By: Dr. Michelle Stanton, DC
In this article, we will cover 3 topics:
Craniosacral Therapy
Specific adjustments of the cranial bones
Lip and tongue ties (TOTs) and their implications
Craniosacral Therapy
This technique addresses the relationship of the Cranium (skull) and the Sacrum (upside down triangle bone at the bottom of the spine), and also the rhythmic pumping of the cerebrospinal fluid (CSF) between the two structures 1. Where the heart’s rhythm is between 60-80 on average, and respiration is 12-16 breaths/min, CSF has it’s own rhythm, pumping at about 11-16x/minute. Good flow is imperative, since CSF has multiple functions:
To act as a cushion for the brain and spinal cord 2
Remove waste products from the central nervous system 2
Deliver nutrition to the nervous tissue 3
As our bodies experience daily stress and micro-traumas (or, after a baby is born – which is a huge stressor on their little bodies), the craniosacral system is often tightened and distorted, leading to tension on the brain and spinal cord. This can lead to a disruption in the CSF flow, compromising the health of the nervous system 1. A practitioner using the craniosacral technique evaluates this tension by feeling for restrictions along the whole system – cranium, spine, sacrum and pelvis. They will also evaluate for any tightness or restrictions in the soft tissues and fascia along those structures, and check the rhythmic flow of the CSF 4. Light mobilizations and soft tissue techniques are then utilized to correct any areas of restriction, therefore restore balance along the craniosacral system and the nervous system.
Note, this technique can be used on patients of all ages, even newborns and infants. In this delicate population, the approximate pressure used is as light as the weight of a nickel.
***While some of these indications would lead to an outside referral, if the disruption is structural in nature, we can work with a patient to correct it.
Cranial Adjustments
Similarly, cranial adjustments can also be performed on patients of all ages, but for the purpose of this article, we will be discussing it from the perspective of adjusting infants. To help create an understanding of the mechanisms, let’s first review some anatomy.
Babies have 6 fontanelles (more commonly known as “soft spots”) on their little baby skulls. These eventually close from 2 months up to 24 months, depending on the fontanelle 5, 6, and they have 2 main purposes 7:
Allow the bones of the baby’s skull to move during passage through the birth canal
Allow for the rapid growth of baby’s head and brain during the first few years of life
Within the skull are also “sutures”, which are where the different bones of the skull connect via fibrous joint. These joints are much looser when we are first born (again, to allow for birth and growth), but then become much tighter into adulthood. 8
When a practitioner evaluates the cranium, they look and feel for bulging or depressions in fontanelles, and for ridging or buckling at the sutures. Ideally, the bones would connect smoothly to one another. Sometimes, however, there is asymmetry in the skull, or a suture is found to be less than smooth, with buckling at the two bones creating a sharp corner. Abnormalities found within the sutures and fontanelles may indicate a malposition of the cranial bones, increased intracranial pressure, dehydration, infections, metabolic or cardiovascular disorders, or other disorders.***
When we can correct disruptions within the cranial bones, the development of the brain and nervous system becomes a much smoother process. It is important to note again: in babies and young children particularly, adjustments to the cranium are very light, since the joints have more pliability and we are working with more delicate tissues and softer bones.
There are visual signs that parents can sometime see themselves (10). Does your baby…
Have one eye that droops lower than the other?
Have an asymmetrical (or uneven) skull?
Have a jaw that juts to one side or the other when they yawn or cry?
Have one cheek or side of the forehead much more prominent than the other?
Turn or tilt their head to one side only, or does their head seem stuck in rotation or a tilt?
All of these may be indications for having your baby checked by a chiropractor or another healthcare professional. Remember, the reason we are evaluating all of this is to enhance baby’s development and overall function. We aren’t just doing this for cosmetic reasons -- some of these findings can have real-life implications and especially catching them while a person is young often leaves them much more simple to correct.
Tethered Oral Tissues (TOTs)
This is a topic that is associated with cranial assesments, but is so big it probably needs to be it’s own blog post eventually to fully do it justice. TOTs are more commonly known as lip, tongue, or buccal ties, and their significance are fortunately being recognized much more in recent years. While other practitioners (such as lactation consultants, midwives, and certain dentists) are commonly more experienced in evaluating for TOTs and their severity, it is something that can be observed during a chiropractor’s cranial examinations.
Ties can often lead to painful nursing, baby not feeding well or enough, popping off the breast, persistent fussiness, or failure to thrive (often because they aren’t getting enough to eat). Effects later in life can include negative dental effects and infections, chronic headaches, joint pain, jaw problems, chronic health issues, on and on 12. If a parent or individual elects to have these ties revised, it can be done with a cut via scissors or laser revision. There is substantial follow up for the parents to do with their child to ensure the wound heals properly and the tie doesn’t reattach.
It is important to evaluate for ties because if we see the body is a ship, then the tongue acts as it’s rudder (not only as described in James chapter 3 for my bible readers out there, but also physically) 11. It is the tongue that helps shape the palette (top of the inside of the mouth) in early life, so when the tongue is tied down and unable to move and spread properly, the hard palette is unable to form correctly. The tongue is also the beginning of the fascial planes that span our entire body. Fascia is like ceran wrap over multiple muscle groups. Fascia runs from head (including tongue) to feet, and some fascial planes cross the midline of the body – so they go from top right to bottom left, and vice versa 13. Beyond cranial adjustments, there are also fascial releases to help support this system, whether or not a person decides to have any existing ties releases.
Implications and what causes TOTs are important topics, but for now I will say that parents should be aware of the possibility of ties and what they may indicate.
https://www.nih.gov/news-events/nih-research-matters/how-sleep-clears-brain
https://exploringyourmind.com/cerebrospinal-fluid-central-nervous-system/
https://my.clevelandclinic.org/health/treatments/17677-craniosacral-therapy/procedure-details
Moses, Andrea (2020, July 18). Introduction to Cranial Adjusting Presented virtually through Pediatric Bootcamp: Virtual Examination, Cranial Adjusting, & Implementation.
Matousek, S. (2020, July 18). Introduction to Cranial Adjusting Presented virtually through Pediatric Bootcamp: Virtual Examination, Cranial Adjusting, & Implementation.
https://fasciaguide.com/treatment/fascia-lines-the-intersections-of-the-body/