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“Craniosacral Approach to the Cardiovascular Physiology: Characteristics, Mechanism and Therapeutic Perspectives.”

tratto da

 http://www.ghrnet.org/index.php/jct/article/view/861/963

una ricerca a cura di

Massimo Armeni, Institute for Craniosacral Therapies, Norma, Italy

Veronica Bravi, Still Osteopathic Institute, Rome, Italy

Stefania D’Emidio, Department of Neurosciences, Physical Medicine

and Neurorehabilitation Operative Unit, San Filippo Neri Hospital – Salus Infirmorum Clinic, Rome, Italy

Massimo Leggio, Department of Cardiovascular, Cardiac Rehabilitation

Operative Unit, San Filippo Neri Hospital – Salus Infirmorum Clinic, Rome, Italy

scarica il .pdf della ricerca

armeni TCS1

ABSTRACT

Although there are dissenting opinions, the “classic” craniosacral

therapy has gained a role in the management and treatment of

clinical problems for which the traditional therapeutic strategies led

to fluctuating results. Similarly, the biodynamic craniosacral therapy

perspective, which involves the intrinsic healing power of the life

breath, has been emphasised. Hemodynamic and cardiopulmonary

parameters are above all influenced by the heart and brain centres,

besides peripheral resistance. Considering the small number of

scientific studies on this topic existing in literature, we focused on the

anatomical aspects and neurophysiological or vascular connections

that can be influenced by craniosacral therapy, aiming to investigate

the potential effects on cardiovascular physiology through anatomic

links. As far as the spinal neurophysiological complex is concerned,

the nervous system preganglionic neurons are located in a cell

column in the intermediate area of the lateral horn of the spinal cord;

this area is called the intermediolateral cell column. The important

vascular effects mediated by the sympathetic chain neurons are only

TOPIC HIGHLIGHT

Craniosacral Approach to the Cardiovascular Physiology:

Characteristics, Mechanism and Therapeutic Perspectives

Massimo Armeni, Veronica Bravi, Stefania D’Emidio, Massimo Leggio

165

Journal of Cardiol Ther 2014 October 10 1(8): 165-168

ISSN 2309-6861(print), ISSN 2312-122X(online)

Online Submissions: http://www.ghrnet.org/index./jct/

doi:10.6051/j.issn.2309-6861.2014.01.52

© 2014 ACT. All rights reserved.

Journal of Cardiology and Therapy

ipsilateral. The right and left columns have different effects on the

heart: the right primarily innervates the sinoatrial node, and the left

innervates the atrioventricular node; therefore, an increase in the

parasympathicotonia and vagal hypertonia induced by biodynamic

craniosacral therapy at the superior centres and the suprasegmental

nuclei level can directly lead to a reduction in the frequency of firing

of sinoatrial and atrioventricular nodes, modifying the hemodynamic

and ventilatory parameters. Even if further in-depth studies are

necessary to confirm our hypothesis and experiences, this therapeutic

perspective could potentially provide a robust tool to approach the

cardiovascular patophysiology.

© 2014 ACT. All rights reserved.

Key words: Craniosacral approach; Cardiovascular physiology; Autonomic

nervous system; Complementary medicine; Clinical benefit

Armeni M, Bravi V, D’Emidio S, Leggio M. Craniosacral Approach

to the Cardiovascular Physiology: Characteristics, Mechanism and

Therapeutic Perspectives. Journal of Cardiology and Therapy 2014;

1(8): 165-168 Available from: URL: http://www.ghrnet.org/index.

php/jct/article/view/861

INTRODUCTION

Although there are dissenting opinions[1-11], the “classic” craniosacral

therapy (CST) has gained a role in the management and treatment

of clinical problems for which the traditional therapeutic strategies

led to fluctuating results. Similarly, the biodynamic CST perspective,

which involves the intrinsic healing power of the life breath, has been

emphasised.

Few recent scientific studies have been conducted to explore the

effects of CST on specific parameters concerning physical exercise,

although the literature includes publications on the effects of the

classic CST, which are sometimes discordant for several clinical

problems[12-17]. However, the craniosacral system is the most intimate

in the human body and it is there that we should focus our attention

Armeni M et al. Craniosacral Cardiovascular Approach

© 2014 ACT. All rights reserved. 166

in the aim to provide the resources for an healthy body.

The craniosacral system (CSS) is defined as a recognised,

functioning physiological system, including the membranes and

cerebrospinal fluid surrounding the spinal cord and brain, the bones to

which these membranes attach and connective tissue related to these

membranes. It is intimately related to and influenced by the nervous,

musculoskeletal, vascular, lymphatic, endocrine and respiratory

system of the body. The CSS is characterised by rhythmic, mobile

activity, being distinctively different from the physiological motions

related to breathing and cardiovascular activity[18].

An important component of craniosacral mobility is referred to

as the primary respiratory mechanism, which manifests as palpable

motion of the cranial bones, sacrum, dural membranes, central

nervous system and cerebrospinal fluid (CSF)[19].

On the basis of their palpatory ability, the goal of the therapist

is to identify the mechanism that needs treatment: fluids, fasciae,

membranes, sutures or bones, the five primary constituents of the

primary respiratory system.

THE PARASYMPATHETIC NERVOUS SYSTEM

The parasympathetic nervous system (PSNS) is divided into two

sections: the cranial and sacral components[20-22].

