Craniosacral Therapy (CST) is sometimes bashed and criticised as pseudoscience, in part due to the lack of robust scientific studies. However, just because robust clinical trials are currently lacking does not negate the scientific theory behind CST, nor does it negate its’ acceptance worldwide by millions of people or the positive results that countless patients report with their children and themselves. I am a registered osteopath, an evidence based practitioner and have a healthy skepticism when it comes to all alternative therapies. However, having trained as a craniosacral therapist during my osteopathic training and having being exposed to it, I cannot deny what I feel when I do happen to use CST nor can I deny the results I have seen with children and adults alike. I would ask you to put aside your skepticism for just a few minutes and take the time to read my blog. Perhaps a CST approach may help you or your children where other therapies have not.

A Brief Overview of The Craniosacral System

The cranial system is a semi-closed hydraulic system which consists of four chambers called ventricles within the brain and includes the spinal cord itself. The cranial system contains within it Cerebrospinal Fluid (CSF), contained within a tough, waterproof membrane (the dura mater) which envelopes the brain and spinal cord. An important function of this system is the production, circulation and reabsorption of CSF. This fluid maintains the physiological environment in which your brain and nervous system develop, live and function.

Craniosacral System

The production and reabsorption of CSF within the dura mater produces a continuous rise and fall of fluid pressure within the cranial system causing subtle movements in the cranial bones which are the interfacing connections between these bones. The human skull contains 22 bones, 8 cranial bones and 14 facial bones.

Cranial Sutures

In the past it was believed that these bones fused in early childhood allowing no further movement. However, in recent decades’ numerous studies have proven that there is movement between cranial bones well into adulthood and beyond. Rodgers et al. (1997) concluded that “Anatomic studies on sutural union provide evidence that sutures may not fuse until late in life and perhaps not at all in some cases making it highly improbable that sutures are completely ossified as some authorities have contended”.

Causes and Effects of Cranial Sutural Restriction.

Abnormal cranial bone motion can inhibit volumetric changes. The subsequent buildup of pressure can contribute to dysfunction and ill health, especially in the Central Nervous System which is enclosed within the boundaries of the cranial system. The causes and effects of sutural restriction are many but may include birth strains in infants due to prolonged or difficult labour, assisted birth by means of forceps or vacuum and unusual presentations such as face, brow and breech. Other causes can range from head trauma to hydrocephalus or even grinding of the teeth. The effects of sutural restriction are also wide and varied but can range from headaches, TMJ issues, vision disturbances and even issues affecting the heart, lungs and digestive system. For example, restriction at the base of the skull (occipital atlantal joint) can cause inflammation or impingement of the vagus nerve having far reaching affects including neck pain, blood pressure issues, increases heart rate, nausea, vomiting, stomach pain and bloating (Iron Neck 2021).

What Types of Issues Can Be Treated with Craniosacral Therapy?

Craniosacral therapy involves the entire cranial system and not just the skull, having far reaching effects on the entire body. You do not necessarily have to be sick to benefit from craniosacral therapy and it can be a helpful in relieving stress and maintaining health. However, it is typically used to treat the effects of mild and severe disorders such as:

• Colic.
• Reflux.
• Digestive issues.
• Tension headaches.
• Chronic pain.
• Fibromyalgia.
• Migraine headache.
• Complex regional pain syndrome.
• Fascial adhesions.
• Multiple sclerosis.
• Neuralgia.
• Neurodegenerative diseases.
• Temporo-mandibular joint syndrome.
• Stroke.
• Post-concussion syndrome.
• Speech impairment.
• Epilepsy.

What Should I Expect During Craniosacral Treatment?

The first point I want to make is that Craniosacral therapy (CST) is a very gentle hands-on treatment and can be used to treat all age ranges, from infants to elderly patients. To the observer it may look like very little is happening which can draw some skepticism. However, as a skeptic myself, and a qualified osteopath who is also trained in craniosacral therapy, I can assure you that there is a lot going on that the astute therapist can feel. In some cases, the patient may feel very little and in other cases a sensitive patient may feel noticeable movement and sometimes, intense emotions.

 

References

Cranial Sutures Available at: https://www.mountsinai.org/health-library/special-topic/cranial-sutures

Craniosacral System Available at: https://www.artofundoing.com/massage-bodywork/craniosacral-therapy-experiences/

Iron Neck (2021) Vagus Nerve and Pain in the Neck: Diagnosis and Treatment. Available at: https://www.iron-neck.com/blogs/news/vagus-nerve-pain (Accessed: 04 May 2022).

