbal cues. The session concludes by reflecting on what was felt and experienced during the treatment.

CST treatment sessions can last anywhere between 30–90 minutes, and the treatment integration period is estimated at 12–48 hours. While some clients report feeling benefits after one or two sessions, three or more regular sessions are recommended to see results. The length and number of sessions will depend on the client’s needs and the nature of their health condition. 

After a session, the client may feel calmer, more relaxed, energized, improved breathing and posture, less tension in the body, and an increased sense of embodiment. Over time, the client may also experience additional benefits, such as relief from symptoms, improved sleep and digestion, increased energy levels and peace of mind, decreased stress and anxiety, an enhanced level of self-awareness, and better quality of life. 

See the Summary section for more information on the treatment process.

Finding a Guide & Guide Perspectives

CST is typically used by chiropractors, osteopaths, physical therapists, massage therapists, and bodyworkers.

However, there are no professional prerequisites for undertaking CST practitioner training. 

There is currently no standardized accreditation, diplomas, or training within the field of CST. There are several different branches and offshoots of CST, and each branch has its own requirements for certification. Depending on the particular CST institute’s policies, some training can be completed in one year, whereas other training programs can be two or more years. Certification typically requires anywhere between 300–700 hours of training. 

There is no license required to practice CST. However, some countries or states/provinces require a “license to touch.” Thus, each certified craniosacral therapist’s responsibility is to ensure that they meet the criteria for the legal practice of hands-on therapy. 

Practitioners can be found through the websites of the major branches and institutes of CST. The seeker may choose a practitioner based on their location and experience with the individual’s health condition.

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Works Cited  – Upledger Institute International – Craniosacral Biodynamics: The Website of Franklyn Sills – Milne Institute: Visionary Craniosacral Therapy – The Biodynamic Craniosacral Therapy Association of North America – ‘The Craniosacral System’, The Irish Association Of Craniosacral Therapists (IACST) –   The Craniosacral Therapy Association – ‘What is Craniosacral Therapy?’, Craniosacral Therapy Association (Jan 9, 2018) – ‘An Introduction to CranioSacral Therapy‘, by Kate Mackinnon (Aug 4, 2015) – Craniosacral Therapy, Wikipedia (last edited: 1 March 2021) – ‘Cranial Sacral Therapy‘, medically reviewed by Gregory Minnis& written by Ana Gotter (Sep 18, 2018) – ‘Craniosacral Therapy Technique, Benefits, Side Effects‘, by Eiji Ozawa (Jan 11, 2020) – ‘Cranio Sacral Therapy’, Walter Blick Integrative Therapies‘What is Craniosacral Therapy?’, Craniosacral Therapy Association – ‘Craniosacral Therapy: Does it work?’, by Debra Rose Wilson, Ph.D. and Jayne Leonard (July 20, 2017) – ‘The Breath of Life: A Craniosacral Primer‘, by Aureal Williams (Jan/Feb 2009) – ‘A Beginner’s Guide to Craniosacral Therapy: Core Connection‘, by Sophia Schweitzer – ‘Craniosacral Work’; by Regina Callahan – ‘CranioSacral Therapy: What is it? How does it work?’, by Tad Wanveer (Dec 28, 2012)

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