Upledger Institute

CranioSacral Therapy in the

Treatment of ConcussionSally Fryer Dietz, PT, DPT, CST-D

Melinda Roland, M.A., P.T., L.Ac., O.M.D., Dipl-Ac, CST-D

The

Craniosacral

System

Influences

Nervous System

Musculoskeletal System

Circulatory System

Lymphatic System

Endocrine System

Respiratory System

Digestive System

A

Concussion

Affects

Nervous System

Musculoskeletal

Circulatory System

Lymphatic System

Endocrine System

Respiratory system

Digestive System

John E. Upledger, DO, OMM(1932-2012)

Coast Guard Medic in the 1950’s

Surgical discovery of Craniosacral

system (CSS)

1975-1983 Professor of

Biomechanics, Clinical research

team MSU to document CSS

1985 Established UII in

Palm Beach Gardens, Florida

(Upledger Institute International)

Upledger Institute

Believed the human body had

a greater capability to self-heal

Found the power of gentle,

intentioned touch to be

extremely effective in the

healing process.

Developed techniques to

address sutural and

membraneous restrictions

CST enhances recovery by:

1. Relieves symptoms: Parasympathetic nervous system.

Decrease need for meds.

2. Facilitates recovery: Rest, relaxation, decreased inflammation

3. Integrates corrections within connective tissue matrix and nervous

system: Addresses strain patterns

4.More productive rehab sessions with less stress on the body:

Patient feels better when they leave…more likely to come back.

Hypothesis:

Increased CSF

flow allows for

improved circulation

in the brain,

flushing of toxins

& decrease in

inflammation.

Promotes healing.

Anatomy of the

CranioSacral System

Meningeal

membranes

Cranium to coccyx

Dural Tube

CSF

Bony structures

(cranium to coccyx)

Cerebral Spinal Fluid

(CSF)

The meninges

The Fascia

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Cerebrospinal FluidProduced in ventricles (Choroid plexus) Resorption in dural sinuses ( arachnoid villa and gran bodies )

Derivative of blood

Shock absorber

Cushions & protects

Nourishes & bathes the brain & spinal cord, removing waste from the CNS (chelating agent)

Glial Cell Attachments

Meninges of Brain

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eninge

Meninges at the Spinal Cord

Cord

Dural Tube

• an extension of the intracranial membrane system

• a sealed membrane that encloses the spinal cord

• exits the spinal cord at every vertebra, travels a short distance along the course of the spinal nerve, then blends with the fascia of the body

• The dural extension is called the dural sleeve

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CranioSacral Movement

Subtle but palpable movement

Narrowing & widening of the skull

Each cranial bone has its own axis of movement

Sutural restrictions can be osseous or membranous

6-12 cycles per minute

CranioSacral Rhythm

The Art & Practice of CranioSacral Therapy

• 5 grams = the weight of a nickel

• Light touch gets under body’s defense mechanism = change without harm

• Gentle, non-invasive manual therapy

• Allows for the detection and correction of imbalances within the CNS

• Corrects restrictions in CSS and body’s structural and physiological systems

• Mobilizes restrictions within cranium, sacrum, dural system and body

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Jugular Foramen

Jugular Foramen

Carotid CanalCarotid Canal

Occipital Base & Jugular Foramen

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Dure mater reflection. 1. Crista galli, 2. Falx cerebri, 3. Sinus sagittalis inferior,

4. Tentorial incisure, 5. Sinus rectus, 6. Confluence of sinuses, 7. Tentorium

cerebelli, 8. Sinus petrosus superior, 9.Sinus Sphenoparietalis, 10. Diaphragma

sellae, 11. Arteria carotis interna, 12. Nervus opticus, 13. Foramen magnum.

Dural membrane

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• In order for tissue to survive and maintain equilibrium, each tissue and• its associated connections must be free in its environment.

• The tissue must have substantial mobility, extensibility and elasticity.

• When a tissue loses equilibrium, what affect does this have on the

• activity within the brain?

• Symptoms can be local or distant

from its origin.

• Symptoms are not exclusive

to physical structures.

Concept

Over 125,000 practitioners trained through

the Upledger Institute.

50 countries where the curriculum is taught

Dr. John E. Upledger Foundation

and

The Ricky Williams Foundation

Concussion Pilot ProgramR

E

S

E

A

R

C

H

Upledger Institute

"Serving Those That Serve-

A New Treatment Intervention

for Concussion Recovery".

