Integrating CST and Chiropractic

Chiropractic education includes a study of the meningeal system surrounding the central nervous system, but such study does not extend to exploration of the inherent motion of this system. The motion of this system, called the craniosacral rhythm in CranioSacral Therapy, or the primary respiratory system in Sacral Occipital Technique, can play a vital role in both diagnosis and treatment. The study of palpation and treatment techniques used in CranioSacral Therapy can for this reason provide a valuable complementary adjunct to chiropractic care, both for enhancing diagnostic accuracy, for improving speed of patients' recovery, and for deepening the therapist's understanding of the root causes and healing processes underlying imbalances.


The anatomy of the craniosacral system consists of the meninges, mainly the dura, along with its attachments to the cranial bones including the facial bones, to the foramen magnum, to C2 and C3, and to the second sacral tubercle, ultimately blending with the periosteum of the coccyx. The container created by the dura holds the cerebrospinal fluid (CSF) which is continually produced from the ventricles, is circulated, and is reabsorbed, bathing the brain and spinal cord. The CSF provides essential nutrients and removes waste. The circulation of the cerebrospinal fluid (CSF) through the brain and spinal cord manifests as a rhythmic flow, called the craniosacral rhythm (CSR). It is evident that any restriction to the flow of the craniosacral fluid and hence to the craniosacral rhythm can translate as stress to the brain and spinal cord. Any imbalance that affects the central nervous system will therefore result in dysfunction and will challenge one’s homeostasis. Yet the importance for an individual’s overall health of free flow of the craniosacral fluid, as manifested through the craniosacral rhythm, extends well beyond its immediate relationship to the meningeal system. In addition, the utility of craniosacral palpation based on the craniosacral rhythm as a tool for treating imbalances extends beyond the dural system alone. The reasons are simple, as described below.

Fascial Connections

As we know, we are one continuous piece of fascial connective tissue from head to toe. This fascial system accommodates the somatic and visceral structures, and any fascial restrictions, contracture or immobility in an area can lead to dysfunction, both anatomically and physiologically. What is not well known, however, is that the craniosacral rhythm produced by the craniosacral system can be felt throughout the body in the connective myofascial and skeletal tissues. This rhythm presumably is modulated through the nervous system from osseous and direct fascial connections. As chiropractors know, motion is a key ingredient of health. The gentle motion of the craniosacral rhythm, rippling through the connective tissues when it is unimpeded, helps all cells to be bathed in continuous ever changing fluids that are critical for life. It helps move the intra and extracellular fluids, the blood and the lymph, in addition to the CSF.

Fluid Flow

The craniosacral rhythm is an innate low horsepower system creating motion in our tissues moving like a lazy river flowing with ease in a forest. And just like that river, however, the slow-moving river of the craniosacral rhythm can be impeded both from within, through restrictions within the dural membranes, and from without, through external fascial restrictions impinging on the craniosacral system. Since the craniosacral rhythm can be felt as a subtle wave throughout the fascial tissues, any restriction in these will also be felt as a restriction in the craniosacral rhythm. This means that craniosacral palpation can play an essential role in identifying the location and nature of fascial restrictions throughout the body. Because of the two-way process of influence between the fascia and the craniosacral rhythm, learning how to palpate the rhythm and to use it as a diagnostic tool can considerably enhance the effectiveness of chiropractic diagnosis. In addition, craniosacral hands-on work can also provide an invaluable tool for treatment of restrictions identified through initial palpation.

Increased Palpation Perception

As hands on therapists, chiropractors continually receive information from the tissues through palpatory perception of affected areas. CranioSacral therapy adds a new dimension of palpation. The cornerstone of CST is blending, the unique ability to use very light, focused and intentioned touch at the interface between therapist and patient. Through “listening” to the tissues, and specifically listening to what the CSR tells us about restrictions within the body, the practitioner learns to work with the rhythm to gently stimulate release and to improve balance of the tissues. A core principle of this gentle technique is that focused non-invasive interactive work with the patient’s tissues helps to activate the patient’s innate healing response. The use of whole body palpation focused on the craniosacral rhythm can both identify new areas of restriction that may have previously gone unnoticed, and assist in treatment of problems already identified through the chiropractor’s existing toolkit.