Rogers, J. S., & Witt, P. L. (1997). ‘The Controversy of Cranial Bone Motion’. Journal of Orthopaedic & Sports Physical Therapy, 26(2), pp. 95–103.

I can’t count of the amount of times an athlete has asked me “Why do my calves keep cramping up?” The first thing I ask is if they are hydrated well. If they are well hydrated, we need to look a little harder. Following is a checklist that I’ve made for an athlete to do their own assessment to determine the cause and hopefully eliminate it.

Leg Cramps During Exercise

Leg cramps that occur randomly are usually caused by mineral deficiency, but those that occur specifically during exercise could also result from inadequate blood supply to the muscles due to vascular insufficiency. These cramps go away once you stop exercising, whereas cramps caused by mineral deficiencies typically don’t go away until you’ve replenished your body with adequate minerals. Especially during long endurance training and sporting events, it’s important to replenish with sports drinks, fruits or other snacks containing electrolytes.

Sodium-Rich Foods

Your body requires sodium to maintain normal fluid balance and regulate blood pressure. Sodium also works together with other electrolytes for muscle contraction and nervous system function. If you’re sodium deficient, your body will most likely tell you by causing you to crave salty foods. I tend to salt my meals with 1 gram of pink Himalayan salt. That equates to about 5 turns of the grinder. I find my muscles feel stronger and fuller when I have sodium on board. According to the UK Salt Association, “The presence of Sodium ions is essential for the contraction of muscles, including that largest and most important muscle, the heart. It is fundamental to the operation of signals to and from the brain. Without sufficient sodium your senses would be dulled and your nerves would not function.” (UK Salt Association, 2022). After sweating during prolonged endurance workouts, you lose a lot of sodium as well as water, so wash down your salted foods with plenty of water.

Potassium-Rich Foods

According to the National Institutes of Health (NIH, 2021), adults need 4,700 milligrams of potassium every day. Potassium is critical for proper nervous system and muscular function, which is why your muscles can cramp if you’re deficient. Consuming too much potassium by taking supplements that greatly exceed the recommended daily value of 4,700 milligrams, however, also poses a threat to your nervous system and even the muscular functioning of your heart. Since most foods contain potassium, you should be able to get enough if you’re consuming potassium-rich foods daily. Whole foods like fruits, vegetables, milk and fish are rich sources of potassium. Bananas, melons, citrus fruits and avocados are potassium-dense fruits, while potatoes, sweet potatoes and winter squash are your go-to veggies for potassium.

Calcium-Rich Foods

Calcium plays a crucial role in muscular contraction, including in your heart and blood vessels. It also plays a role in nerve impulse generation. If you’re calcium deficient, you may experience muscle cramps or impaired muscle contraction. According to Harvard Health Publishing (Harvard Medical School, 2022), the average adult needs about 1,000 milligrams of calcium daily. You can get 244 milligrams of calcium in a 200-milliliter glass of skimmed milk. The most calcium-rich vegetables are dark, leafy greens. Almonds, figs, yogurt and cheese are also good sources.

Magnesium-Rich Foods

Magnesium is a mineral that stabilizes adenosine triphosphate, which is the energy source that fuels muscular contraction. Feeling weak, cramps and muscle twitches are signs of magnesium deficiency. Increase your intake by eating beans and legumes, nuts and seeds, whole grains, bananas and dark, leafy greens.

References:

Irish Heart Foundation (2022) Let’s Strike Before Stroke. Available at:  https://irishheart.ie/campaigns/strike-stroke/salt/ (Accessed 29 April 2022).

Harvard Health Publishing. Harvard Medical School. Staying Healthy. How much calcium do you really need? Available at: https://www.health.harvard.edu/staying-healthy/how-much-calcium-do-you-really-need (Accessed 29 April 2022).

National Institutes of Health, Office of Dietary Supplements (2021) Potassium, fact Sheet for Health Professionals. Available at: (https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/ (Accessed 29 April 2022).

Salt Association (2022), Salt & the Function of Our Cells. Available at: https://saltassociation.co.uk/education/salt-health/salt-function-cells/ (Accessed 29 April 2022).

Introduction

Hamstring injuries in my opinion are largely preventable, and can be predicted and avoided in many cases with a little knowledge. I myself have suffered a complete hamstring tear which required surgical reattachment and extensive rehabilitation. I’d like to put my academic and personal experience to good use in an effort to prevent other athletes suffering repeated interruption to sport or worse, a potentially catastrophic career ending injury. Following is my list of what I feel are the main predisposing factors to suffering a hamstring tear.

