Craniosacral Therapy: The missing link in healthcare?
/We are in the midst of evolving health challenges, and there is very little that the conventional healthcare system will be able to offer those who are suffering from complications related to long COVID. Our work as holistic health practitioners is a missing link in our decidedly under functioning healthcare system.
We have to own our importance within the fabric of healthcare without needing or waiting on the validation of the conventional system. The relevance of our work in the face of an ongoing pandemic—one likely to redefine what endemicity means—cannot be understated.
There may be cases where mildly symptomatic infections can cause ongoing cognitive issues, myalgias, or other health problems. (1) Treatment and recovery are complex processes requiring a thorough understanding of the complexity of COVID’s impact on different bodies. (1) The symptoms associated with Post-COVID sequelae are subclinical and require the insights that well-established relational care can provide.
>> READ MICHAEL’S COVID CASE STUDY
The most important thing remains connection—human to human connection. We need that always, especially now. As holistic health practitioners, we set aside an hour to be with people—not 15 minutes—and in that time, we can connect and establish context for how they’re experiencing their current situation.
Context matters. Sometimes, it is quite literally everything. The 15-minute appointment is, by nature, context deficient. Our work utilizes the insights that context creates to provide a radically more human—and often more effective—approach to health care.
Research models versus reality
In light of COVID’s impact on the CNS and PNS, I did a little digging into the current research. I came away with a deeper appreciation for the mystery of the body and the importance of being curious and open to frame context more accurately.
Researchers are finally admitting that their understanding of the physiology of the cranial realm is not well understood. This research is opening to possibilities rather than closing down our full potential. (2)
So much is possible when we can freely state we don’t know something and remain curious. That is the approach I bring to my queries in the realm of research. I am well aware of the materialist and capitalist paradigms underlying most medical research. However, we can look with curiosity at new data and apply it to what we know from our work.
Research articles don’t make for good reading, and often the granularity is in service of a disembodied approach that is at odds with the systems thinking, which roots and sustains our medicine.
I reviewed several articles (listed at the end of this post) and then consulted with colleagues on interpretation. I have opted for a more common language approach to my analysis here.
We know from experience that craniosacral therapy offers people relief and release from a wide range of symptoms. We don’t always get to see how that happens, but it is beyond doubt. It’s nice when we can have reasonable models for the how but it isn’t necessary for change to happen.
Said another way, there is more we do not know about how the body works than is known. We don’t have to avoid that mystery. We can surrender to it and be curious about what we learn.
I have two guiding questions when encountering research or physiological models:
“How is this helping me explore how the body might be experiencing itself?”
And a quote from Anatomy educator Gil Hedley: “We must hold our models loosely.”
Models are, by definition, not reality; they are a simplification of approximation of reality. Medical science often loses sight of the limits of its current model and treats the model as truth.
Models in flux
We are complex holobionts with emergent properties that can’t be predicted by looking discreetly at the parts. There’s no greater demonstration of this complexity and relationality than in the emergent behavior of consciousness in our nervous system. Consciousness, understood as an emergent systemic property that confers a remarkable social intelligence and empathy for others, is the opposite of Descartes’s dualism.
—Rupa Marya and Raj Patel, co-authors of Inflamed
Research findings are like compost for our imaginations. When we work, we conjure the images of relationships between structures—their properties and qualities—and let those imaginings inform our touch. I believe this changes the quality of our contact as we establish the connection with the body-brain, and the bodies we work with feel that awareness.
The underlying physiology of the central nervous system is one of the least understood systems in the body. The models of the craniosacral system can be complex. One way I like to approach it is to say the system consists of “bones, a bag (with some parts), fluid and stuff.”
From a craniosacral therapy perspective, we mainly talk about cerebrospinal fluid (CSF), and in light of recent research, that perspective may need to be revised. Other fluids flow around central nervous system tissues (the brain and spinal cord) that work with the CSF. Together, they are likely doing more than conventional modeling understands due to materialist medicine’s bias towards breaking things apart into constituent pieces. As holistic care providers, we know that the whole is so much more than the sum of its parts.
