Osteopathy In The Cranial Field

What Is Osteopathy In The Cranial Field (OCF)?

OCF was developed as an extension to the osteopathic approach. The cranial concept, first put forth by W. G. Sutherland, DO and originally alluded to by A.T. Still, MD, involves the application of Dr. Still's principles of Osteopathy to the head (cranium) and to the tailbone (sacrum). It is based on The Five Components of the Primary Respiratory Mechanism.
The "cranial osteopath" is not preferential to the cranium or the sacrum. Instead he or she includes these areas in an overall evaluation and treatment plan, considering the whole body as one dynamic, integrated unit of function.

What Training Is Required?

The practice of Cranial Osteopathy requires diligent study in applied anatomy, physiology, embryology, and pathology. Some osteopathic schools teach courses of study to their students, though most DOs seek training after they have graduated. It takes hundreds of hours of study and training to understand this field and a minimum of 5 years of training to be certified. Course are taught to qualified individuals only: DOs, MDs, and DMDs. This is necessary due to the extensive medical background needed to understand and apply these concepts. The instruction absolutely requires a minimum of one highly skilled instructor to every 4 students, in order to give proper "hands on" training.
Cranial Osteopaths were originally labeled "quacks" for identifying bones in the skull as being slightly "mobile" and the structures within as treatable. Today, scientists and many MDs, with the benefit of high tech diagnostic equipment, not only concur that cranial motion exists but that it is central to the function of the body.
There are many forms of treatment and therapy that claim to do the same thing as cranial osteopathy, but none can approach it. It is not possible to get the extensive training and close supervision needed to understand this approach to medicine any other way than through an osteopathic education. No other system of manual medicine requires practitioners to apply such detailed clinical knowledge with such a unique perspective. The study is rigorous but the rewards of this are in the results, with profound changes not possible any other way.

The Five Phenomena of the Primary Respiratory Mechanism

When Dr. Sutherland introduced the cranial concept, he drew on his many years of study and clinical practice, to base it on fundamental physiologic principles. He had observed 5 basic phenomena at work in the human body. He called these the five phenomena of the primary respiratory mechanism.
The word "primary" was used as it indicated something that was basic or first. The word "respiratory" referred to metabolism or physiological respiration. The human body was considered a complex "mechanism" (a grouping of parts working together towards a definite action), hence the use of this word.
Though primary respiration has 2 phases, inhalation and exhalation, this is a separate concept from and not to be confused with secondary respiration. Secondary respiration refers to the process that goes on with movement of the rib cage involving a change in volume of the lungs with oxygen and carbon dioxide exchange. Primary respiration is a deeper, more basic process to life.

  • Phenomenon #1

    Inherent motility of the brain and spinal cord.

    The central nervous system (brain and spinal cord) has an inherent rhythmic motion. In the inhalation phase of primary respiration there is a very slight coiling (roughly mimicking its embryological development) with a shortening from top to bottom (decreased cranial to caudal length) of the spinal cord.
    The bones of the head and the CNS become slightly wider (increased transverse diameter) and shorter from front to back (decreased AP diameter). The exhalation phase of primary respiration is just the opposite of this. This is not large, but it is a significant amount of change. Estimates place the change at hundredths of an inch, but it varies according to where it is measured.
    There are cavities and spaces in and around the CNS, and as the brain and spinal cord change shape with the inherent rhythmic motion, the volume of these aforementioned spaces and hence the amount of fluid that they hold will change.
    This type of motion is not limited to man, but is a basic and vital property of any living organism with a nervous system.
  • Phenomenon #2

    The rhythmic fluctuation of the cerebrospinal fluid.

    The cerebrospinal fluid (CSF) fluctuates, or moves back and forth in a relatively closed container, the central nervous system. As the brain and spinal cord change shape and go through their cycle of inhalation and exhalation, the CSF fluctuates back and forth in the spaces in the brain and spinal cord.
    As the brain is constantly producing CSF, the small excess travels out along the channels around the nerves during primary respiration exhalation.
    The CSF has important functions in circulation and nourishment of body tissues.
  • Phenomenon #3

    The motion of the dural membranes.

    The membranes in the head, called dura mater, surround the bones, comprise major veins in the head, and are essentially continuous with the brain. (There are actually 3 layers of membranes or meninges in the CNS which all blend into one another and then into the brain.)
    The dural membranes appear like 3 attached sickles, forming a "tripod" of support for the brain and the skull. They limit and control the slight motion in the bones of the head, and the whole mechanism involving the cranium through the sacrum.
    The membranes surround the spinal cord like a large cylinder and are anchored firmly to the base of the skull and the sacrum thus forming a core link between the 2 structures.
  • Phenomenon #4

    The articular mobility of the bones of the cranium.

    There are 26 bones in the head and they are all in slight rhythmic motion along with the CNS, CSF, membranes, and sacrum. These bones all fit together like the gears of a watch and influence each other.
    The joints in the head or sutures are comprised of connective tissue, nerves, and blood vessels. This is like any other joint in the body and as such is designed for motion.
    It is interesting to note, that a newborn has plates of cartilage enclosed by membrane in the vault (top of the head) and has no real sutures there. It is only later as the child grows and matures that the bones and sutures develop. By age 13 there is moderate suture formation, not being fully developed until after 18 years old.
    Why do these bones eventually form joints rather than fuse into one large, continuous structure? It is due to the fact that the sutures are formed to accommodate motion that is already present. Motion is a basic property of life; the primitive CNS in a developing child in utero has been in motion since before the bones were even formed! So as they were developing, they were in motion. Under normal circumstances, this motion continues until death.
  • Phenomenon #5

    The articular mobility of the sacrum between the ilia.

    Since the dura mater is attached to the base of the skull and the sacrum (tailbone), as previously mentioned, the motion of the cranial mechanism is transmitted to the sacrum. The cranium and the sacrum work together as a unit.
    The primary respiratory mechanism is in constant, rhythmic, cyclical motion. The movement of the brain and spinal cord, CSF, meninges, and bones are all synchronous with each other forming one large integrated unit of function.