We have had a bit of vagal system extravaganza at MMI lately. I have been inspired by some dissection stuff during my class with Gil Hedley to re-look at vagal system anatomy. Dissection is messy business, and while we saw the vagus in the wild, as Gil likes to say, it was difficult to get the impressions of it that I wanted.

When in doubt, check the jaw. In our mapping of the craniosacral system, I place utmost importance on treating the jaw. While not directly part of the CS system, the jaw may be the place where the most energy enters into the system. I want to share a case study as an example of how this can work in the clinic.

The myodural bridge is where myofascia of two of the sub occipital muscles, the rectus capitis posterior major and minor, have fascial connection with the dural tube–the membrane surrounding the spinal cord. This means that good myofascial work at the sub occipitals could also be considered fairly direct work on the craniosacral system.

It’s been 5 years since we launched our new CST program and we figured it was time to take all that we’ve learned delivering it and make some changes. 

We believe education isn’t just about transferring knowledge or skills, but a living laboratory for possibility. Because of that we are constantly learning from our time in the classroom. Just like we do in the clinic; we reflect on what we are doing and ask ourselves what have I learned from my time with this person and how can I use that to create better treatment with them? MMI does that with our curricula too. Nothing about learning is static.

There is no one size fits all approach to assessing and treating lower back pain. Each person deserves to be treated with curiosity and as open of a mind as possible. Of course, there are key characters like the psoas and quadratus lumborum, there is tension distributed into the low back via shortened hamstrings, and treating the glutes (especially glute medius) is often gold.

It is almost the Summer Solstice. Peak light amidst dark times. I’m not a fan of bypassing and would rather embrace what is and transform from there, knowing that the process of transforming structures both intrapersonally and collectively is messy and something that occurs over time. It is, as anonymously quoted by the psychologist Ira Progoff, “this solitary work we do together.”

I think about this quote a lot as it captures a specific dynamic of our professional lives. We are often in a room, just us with one other person doing our work and yet we also need a community of colleagues with whom we can share the totally weird and unique dynamics our job involves. Seriously, what other job is like ours?

May is Ehlers-Danlos Syndrome (EDS) awareness month. I am three months into a training program through the Ehlers Danlos Society’s ECHOs program. I have learned so much and feel humbled at what I was unaware of regarding the symptom pictures associated with these syndromes. It's more than bendy joints.

I’ve wanted to share some thoughts in honor of Craniosacral Awareness Week and it’s been a troublesome endeavor for me: partly because the work is important to me and partly because I am conflicted by what I see happening in the field and it makes me sad. It’s also unsettling to share thoughts and feelings that go against the grain.

Medicine, even natural or holistic medicine, is a field that despite what one might think, doesn’t reward unconventional and non-conforming viewpoints. When I began studying craniosacral therapy 25 years ago, I never would have imagined there would be a paradigmatic mainstream in the field but it appears that one has emerged. This fact contradicts my experience practicing, studying, reflecting on and teaching this work over the last 25 years.

EDS and HSD are diseases affecting the connective tissues. They are thought to be genetic in origin. They are spectrum disorders and so symptom pictures are highly variable.

The Ehlers-Danlos Society offers this definition of EDS: The Ehlers-Danlos syndromes (EDS) are a group of 13 heritable connective tissue disorders. The conditions are caused by genetic changes that affect connective tissue. Each type of EDS has its own set of features with distinct diagnostic criteria. Some features are seen across all types of EDS, including joint hypermobility, skin hyperextensibility, and tissue fragility.

Hypermobility Spectrum Disorders can co-occur with EDS or present on their own. There is often overlap in symptoms between the two and differentiating between them can be challenging.

The Ehlers-Danlos Society offers this definition of HSD: Hypermobility spectrum disorders (HSD) are connective tissue disorders that cause joint hypermobility, instability, injury, and pain. Other problems such as fatigue, headaches, GI problems, and autonomic dysfunction are often seen as part of HSD.

Myofascia means the fascial system that contains, organizes and connects our muscles with each other across joints; including, tendons, ligaments and their bony attachments. 

The anatomy we learned in school, with its emphasis on origins and insertions leaves us with an incomplete picture of the soft tissue milieu. Our approach emphasizes the relationships between muscles via the fascia. 

I have been thinking about “safety” lately. I love the polyvagal theory because it places feelings solidly within the ranges of our physiological felt sense, aka interoception. Many people experience the range of their emotions as physiological sensations (or symptoms depending on perspective/severity). The polyvagal theory offers us a map to help our people interpret what the body is expressing. However, most articulations of the theory use the word “safety” in a way I find troubling.

Our job isn't easy. And the holidays can make everything more intense, highs and lows. This week I have already seen multiple folks in more acute states of struggle than usual. It can sometimes be a challenge to fully show up for our people and make sure we are tending to our own sweet selves. Don't worry, this wont be a treatise on self-care. Rather, I'm thinking about "inspo!" Sometimes inspiration just happens and that's rad but unpredictable and we might need it more frequently than that. I believe we can cultivate that feeling of inspiration in lots of ways.

We think you will enjoy this wide ranging and enlivening conversation between Shayne Case and Michael McMahon. Topics include perspectives on healing in this current time, big ideas, specific love of words and much more!

Shayne Case is a mother, healer, writer, medicine maker, and an enrolled member of the Cheyenne River Sioux Tribe. 

The New York Times and Medicine Acknowledge Fascia is Important (!)

I always brace myself before reading an article in a mainstream pub about something that our collective fields have been working with and exploring for a very long time and to good effect (see NYT article on the vagus nerve that emphasizes potentials for drugs and inserted gadgets rather than attuned health care and relationships). Such was the case with the recent NYT brief on “New” understandings about fascia. 

Let’s talk about working with folks after a spinal surgery. This is a follow up to the post about “dose” when it comes to bodywork. We will see that dose, not just in one session but over the arc of treatment is important in these cases. We want to have our eye on the long game for our people.

I get asked a lot about “my approach” to craniosacral therapy (CST). Of course, I have one. It is always evolving and is rooted in my experience of doing the work with the people I am treating. I am not beholden to anyone else’s ideas about the craniosacral system, I love being with each person’s system and listening to and participating with  how their system presents itself…

Wellness/biohack culture is obsessed with the vagus nerve and yet often misses the point of what can be helpful about understanding the polyvagal theory and the individual dynamism of each of our vagal systems. There isn’t a shortcut for deepening our capacity for both self and co-regulation. 

I want to highlight a piece of writing  by Susan Raffo on the history of “Osteopathy” and craniosacral therapy (CST). It is an unfortunate history and needs to be addressed in all places that folks are learning and practicing this work. I am grateful to have come upon Susan Raffo’s work, both this piece and her newish book, Liberated to the Bone. 

The Diaphragm as a (silent) Mediator of Emotional Experience…The diaphragm is a myofascial structure with all of the properties of our myofascial system plus the added link to our autonomic nervous system via our breathing. Because of this connection with breath the diaphragm can act as a below-the-level-of-conscious-awareness mediator of our emotional experiences.

Check and Adapt is something I’ve been practicing since my time as a wilderness guide. It applies to everything from how I approach a client on the table to business planning at a high level to the ongoing evolution of the Moving Mountain Institute curriculum design. Once you start working you learn more information. Check and adapt gives you the flexibility to evaluate what’s working, what needs to change and ways to think about how to change.