Enter interstitial fluids (ISF) flowing alongside cerebrospinal fluids separate from blood. Different models exist, describing the channels these fluids flow through, but researchers admit they don’t seem to know precisely how these flows happen.
A new look at brain fluids
CSF and ISF are essential in maintaining a healthy milieu for the wide-ranging and complex functions of the central nervous system. One key aspect is dealing with immunity, transferring metabolites, maintaining homeostasis, and controlling inflammation. But they aren’t just a sloshing free flow. There is an underlying supportive function found in neuroglial cells. (3)
Neuroglial cells—or glial, meaning glue—have long been disregarded as packing material. However, now that we know that neurons cannot fire without healthy glial cells, we can dispense with the packing material glue concept.
There are four types of glia; microglia, astrocytes, oligodendrocytes, and their progenitors. They serve various roles within the functioning of the CNS and PNS, primarily communication, connection, fluid movement (and maybe secretion), and immunity. Said another way, they help the system function as a whole and heal when injured. (4).
Suppose you are familiar with the properties and variance in the connective tissue realm. In that case, you are probably already thinking that this glial tissue is similar to (not the same as) the fascial system in the main body. Imagine the extracellular matrix and extracellular fluids, but now in the CNS with CNS-specific jobs and properties.
We are talking about the glymphatic system. The glial cell type that is specifically involved is the astrocytes. They structure pathways through which the ISF can move and transport metabolites out of the CNS. There is a relationship between this movement and the CSF, but the models are unclear what exactly that is.
Interestingly, there was some agreement across studies that a significant portion of the CSF and ISF enters the lymphatic system below the ethmoid bone via the nasal pathways. (5)
There is also universal agreement that this system functions most fully when we are sleeping. Some research indicates that the glymphatic system increases activity in deep relaxation—think meditation, yoga, qi gong, craniosacral therapy, or acupuncture. To further complicate things, we know that the gut-brain microbiota axis is as meaningful to the function of the CNS as the glial system.
How hands-on healthcare providers can help patients heal from COVID-related complications
Every research paper I consulted concluded that optimizing the glymphatic system is crucial for maintaining healthy CNS function and healing after illness or injury. Examples cited ranged from TBIs to Alzheimer’s and other neurodegenerative diseases.
Given COVID’s spike protein and its ability to create inflammation, it seems logical to conclude that infection may cause neuroinflammation. This inflammation may be why folks have such cognitive impairments long after their initial infection with COVID.
The environment of the CNS is part of how it works; it isn’t only the neurons. Our physiological models are biased toward things—isolating, naming, and defining their function. But we know, instinctively, we are much more than that.
Post-COVID conditions or Long-COVID likely involve inflammation of multiple systems, with symptoms arising uniquely in each individual depending on their specific constellated physiology.
Because of this, it seems relevant to consider craniosacral work as a component of care—and hopefully healing—for people suffering multiple chronic and long-term afflictions after COVID infection. It may, in fact, be the missing link in healthcare. For this reason, I advocate for touch-based therapists to be skilled in techniques that allow them to work meaningfully with multiple systems and, in this way, treat the whole person.
Resources:
Belluck, Pam Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection. New York Times 2021
Nadia Aaling Jessen, Anne Sofie Finmann Munk, Iden Lundgaard, and Maiken Nedergaard The Glymphatic System—A Beginner’s Guide. Neurochem Res. University of Rochester 2016
Tomas Brinker, Edward Stopa, John Morrison, Patra Klinge. A new look at cerebrospinal fluid circulation. Fluids and Barriers of the CNS 2014 11:10.
Nadia Aaling Jessen, Anne Sofie Finmann Munk, Iden Lundgaard, and Maiken Nedergaard The Glymphatic System—A Beginner’s Guide. Neurochem Res. University of Rochester 2016
Benjamin A. Plog and Maiken Nedergaard The glymphatic system in CNS health and disease: past, present, and future. Annual Rev Pathol. University of Rochester 2018
Megan Bulloch, Phd. Personal correspondence
Dr. Rebecca Groebner, D.Ac, L.Ac. Personal correspondence
