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Compensatory Relationships

CranioSomaticsTM: compensatory relationships
By G. Dallas Hancock, DC, MS, LMT, & Flo Barber, LMT

This article was published in the AMTA Florida Journal, Spring 2000, #13; 8-9

In presenting talks on cranial techniques at various organizations, we generally ask for a show of hands on how many therapists have studied craniosacral procedures and how many actually use craniosacral procedures. The first question generally results in a much larger count than the second. Inquiry into the reasons why trained craniosacral therapists are not using the procedures frequently elicits concerns about their lack of ability to demonstrate, either to themselves or to the client, causal relationships between restrictions in the craniosacral mechanism (which the client often can not feel), and the somatic dysfunctions they do feel. Some therapists feel that this creates a credibility gap between themselves and the client and/or the referring physician. There appears to be a need for an ‘objective’ and integrated approach to the evaluation and treatment of cranial ‘lesions’ (distortions) that recognizes and utilizes the relationships between cranial and somatic components.
Sutural restrictions can generally be correlated with patterns of altered function of muscles, fascia, and joints elsewhere in the body. For example, a practitioner knowledgeable in craniosomatic principles should be able to identify the specific sutural restrictions related to a shoulder dysfunction or, conversely, the muscle, joint, and fascial involvements created by a restriction in the nasomaxillary suture. We coined the term ‘craniosomatic’ in 1996 to express this concept of the very extensive and predictable relationships that exist between the cranial sutures and specific muscles and joints throughout the body.

These interrelationships present potential problems relative to identifying the primary cause of presenting symptoms, and validating treatment outcomes. For instance, if identified craniosacral restrictions are released, and these restrictions were only secondary (compensatory) to dysfunctional muscles, fascia, or joints elsewhere in the body, the restrictions may recur on weight bearing or walking. But, how many therapists ‘road test’ their patients and then reevaluate them to find out if the restrictions have recurred? How many practitioners test muscle function before and after treatment? Although functional muscle testing was developed in 1912 by Robert Lovett, M.D., to evaluate neurological damage in polio patients, its use to identify functional weaknesses in compensation patterns is an effective pre- and post- treatment assessment procedure. Whatever the evaluation methodology – and it is preferable to confirm findings using more than one method – post-testing is essential after the client has been weight bearing and has walked a short distance.

Many therapists are not aware of numerous types of compensation patterns that adversely affect treatment and the evaluation process. Some of these patterns are related to weight bearing, some occur with normal joint movement, and others occur as part of repetitive motion disorders, but all affect the craniosacral mechanism and the musculoskeletal system. Regardless of the cause, each cranial SBS pattern (torsion, sidebend, etc.) will present as a unique full-body compensation pattern. The symptoms are specific to the SBS pattern and include alterations in the function of the cranial mechanism, eye movements and TMJ, and specific patterns of hyper- and hypotonic muscle function. Various other soft tissue involvements may also be identified. Several categories of other compensatory patterns are presented here.

The first category consists of specific postural compensation patterns that are universally present in the patient population. These patterns, which I have named Primary Distortion PatternsTM, are present at birth (inborn). They can be confirmed by functional muscle testing, palpation, etc. Although they can be temporarily released by typical cranial techniques while the patient is supine, these Primary Distortion Patterns (cranial restrictions, postural distortions and functional muscle weaknesses) will immediately return on weight bearing. However, these Primary Patterns can be permanently eliminated at any age, using CranioStructural IntegrationTM techniques, which we have developed and teach. It is not known if these corrections are sutural, muscular, fascial, membranous, ligamentous, or reflexive in nature, but the benefits are very long-term or permanent.

A second category of compensation patterns involves the facilitation/inhibition reflex patterns associated with flexion and extension of most major joints. For example, if the client flexes the wrist, elbow or ankle, the antagonist muscles (the extensors) will be weakened on the same side. This temporary compensation may affect the entire body, including cranial sutures, and generally lasts up to 20 seconds (but sometimes longer).

A third category of compensation patterns appears to be associated with facilitated neurological pathways resulting from trauma or intense repetitive motion. These compensation patterns may be reflexive in nature, and can last for extended periods, producing self-perpetuating patterns of hypertonicity. They can involve virtually any joint, and may predispose tissue to injury. These facilitated patterns are often associated with chronic and/or acute pain patterns, such as trigger points, carpal-tunnel syndrome, tennis elbow, etc. These patterns of pain and dysfunction can be eliminated by Facilitated Pathway TherapyTM, a new treatment modality developed by Flo Barber, LMT.

A fourth category of compensations that definitely should be understood is the correlations between posture and dental occlusion. Postural changes involve the muscles of mastication, anterior neck flexors, SCM, and other muscles. These changes also affect the sphenoid and temporal bones, directly influencing the position and function of the maxillae and mandible. Conversely, alterations in occlusion immediately affect the position and function of the sphenoid and temporal bones, resulting in alterations to the craniosacral mechanism and posture. Ask a patient who doesn’t wear dentures, and is missing the molars on either side, to bring his teeth together normally and bite. Observe the cranial and postural compensations that occur. There are obvious benefits to be gained by coordinating dental orthodontic procedures with cranial interventions, a fact that should be more widely recognized.

Regardless of how evaluation is done, the effectiveness and longevity of treatment results can be affected by a number of factors. Although we as therapists have limited influence over environmental factors that come into play after the patient leaves our office, we need to be aware of the factors that we can monitor and influence within our clinic setting. All of the compensation patterns discussed above affect craniosacral and somatic functions. If the underlying causes of these compensations and dysfunctions are not addressed, the patient may feel improvement at the end of the therapy session, only to have many of the symptoms recur in a relatively short time after treatment. Effective post-treatment evaluation can help provide the information necessary to identify remaining symptoms and offer the practitioner the opportunity to address causative factors that remain.

The goal of the therapist should be to assist each client in reaching optimum health. This is clearly an ambitious goal. It requires treating more than just the craniosacral mechanism; it requires treating the body holistically. CranioSomatic Therapy is a holistic approach. In our practice we address the cranial and musculoskeletal systems as a single entity. We treat and eliminate – insofar as possible – each of the categories of compensation patterns discussed above, and more. We evaluate and educate our patients on other environmental factors – such as shoes, glasses, fragrances, seating, work stations, constricting clothes, etc. – on an ongoing basis, to assist them in moving towards optimum health.

Pre- and post-treatment evaluations should be tools that assist a practitioner in providing more precise treatment. Awareness of the variety of compensatory patterns that affect both therapy and evaluation is one more step towards effective therapy that achieves treatment objectives.