Subsequent Tear(s) with inadequate rehabilitation

It is widely accepted that those with a previous hamstring tear are more likely to experience a reoccurrence. When a hamstring tear occurs the body produces scar tissue which I’d crudely describe as hard chewing gum. If no treatment or rehab is given this scar tissue will not behave like normal elastic tissue and when enough force is put through the muscle the surrounding tissues will lengthen but the scar tissue will come to an abrupt halt and re-tear. An injury will heal without rehab but may be problematic in the athlete’s future. To allow this newly forming tissue to act like normal elastic tissue it requires manual intervention to separate fibers and encourage blood supply. Tissues also heal along lines of stress, so appropriate non painful stretching as the muscle is healing will help. Appropriately prescribed rehabilitation exercises are also a key component in the prevention of further injury.

Lack of Flexibility

The obvious culprit is tight hamstrings which can cause a hamstring strain and does need to be addressed if this is the case. However, in my experience the often overlooked cause of a hamstring tear is tightness in the hip flexors (iliopsoas and rectus femoris). These muscles on the front of the body can pull the pelvis forward and downwards and the low spine into hyper lordosis. This has the effect of pre-stretching the hamstrings and when the athlete sprints, flexing the hip and extending the knee, the already pre-stretched hamstrings can reach their limit and a tear can occur.

Inadequate Warm-up

Although this is an athlete’s personal responsibility, sprinting in cold weather with cold muscles has been the cause of many torn hamstrings. A dynamic warm-up is essential to increase blood flow, mobilise joints and increase the overall body temperature. This will allow the hamstrings to lengthen at speed and under load. Failure to do this often leads to the athlete pulling up and grasping the hamstring in agony. So, an adequate warm-up is a no brainer.

Muscle Imbalances

Although less common than in the past, due to increased knowledge of strength and conditioning, strength imbalance can contribute to a hamstring tear. A little forethought and planning can prevent this happening. Over strengthening the hip flexors and quadriceps while neglecting the posterior chain can indeed cause a tear in the hamstrings. The hamstrings don’t need to be as strong as the quadriceps but do need to be proportionately strong in order to control rapid lengthening when the hip is maximally flexed and the knee extended when the athlete is sprinting. This can be achieved with posterior chain exercises such as stiff leg deadlifts, hamstring curls and Nordic curls. A systematic review and meta-analysis of 8459 athletes concluded that inclusion of the Nordic curl reduced hamstring injuries by 51% in athletes (Van Dyk et al 2018)

Anterior Pelvic Tilt

Very much related to muscle imbalances, tight hip flexors (iliopsoas) can pull the spine forward and downwards and pull the pelvis into a forward and downward rotation. This has the effect of bringing the low spine into a concave arch called lordosis and will cause the facet joints to close thereby reducing movement in the low spine, potentially causing low back pain. The forward and downward rotation of the pelvis (known an anterior pelvic tilt), caused by the rectus femoris, in the front of your thigh, will pull at the proximal hamstring attachment, which is onto your pelvis at the gluteal fold, at your backside. This pre-stretched position of the hamstrings can become a problem when sprinting as discussed earlier, perhaps predisposing the athlete to injury.

Leg Length Discrepancy

Last but not least. In my opinion, this is a really good predictor of unilateral injuries in the lower body, and was originally eluded to by (Cibulka et al 1986). It is my view that an anterior (forward) rotation of the pelvis on one side, known as an anterior innominate, is a major predisposing factor to a hamstring injury on the same side. In fact, in every low body injury that I treat, whether a hamstring, Achilles or groin injury, I will always examine the pelvis to see what forces and imbalances are at play. Treating the injury is the easy part. Figuring out the cause is the real skill and is more likely to resolve the problem in the longer term.

So What?

The bottom line is that clinical structural examination by a skilled and knowledgeable osteopath could identify the issues outlined above. Subsequent treatment such as osteopathic manipulation to correct leg length, soft tissue work, stretching, mobility and appropriately prescribed rehabilitation exercises could prevent constant interruption to your chosen sport, or a catastrophic career ending injury such as a complete hamstring rupture.

References

Van Dyk, N., Behan, F. P., & Whiteley, R. (2019). ‘Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes’. British Journal of Sports Medicine, 53(21), pp. 1362–1370.

Cibulka, M.T., Rose, S.J., Delitto, A., & Sinacore, D.R. (1986). Hamstring Muscle Strain Treated by Mobilising the Sacroiliac Joint’. Physical Therapy, 66(8), pp.1220-1223.