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The Craniosacral Approach to Essential Health

by Michael Kern(more info)

listed in craniosacral therapy, originally published in issue 76 - May 2002

"Worms will not eat living wood where the vital sap is flowing; rust will not hinder the opening of a gate when the hinges are used each day.
Movement gives health and life. Stagnation brings disease and death."
 Proverb in traditional Chinese medicine


Intrinsic in each of us is a remarkable ability for self-regulation and healing. This is one of the fundamental tenets of osteopathy, outlined by its founder, Dr Andrew Taylor Still. In the practice of craniosacral therapy, a gentle yet powerful approach that has developed from the roots of osteopathy, it is recognized that our self-healing forces are carried in a series of subtle rhythms which permeate the body. These rhythms express what is referred to as 'primary respiratory motion', because they underlie and are more fundamental than all the other rhythms of the body (such as heart beat and lung breathing). Primary respiratory motion is considered to be produced by our intrinsic life force, which was called the 'Breath of Life' by Dr William Sutherland who developed this approach.

Palpating primary respiratory motion from the sphednoid bone and occiput
Palpating primary respiratory motion from the
sphednoid bone and occiput

Tissue Breathing

From an early stage of his investigations, Dr Sutherland understood that he was exploring an involuntary system of 'breathing' in tissues, important for the maintenance of their health. At a fundamental level, it is this property to express motion that distinguishes living tissues from those that are dead. Dr Sutherland perceived that all cells of the body need to express a rhythmic breathing in order for them to function to their optimal ability. This rhythmic activity produced by the Breath of Life vitalizes cells and tissues, maintaining the numerous physiological functions necessary for their survival. Dr Sutherland also discovered that manual palpation of this subtle motion provides a wealth of clinical information. The balanced manifestation of these rhythms in the body denotes the effective distribution of the Breath of Life and is indicative of healthy function. Significantly, many different symptoms and pathologies that involve both body and mind are related to disturbances of primary respiratory motion.

This brings us to two basic tenets of craniosacral work:

  • Life expresses itself as motion;
  • There is a clear relationship between motion and health.

Primary Respiratory Motion

As the Breath of Life is expressed in the body, a series of tide-like rhythms are generated. From the core of our being there is a succession of rhythms that emerge, creating a whole system of primary respiratory motion.

Each tidal rhythm is marked by two phases of motion (see Figure 1):

Figure 1. Primary inhalation (left) and exhalation (right)
Figure 1. Primary inhalation (left) and exhalation (right)


1. A 'breathing in', often referred to as 'inhalation' - marked by a subtle rising of tissues and fluids towards the top of the body and a widening from side to side;
2. A 'breathing out', often referred to as 'exhalation' - marked by a subtle receding of tissues and fluids towards the lower part of the body and a narrowing from side to side.

An inhalation phase followed by an exhalation phase constitutes one rhythmic cycle.

The 'Three Tides'

At least three subtle rhythms have been identified, each having a different rate, producing rhythms within rhythms (see Figure 2):

1. The cranial rhythmic impulse (CRI): the outermost rhythm produced by the Breath of Life, occurring at an average rate of between 8-12 cycles per minute. It is expressed as a minute rocking motion of all the fluids, bones, membranes and tissues of the body. Individual structures of the body behave like boats gently rocked on the surface of the ocean. The CRI has been scientifically measured in numerous research experiments;[1-3]

2. The mid-tide: a tidal rhythm expressed at a slower rate of approximately 2.5 cycles per minute.[4-6] A deeper motion, considered to be the driving force that underlies the CRI. Carries the available bio-energy or 'biodynamic potency' of the Breath of Life, which is expressed in the fluids of the body, bringing vitality and integration wherever it manifests. The mid-tide is expressed as a subtle inner breathing involving tissues, fluids and potency which all move together as 'one thing';

3. The long tide: the first stirring of the Breath of Life as it emerges from the very ground of our being. A deep and slow rhythmic impulse expressed at a rate of about once every 100 seconds. It has a light and airy quality as it permeates the body as our most essential life breath. Sometimes experienced as a shimmering or a subtle electrical wind.

Primary Respiratory Mechanism

While primary respiratory motion is a whole-body phenomenon, there is a system of interrelated tissues and fluids at the core of the body which plays an important role in expressing and disseminating these subtle rhythms. This interconnecting system is comprised of cerebrospinal fluid, the central nervous system, the dural membranes which surround the central nervous system, the cranial bones and the sacrum. These five core aspects are sometimes referred to as the 'primary respiratory mechanism' or 'craniosacral system' (see Figure 3). The subtle physiological motion of these five aspects is considered to have important consequences for the whole body, as many pathologies can be traced back to some disturbance in their function.

