resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
November, 2008, Vol. 08, Issue 11
The Pressurestat Model Explains the Craniosacral Rhythm
By John Rollinson, D. Eu, CST-D; guest author for John Upledger, DO, OMM
The Pressurestat Model illustrates the mechanism behind the circulation of cerebrospinal fluid through the semi-closed, hydraulic craniosacral system.Originally defined by Dr. John Upledger and a team of researchers at Michigan State University in the 1970s, the model explains the palpable, rhythmic expansion and contraction of the craniosacral system.
The brain and spinal cord are surrounded by cerebrospinal fluid (CSF). This fluid transports nutrients, hormones and peptides. It removes metabolic waste and toxic substances. It serves as a shock absorber, floating the brain to counteract gravity. It even influences respiration and cerebral blood flow, among its many functions. Given all this, it's easy to see how essential it is for CSF to flow unimpaired. If an area of brain tissue is even partially deprived of optimal CSF motion and flow, that area will be forced into some degree of functional compromise.1
Cerebrospinal fluid is held within the dural membrane that surrounds the brain and spinal cord. This tough, watertight sac takes the shape of the interior of the cranium and intervertebral canal. Though dura mater doesn't stretch much, this fluid container is flexible and allows for CSF pressure changes. When pressure increases, the dural membrane expands, and the bones of the cranium and sacrum move along with it. When pressure decreases, the reverse occurs.
This filling of the craniosacral system is known as flexion, and the emptying is known as extension. During flexion, the head becomes wider transversely and shorter in its anterior-posterior dimension. The whole body externally rotates and widens. After flexion, this motion passes through a neutral zone on its way into extension, during which the head narrows and elongates and the whole body internally rotates.
Under normal circumstances, the craniosacral system proceeds cyclically through flexion and extension at a rate of about six to 12 cycles per minute. We can feel this rhythm at various places on the body because "this whole-body response is probably due to the pumping effect of the cerebrospinal fluid upon the motor system ... which causes a rhythmical tonification and detonification of the myofascial system in response to rhythmically fluctuating nerve signals."2
Tracing the Flow of Cerebrospinal Fluid Through the Craniosacral System
So, we have a hydraulic system that surrounds the brain and spinal cord. To understand how it is semi-closed, we must first understand how CSF enters and leaves the system. Within the ventricles of the brain, you'll find a capillary network - the choroid plexus - that produces CSF. In essence, blood circulating through the choroid plexus is "turned into" CSF, which then enters the craniosacral system.
The choroid plexus has stretch- and compression-sensing receptors within the saggital suture of the cranium. As CSF is added to the craniosacral system and its volume increases, the dural container expands, spreading the bones of the head. The parietal bones then move apart and spread the saggital suture. When this happens, the whole neuromechanism signals the choroid plexus to stop or greatly reduce the production of CSF. As the fluid drains from the system, the dura and cranium shrink and the parietals come together, compressing the saggital suture. The pressure-sensing nerve endings connected to the choroid plexus then send a signal to resume CSF production and the cycle repeats.
Normally, the system seems to operate on a cycle of about six seconds; CSF is produced for about three seconds and then production ceases for about three seconds. This creates the rhythmical rise and fall of fluid pressure within the system.
From the lateral ventricles, CSF enters the third ventricle via the foramina of Monro, then the fourth ventricle via the cerebral aqueduct. The CSF then enters the subarachnoid space and the central canal of the spinal cord via the foramina of Luschka and of Magendie, where it joins the CSF that is already bathing the brain and spinal cord, and all neural tissue enclosed by the dura mater. The fluid then circulates down and around the spinal cord and up and around the brain.
Cerebrospinal fluid passes out of the semi-closed hydraulic system via folds - called arachnoid granulation bodies or arachnoid villae - of the arachnoid layer of the cranial meninges that project through the inner layer of dura mater into the venous sinuses of the brain.3 CSF is reabsorbed into the venous blood through these arachnoid villae, which are primarily in the saggital venous sinous.
Although the rate of reabsorption is fairly constant, it seems to be regulated (think of a car idling) by a cluster of arachnoid granulation bodies found at the anterior end of the straight sinus. From its position at the "crossroads" of the intracranial membranes, this cluster can become aware of any tension within the membrane system and may regulate the outflow of CSF accordingly.
To summarize in a different way, the craniosacral system is like a leaking toilet with the tank cracked into pieces and lined with a giant exam glove (which is the dural membrane). The float-switch in the toilet tank is the saggital suture, which causes an inflow whenever enough water/CSF leaks away down the drain (sinuses).
Generating Whole-Body Effects
The craniosacral system is intimately related to the nervous, musculoskeletal, vascular, lymphatic, endocrine and respiratory systems. Just as abnormalities in the structure or function of any of these systems can influence the craniosacral system, abnormalities in or injuries to the structure or function of the craniosacral system can have profound and deleterious effects on the development or function of the nervous system, especially the brain.4
There are also ways in which the craniosacral system directly influences important, ongoing physiological processes. For instance, the continuing rhythmical movement of the system may serve to "milk" the pituitary gland and affect the neuroendocrine system. The rhythmic motion may also be an important stimulus for the development of the brain. Similarly, the motion around the skull sutures may pump the newly formed red blood cells out of the flat bones of the skull and into the general circulation.5
Of course, any abnormality of the craniosacral system could impact the body or any of its parts through the central nervous system. Any deficiency in circulation of CSF could affect brain and nerve functioning. Any restriction of nerves passing out of the craniosacral system due to restrictions in the cranial sutures or membranes may affect their end organs. Thanks to the Pressurestat Model, we can see why.
Click here for previous articles by John Upledger, DO, OMM.
John Rollinson practices full-time in Northampton, Mass., and at several school clinics in the area. You can contact him at www.rosetrust.org.
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