Dural/Cranial Counterstrain

One of the many benefits of the Strain and Counterstrain (SCS) approach is that the technique can be used to treat dysfunction which occurs in different tissues and systems of the body. This includes what is called the craniosacral system.

Understanding the Craniosacral System

The human skull or cranial vault consists of multiple cranial bones lined by a continuous connective tissue membrane called the dura mater or dural membrane. In essence, the bones of the skull can be seen functionally as hard areas inside a continuous connective tissue membrane that encompasses and protects the brain.

The dural membrane also called the ‘dural tube,’ descends through the foramen magnum (opening at the base of the skull), attaches to the first 3 cervical (neck) vertebrae and anchors to the bottom of the spine (sacrum.)  Inside the dural tube, is a substance called cerebral spinal fluid which is a serum like fluid that circulates through the cavity of the spinal cord functioning as a shock absorber. This physiologic system which includes: cerebrospinal fluid, cranial connective tissues, cranial bones, sutures, and vessels is collectively called the craniosacral system.

Musculoskeletal Pain Cause by Chronic Contraction

The dura matter itself is made predominantly of collagen and elastic fibers that are embedded in extracellular ground substance, in other words, the dura mater is made of “fascia.” In fact, the dural membrane is the body’s deepest layer of fascia.

This is an important fact because, as discussed in other parts of the website, we now know that fascia is a contractile tissue that can go into a state of chronic contraction sufficient to cause musculoskeletal pain and dysfunction. [Reference: Fascia is able to contract in a smooth muscle like manner and influence musculoskeletal mechanics (Schleip and Klinger). See Research Articles.]

Significance of Cranial Tender Points

The existence of a cranial tender point indicates that the dura mater, epicranial fascia, temporoparietal fascia or one of the superficial muscles of the cranium (frontalis, temporalis or occipitalis) is in a state of chronic dysfunction. Stated simply, the fascia of the cranium can tighten chronically causing both a diagnostic tender point and a wide variety of medical conditions.

These conditions include: tension headaches, sinus problems, generalized nerve sensitivity (Allodynia), TMJ dysfunction, chronic back / neck pain, facial pain, migraine headaches etc. The allopathic medical community calls pain or scalp tenderness originating from the fascia of the cranium “nummular” or “ponytail headaches.”

Alleviating Tender Points with Cranial SCS

Traditional Craniosacral Therapy which is focused on correcting a perceived cranial “pulse” or “rhythm” inside the craniosacral system, is quite controversial due to poor inter-examiner reliability and a lack of scientific evidence to support the proposed mechanism.

Cranial SCS, however, uses objective tender points associated with the muscular and fascial tissues of the cranium in order to diagnose dysfunction. The proposed mechanism of cranial SCS is simply the well accepted and documented existence of myofascial pain syndrome. [References: Signs and symptoms of the MPS: A national survey of Pain management Providers. Harden SP Bruehl, Journal of Pain 2000; Myofascial Pain. Joanne Borg-Stein, David Simmons Archives of Physical Medicine and Rehab. See Research Articles.]

Cranial tender points, once identified, are alleviated utilizing the simple concepts of positional release as is the case with all SCS treatments. The only difference between traditional SCS and cranial SCS is that with cranial tender points, the myofascial tissues (muscular and connective tissues) of the cranium are manipulated versus the myofascial tissues of the spine or extremities.

If you feel you may have the symptoms of craniofascial dysfunction, feel free to set up a detailed evaluation with one of the trained Strain and Counterstrain practitioners at ARC Physical Therapy.