Essential Blueprint

Dr Sutherland perceived that the Breath of Life carries a basic Intelligence (which he spelt with a capital 'I') that is beyond the relatively meagre intelligence of our human ideas and concepts.[7] This 'Intelligence' has been described by osteopath Dr James Jealous as possessing an essential blueprint for health referred to as an 'original matrix'.[8] This is a deep and unwavering ordering principle intrinsically distributed around the body in the tidal rhythms of primary respiratory motion.

Our original matrix is present at the very beginning of life as the cells of the embryo differentiate to form a human being according to a precise and primary design.[9] According to pioneering embryologists Blechschmidt and Gasser, there are no genetic mechanisms capable of promoting such organized development at this very early stage.[10] They concluded that there must be an ordering principle operating through the fluids of the developing embryo that carries out this function. Significantly, this is the same conclusion that Dr Sutherland came to when considering the role that fluids play in carrying the Breath of Life. The rhythms of the Breath of Life continuously deliver this ordering principle into the fluids of the body, with cerebrospinal fluid (the 'sap in the tree') playing a particularly important role in this process. Nevertheless, as all living cells contain fluid, each cell of the body becomes thus imbued. Therefore, the various tissue and fluid systems of the body not only form around this essential blueprint, but are also maintained by it until the time of death. As long as there is life, this ordering principle is never lost.[11] Leading craniosacral therapist, Franklyn Sills, writes, "In healing work this is a critical point to understand. No matter how desperate the situation, the information of the whole, its inherent ordering principle, or blueprint, is still available in each part. The blueprint of health is thus present in each part and is still available if it can be accessed."[12]

Patterns and Fulcrums

At a deep level, all our self-healing and self-regulating capabilities are driven by the available potency of the Breath of Life. However, the capacity of this potency to dissipate stressful experiences or trauma (i.e. physical, psychological, toxic or genetic) can become overwhelmed. It may be impossible for us to then return to our natural way of functioning. In this case, the next best thing happens; these stressful forces become localized in the body to limit any damage that may be caused. In this way, focal points of inertia are created, and the body compensates. However, these 'inertial fulcrums' become places where the Breath of Life is unable to find full expression in the tissues, and are therefore sites where our essential ordering principle is unable to manifest. This is considered to be the very origin of disease and pathology.

Cranial Working

Working with the Wisdom

Modern medicine's obsession to fight disease and eliminate its symptoms, without considering its origins, reveals a basic mistrust of the intelligence of the body. However, in a holistic understanding, every disease process can be seen as the most intelligent way the body is able to organize according to prevailing circumstances. The emphasis of the craniosacral approach to treatment is to support the health that is always present, rather than fighting the disease. Our most fundamental resource of health is the potency of the Breath of Life. If this intrinsic resource can be accessed and supported, then more wholesome and efficient expressions of wellness can emerge.

Craniosacral treatment works with the physiology of the body, not against it. The intelligence of symptoms is acknowledged, as well as the intelligence of the body's attempts to deal with them. However, in order to appreciate this wisdom, we have to be prepared to listen to what the body is saying. Instead of fighting the body, we may need to hold some peace talks!

Creating the Conditions

The movement towards integration and health is a natural tendency, an ever-present and powerful force. However, the path to health necessitates developing the right conditions. For example, a cut finger doesn't have to be told how to heal, but it does need to be kept clean and protected.

The essential aim of craniosacral treatment is to facilitate the expression of primary respiratory motion in tissues that have become inertial, fragmented and disordered. Dr Sutherland realized that the intrinsic forces within the patient's own body can be utilized, rather than having to apply any external force.[13] Therefore, treatment is always very gentle and non-invasive. One of the key approaches in this process is to seek the optimal alignment at which the patient's own intrinsic forces can come back into play and naturally dissipate any stressful forces that have become trapped in the body. The practitioner can gently facilitate (through his or her hands) the best possible conditions for this to happen.

Accessing 'States of Balance'

Finding this optimal alignment is described as accessing a 'state of balance'. In this state, there is a balancing of any forces and tensions gathered around a site of inertia. When this occurs, there is a local settling and stillness that can happen in the patterns of primary respiratory motion. It is at this point that there is the least possible resistance in the tissues, and a minimal amount of 'push and pull'. This neutral position is unique for each strain pattern in the body. If you imagine a circular see-saw with children sitting all around it, this is the point where the weight of all the children is evenly distributed around the central fulcrum point.[14] Once there is no force or tension being exerted in one direction or another, a settling of tissue and fluid motion occurs and the self-healing forces of the body can most easily come into play.