This study has been accepted for publication in the journal “Medical Acupuncture”

Authors: Wetzler, Gail, PT, DPT, EDO, BI-DFryer Dietz, Sally, PT, DPT, CST-D

Roland, Melinda, M.A., P.T., L.Ac., O.M.D., Dipl-Ac, CST-D Ahern, Dee, PT, BI-D

"Medical Acupuncture" is connected to Harvard University

and relates to all variables of complimentary medicine.

Purpose of Study

To demonstrate that advanced manual therapies administered by certified, licensed manual

therapists would help to alleviate the symptoms of post concussion syndrome.

Five day intensive manual therapy program at the

Upledger Institute in Palm Beach Gardens Florida.

Designed for football players who had a predisposition

to CTE (Chronic Traumatic Encephalopathy) &

other sports related injuries

All had been suffering from their injuries for years!

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Year 1 Pilot (2015): Five Participants

Year 2 (2016) - Seven participants

Year 3 (2017) - Pending

The players all received treatment twice a day

for five days with therapists certified in

Upledger CranioSacral Therapy.

All were examined & diagnosed

by a medical doctor trained in sports medicine

Diagnoses:

Post concussive syndrome &

other sports related injuries.

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Performed by

Independent

physicians &

therapists.

Pre & Post TestingUsed “Gold Standard” evaluation tools

First Day (day 1)

Last Day (day 5)

4 weeks later

3 months post RX

Physical Medical Exam

(physical, orthopedic exam, strength, range of motion, rhomberg test,)

Neurocognitive testing

(imPACT Test)

Psychological Testing

(Beck Depression Inventory, SF 36 Quality of Life)

Pain Assessments

(HIT 6 Headache Intensity Test, Numeric Pain Intensity Scale)

Vestibular & Balance Tests

(Dizziness Handicap Inventory, Dynamic Gait Index, TUG – timed up and

go test)

Specialty Tests year 2+

(Dynavision, VOMS, Vision, Interactive Metronome)

:

AnxietyDepression

Sleep problemsFatigue

Cervical/head pain

Difficulty withMemory, Learning, Reading, Decision making

Symptoms

balance, dizziness,

digestive or elimination problems

Minor Complaints

Major Complaints

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The Results

CERVICAL

RANGE OF MOTION

Normal Cervical Flexion from neutral:

40-60 degrees

CERVICOGENIC PAIN

Pain Scale

1-10

10 worst

1 no pain

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Numeric Pain Scale:

Total Body 1-10

HEADACHE IMPACT TEST (HIT)

Score Range 36-78

Higher scores =

greater impact on life

78

36

DIZZINESS HANDICAP

INVENTORY (DHI)

Scores:

16-34 Points (mild handicap)

36-52 Points (moderate handicap)

54+ Points (severe handicap)

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DYNAMIC GAIT INDEX

Total Score = 24

Interpretation

< 19/24 = predictive of falls in the

elderly,

> 22/24 = safe ambulators

Total Score Levels of Depression

0-10 = These ups and downs are considered normal

11-16 = Mild mood disturbance

17-20 = Borderline clinical depression

21-30 = Moderate depression

31-40 = Severe depression

over 40 = Extreme depression

21 QUESTIONS

LOWEST SCORE 0

HIGHEST SCORE 63

Dynamic SF-36

Quality of Life Scale

Designed to assesses

health improvement &

treatment

effectiveness.

HIGH SCORE IS

MORE FAVORABLE

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HOURS OF

SLEEP

Self Report

imPACT COGNITIVE

EFFICIENCY TEST

Thank you!

Upledger Institute

ADDITIONAL RESEARCH

A growing list of case studies & research articles can be found at

www.UPLEDGER.COM

For more information on CranioSacral Therapy visit the Upledger booth

Research Articles:

•Alsalaheen B, Mucha A, Morris L, Whitney S and et al. (2010), Vestibular rehaabilitation for dizziness and balance disorders after concussion. Journal of Neurological Physical Therapy; 34 (2): 87-93

•Amen, D, Raji C, Willeumier K, Taylor D, Tarzwell R, Newberg A, Henderson T, Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury in Focused and Large Community Datasets, PLoS One, July 2015

• Arnadottir, T.S., Sigurdardottir, Arun K, Is craniosacral therapy effective for migraine? Tested with HIT-6 Questionnaire. Complementary Therapies in Clinical Practice, 2013. 19: 11-14.