The Subluxation Complex

For example, subluxation complexes involve not only reduced motion and fixation of the vertebra but also reduction of the craniosacral motion of the vertebral complex. Chiropractic adjustments alone do not always restore this motion. There can still be a drag on the vertebra from tightness of ligaments or tendons, inflammation, or an existing chronic skeletal condition. Simple light touch palpation of the vertebra exaggerating the craniosacral rhythm can bring about mobility and release, complementing the original adjustment. This process can be applied both to the surrounding tissues and to the nerve root and dural sleeve. Because chronic subluxations can be the result of meningeal stress on the dural sleeve causing pressure on the nerve root, craniosacral palpation and release can be particularly effective in such cases.

Facilitated Segments

CranioSacral Therapy can also be particularly helpful in the treatment of facilitated segments. The concept of facilitation was first developed by Dr. Irvin M. Korr PhD, at that time chief of physiology education at the Kirksville College of Osteopathy. Through his research and experimentation, he concluded that there can be hypersensitive spinal cord segments that become chronically dysfunctional no matter where a stress might originate. A facilitated segment of the spinal cord is quickly excitable or facilitated, hence the name facilitated segment. Neuronal input will easily trigger it, and there are typical tissue changes around the facilitated segment in many cases: palpable changes in tissue texture, warmer skin, reduction of joint mobility, tenderness of the tissues, sympathetic nervous system changes in the skin making it rougher, increased sweat activity of the tissues, etc. Chiropractors encounter these facilitated segments as the chronic subluxations or weak links their patients have. Any therapy that can arrest the self-perpetuation activity is helpful. Adjustments alone do not always get to the facilitated segment for one reason the dural membrane covering the spinal cord in a facilitated area is not always released. In such cases, gentle CST manipulation of the dura in the area can assist the release of the cord and thus reduce the chances of the chronic subluxation pattern typical of facilitated segments.

Energy Cysts / Somato Emotional Release

A further aspect of CranioSacral Therapy that can be useful to chiropractors involves the concepts of energy cyst and Somato Emotional Release (SER). An energy cyst in the body is a localized area of increased activity that usually results from a strong impact to the body. Generally, the body applies its innate healing response to discharge aberrant energies entering into it. There are times, however, where it cannot do so simply due to the load of the impact, and the density of tissues it has to move through. The result is an energy cyst which can result from physical trauma that overloads the system, and sometimes also from emotional trauma. Because the body cannot fully dispel the energy, it adapts to it by containing it and localizing it, hence the term cyst. The energy becomes walled off to confine this area of entropy. While this is a natural protective mechanism initiated by the innate healing response and aiming at optimal function, it is not without its cost. The body is forced to divert vital energies from daily physiological processes to contain the cyst, and fluid dynamics must work around it. As a result, the body sustains tissue contracture along with any emotional energies that might have occurred at the time of impact. Impacted energies, with emotions or without them, can reside in the body for years, and even for a lifetime.


Chiropractors encounter the effects of energy cysts and somatic emotions as held areas of tightness and contracture that can be resistant to effective treatment and that tend to worsen over time. Craniosacral palpation can assist in identifying these energy cysts underlying such chronic problems. In addition, craniosacral techniques of gentle unwinding, positional tissue release and dialoguing while relying on the craniosacral rhythm can release energy cysts along with the emotions retained in the soma.

Chiropractic Class

This workshop will introduce chiropractors to the functional dynamics and anatomy of the craniosacral system, to palpation of the craniosacral rhythm and to its application in diagnosis and treatment of problems commonly presented in the chiropractic environment. The goal is to provide participants with techniques that they can use within a chiropractic appointment time frame. The class is designed for a small group, so as to provide individual attention to participants as they work with each other.

Upledger Center for Integrative Therapy

Dr. Lisa Upledger, D.C., CST-D*, FIAMA 

Ph: 561-267-4156


NCBTMB Approved CE Provider Learn More


*The specialty recognition "CST-D" has been received from a private organization

not affiliated with or recognized by the Florida Board of Chiropractic Medicine.