resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
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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