•Bulat, M. Klarica M., Recent insights into a new hydrodynamics of the cerebrospinal fluid. Brain Res Rev 2011, 65:99-112.

•Denton, GL, Brainlash, Maximize Your Recovery From Mild Brain Injury, Demos Medical Publishing, Inc. 1999

•Eisenberg, M. A., Meehan III, William P, Mannix, R, Duration and Course of Post Concussive Symptoms. Pediatrics, 2014 133 (6)

•Fryman V, A Study of the rhythmic motions of the living cranium, J AM Osteopathic Assoc, 1972,70:1-18

•Haller H, Lauche R, Cramer H, Rampp T, Saha FJ, Ostermann T, Dobos G, raniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial, Clin J of Pain, May 2016: 32(%) 441-9

•Hawker G, Samra M, Tetyana K, French M, Measures of Adult Pain, Measures of Pathology and Symptoms, Arthritis Care and Research, Nov. 2011, p 240-252

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• Jakel, A., von Hauenschile, P., A systematic review to evaluate the clinical benefits of craniosacral therapy. Complementary Therapies in Medicine, 2012. 20(6): p. 456-65.

• Johanson CE, Duncan JA, Klinge PM, Brinker T, Stopa EG, Silverberg GD: Multiplicity of cerebrospinal fluid functions: New challenges in health and disease. Cerebrospinal Fluid Res 2008, 5:10

•Keffelgaard, I., Roe C., Soberg H and Bergland, Associations among self-reported balance problems, post concussion symptoms and performance based tests: a longitudinal follow-up study, 2012, Disability and Rehabilitation, 34(9): 788-794

•McCory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: 4th International Conference on concussion in Sport held in Jurich, November 2012 Br J Sports Med 2013 47: 250-258

•McPartland JM, Greenman PE, Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopathic Assoc, 1995;95(3): 182-188

•Moskalenko YE, Fryman VM, Weinstein GB et al, Slow thythmic oscillations with the human cranium: phenomenology, origin and informational significance. Human Physiology: 2001; 27920: 171-178

•Moskalenko YE, Kravchenko TI, Gaidar BV, et al. Periodic mobility of cranial bones in human. Human Physiology 1999; 25(1): 51-58

•Small G, Kepe B, Siddarth P, Ercoli l, Merrill D, Donoghue N, Bookheimer S, Martinea J, Onalu B, Bailes J, Barrio J., PET Scanning of Brain Tau in Retired National Football League Players: Preliminary Findings, Am J Geriatr Psychiatry February 2013, 21:2

•Soble J, Silva M, Vanderploeg. R, Curtiss G, Belanger H, Donnell A, Scott S. Normative Data for the Neurobehavioral Symptom Inventory (NSI) and Post Concussion Symptom Profiles Among TBI, PTSD and Non-clinical Samples, The Clinical Neuropsychologist, 2014

•Wells, Adam et al, Reliability of the Dynavision D2 for Assessing Reation Time Performance. 2014. Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando.

•Willer B, Leddy J, Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination, Society for Academic Emergency Medicine, 2016, ISSN 1069-6563

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Neural Visceral Relationships

•Aziz Q, Thompson DG, Ng V, Hamdy S, Saskar S, Brammer MJ, Bullmore E, Hobson A, Tracey I, Gregory A, Simmons A, Williams S, Cortical Processing of Human Somatic and Visceral Sensation, J Neuroscience, April 2000, 20(7):2657-2663

•Bansal V, Costantini T, Kroll I, et al, Traumatic Brain Injury and Intestinal Dysfunctions: Uncovering the Neuro-Enteric Axis, J Neurotrauma, 2009:26(8):1353-1359

•Coen s, Gregory L, Yaguez L, Amaro E, Brammer M, Williams S, Aziz Q, Reproducibility of human brain activity evoked by esophageal stimulation using fMRI, Am J Physiol Gastrointest Liver Physiol, March, 2007, 293:G188-G197

•Gaddam S, Buel T, Robertson C, Systemic Manifestation of Traumatic Brain Injury, Handbook Clinical Neurolog, 2015, 5:127:205-218

•Kharrazian, Datis, Traumatic Brain Injury and the Effect on the Brain Gut Axis, Alternative Therapies, Vol 21 Suppl 3, 2015

•Sarkar S, Hobson A, Furlong P, Central Neural Mechanisms Mediating Human Visceral Hypersensitivity, Am J Physiol Gastrointest Liver Physiol,

28:1:G1196-G1202, 2001