Using their hands, the practitioner can introduce subtle suggestions of settling into the tissues and fluids around a site of inertia. Once a settling occurs and the 'state of balance' is reached, the practitioner need only wait for the intrinsic forces of the patient's own physiology to get to work. This is marked by the mobilization of any forces that have become trapped at the inertial fulcrum. This may first be felt as a bubbling, followed by tissues starting to breathe openly as primary respiratory motion is restored. During this process, old memories or emotions may come to the surface as any trapped forces that relate to the original stress or trauma are dissipated. Consequently, our essential blueprint for health is able to find expression. One patient described this experience as, "Now, this is the way I'm supposed to be!" One young boy described how he could feel his face literally changing shape as his birth trauma started to resolve. "It's just like in the film The Mask!" he exclaimed.[15]

Inherent Treatment Plan

Each condition with each patient has its own unique way of wanting to resolve its inertia. If the way the body naturally attempts to seek balance is identified, this process can simply be supported by the practitioner's contact and presence. The practitioner need only follow the intelligent process being led by their patient's own physiology. In order to do this, we may have to let go of our concepts and projections about what we think should happen. Only then can this deeper intelligence be appreciated. Our natural priorities for healing, known as the 'inherent treatment plan', manifest as focal areas of activity within the patterns of primary respiratory motion. It may seem uncanny, but the natural wisdom in the body unfailingly knows what it needs next to find optimal balance.

It sometimes takes many minutes of 'neutral listening' before the inherent treatment plan is revealed. This needs to be an open, fluid and dynamic process, because it works with the way in which the Breath of Life unfolds as a living expression. The wisdom in the body is always leading us. In this approach, the patient is looked at from the inside-out rather than from the outside-in.[16]  an outsider looking in, it's usually more difficult to know what needs to happen, but as an insider looking out, it's easier to follow the natural priorities of treatment as they unfold. On following this principle, Dr Jealous states, "We use our hands diagnostically, perceptually, and therapeutically – that's how simple and profound this is. We are not listening for symptoms but for a pre-established priority set in motion by the health of the patient."[17]

Order of Healing

Following the inherent treatment plan is, actually, the easiest possible way that a particular stress pattern can resolve, but it doesn't necessarily mean that the sites of pain or current symptoms are the first places to be worked with.[18] To give an illustration, let's say that someone comes for treatment of lower back pain. The practitioner may make contact at the lower back to 'tune in' to what is happening there, but as they widen their field of perception they may become aware of patterns in other areas of the body.

For example, there may be a gathering of inertial forces in the diaphragm and a contraction of tissues in that area. After a 'state of balance' is facilitated in this pattern, some tissue activity may then start up in the neck. Placing attention there, fast tremors may start to manifest, indicating that there is some held-in shock dissipating from the tissues, perhaps from an old injury. When that has ceased, the whole upper spine may be able to reorganize and readjust. Finally, and perhaps only then, something may be ready to resolve at the lower back. The point is that the practitioner could not have known in advance the order in which these things needed to occur. The treatment plan was only revealed by following the priorities and intelligence of the patient's own primary respiratory system.[19]


1. Frymann VM. A study of the rhythmic motions of the living cranium. JAOA. 70: 928-45. May 1971.
Reprinted in Feely Richard (ed.). Clinical Cranial Osteopathy. The Cranial Academy. YEAR?
2. Tettambel M, Cicora A and Lay E. Recording of the cranial rhythmic impulse. JAOA. 78: 149. October 1978.
Reprinted in Feely Richard (ed.). Clinical Cranial Osteopathy. The Cranial Academy. YEAR?
3. Upledger JE and Karni Z. Mechanical electric patterns during craniosacral osteopathic diagnosis and treatment. JAOA. 78: 782-91. 1979.
4. Sills F. Craniosacral Biodynamics. Draft version. North Atlantic Books. 2001.
5. Becker R. Life in Motion. Rudra Press. p124. 1997.
6. Jealous J. Around the edges. The Tide. The Sutherland Society. Spring 1996.
7. Sutherland WG. Teachings in the Science of Osteopathy. Rudra Press. p14. 1991.
8. Jealous J. ibid.
9. Sills F. ibid.
10. Blechschmidt E. and Gasser R. Biokinetics and Biodynamics of Human Differentiation. Charles C Thomas. Springfield, IL. pxiii. 1978.
11. Jealous J. Healing and the Natural World. Alternative Therapies. 3(1). January 1997.
12. Sills F. ibid.
13. Sutherland WG. ibid. pxii.
14. Sills F. ibid.
15. Perrow C. Personal communication.
16. Sills F. Lecture on the Tides. Unpublished. June 1998.
17. Jealous J. Healing and the Natural World. ibid.
18. Sills F. Lecture on the Tides. ibid.
19. Sills F. Craniosacral Biodynamics. ibid.

Further Information

For details of introductory weekends and practitioner training in craniosacral therapy contact: Craniosacral Therapy Educational Trust, 78 York Street, London W1H 1DP; Tel/Fax: 07000-785778;


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About Michael Kern

Michael Kern is a craniosacral therapist, osteopath and naturopath with a practice in London. He is co-founder of the Craniosacral Therapy Educational Trust, senior tutor for the College of Osteopaths, the International Cranial Association and the University of Westminster. He also teaches craniosacral therapy courses in the USA, Switzerland and Italy, and is author of Wisdom in the Body - The Craniosacral Approach to Essential Health (Thorsons, ISBN 0-7225-3708-5, 2001).


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