The cranial component consists of the following structures: (1)

The vegetative nuclei of the brainstem; (2) The autonomic fibres that

connect these nuclei to the cranial nerves; (3) The papillary nucleus

of the cranial nerve (III); (4) Tears, the nasal mucus and its cranial

nerve (VII); (5) The superior salivatory nucleus and its cranial nerve

(VII); (6) The inferior salivatory nucleus and its cranial nerve (IX);

(7) The masticatory nucleus, its cranial nerve (V) and the fibres that

connect it to face, conjunctiva and buccal mucosa; (8) The cardiopneumo-

digestive nucleus and its cranial nerve (X).

The sacral component is a vegetative, sensory and motor centre

derived from segments S2-S4 and innervates the sigmoid colon,

rectum, urogenital system, urinary bladder, kidneys, sexual organs

and external genitalia via the pelvic nerve[20-22].

Unlike the sympathetic nervous system (SNS), the PSNS does not

have a monosynaptic connection to the adrenal medulla, which is an

important aspect from the physiological viewpoint[20-22].

Hemodynamic and cardiopulmonary parameters are above

all influenced by the heart and brain centres, besides peripheral

resistance. Considering the small number of scientific studies on this

topic existing in literature, we focused on the anatomical aspects and

neurophysiological or vascular connections that can be influenced by

CST[20-22].

Hypothetically, the neuroanatomical links can modify some

hemodynamic and ventilatory parameters, at rest and/or during

exercise, such as heart rate and heart rate recovery prognostic

index[23-31].

ANATOMY

In the heart, the sinus node artery perfuses the sinoatrial node (SAN),

positioned on the wall of the right atrium, and 80% of this blood

comes from the right coronary artery while 20% comes from the

circumflex artery. The right vagus nerve and the sympathetic system

innervate this node. The atrioventricular node (AVN) is positioned near

the opening of the coronary sinus, between the mitral annulus and the

medial margin of the tricuspid valve; here the perfusion comes from

the fibrous septum branch of the right coronary artery. The bundle of

His is a direct continuation of the atrioventricular node and descends

to the left side of the superior margin of the interventricular septum

(SIV); the bundle has dual blood supply, partially from the AVN

artery and the descending anterior (DA) coronary artery (first septal

perforator branch)[20-22].

Both the right and the left branches originate from the bundle of

His. The right branch continues along the right side of the IVS under

the endocardium and is supplied by both the right coronary and the

DA coronary arteries. The left branch is positioned on the left side

of the SIV in the sub-endocardial layer, from which anterior superior

and posterior inferior fascicles originate. These branches end in very

thin Purkinje fibers[20-22].

As far as the spinal neurophysiological complex is concerned, the

nervous system preganglionic neurons are located in a cell column

in the intermediate area of the lateral horn of the spinal cord; this

area is called the intermediolateral cell column (IML). The column

seamlessly spreads from the midbrain to the sacral spine, although

the autonomic nervous system innervation arises from the sacral

spine corresponding to the T1–L2 segments. The IML sends impulses

only ipsilaterally and is inhibited by the brainstem structures that

are stimulated by ipsilateral cortex and cerebellum; the brain can

be stimulated in order to increase the IML inhibition, and generally

augment the afferent bombardment from the contralateral side.

Arteriolar vasoconstriction, capillary dilatation, piloerection and

perspiration, which occur at the segment level, are the principal

systemic effects of the IML[20-22].

The important vascular effects mediated by the sympathetic chain

neurons are only ipsilateral. The right and left columns have different

effects on the heart: the right IML primarily innervates the SAN and

the left IML innervates the AVN. This last anatomical clarification is

very important in considering the potential direct connection between

the CSS and the origin of cardiac impulses; therefore, an increase in

the parasympathicotonia and vagal hypertonia induced by biodynamic

CST at the superior centres and the suprasegmental nuclei level can

directly lead to a reduction in the frequency of firing (FOF) of SAN

and AVN, modifying the hemodynamic parameters[20-22].

As well known, craniosacral injuries and injuries of the vertebral

axis with interference on the paravertebral ganglionic chain,

originating at the superior dorsal rib level, are physiological injuries

that have a direct perturbatory influence on the autonomic nervous

system (parasympathicotonia or orthosympathicotonia) and vascular

system[20-22].

SEARCH STRATEGY FOR IDENTIFICATION

OF STUDIES

Computerised searching of the following literature databases was

performed: PubMed, Cochrane library. The following clinical

keywords were used to search for the intervention of interest:

“craniosacral therapy, heart rate, heart rate recovery, autonomic

nervous system and cardiovascular physiology”. Candidate articles

were then screened for possible inclusion in this review. Table 1

summarizes some of the studies and their main findings.

BIODYNAMIC CRANIOSACRAL THERAPEUTIC

APPROACH

CST is a non-invasive method, derived from osteopathy, developed

in the 1970s by J. Upledger, MD[32]. It is based on the assumption

that there is a fine rhythmic movement, which pervades the body

and can be discerned by practised therapists under their palpating

hands. This movement can be utilised for diagnostic as well as

therapeutic purposes by regulating the flow of cerebrospinal fluid[33].

167 © 2014 ACT. All rights reserved.

Armeni M et al. Craniosacral Cardiovascular Approach

The focus of craniosacral examination and treatment lies on the

craniosacral structures; these include the bones and connective

tissues (membranes of the brain and spinal cord) of the skull

and spine and the cerebrospinal fluid. Anatomically surrounding

and physiologically sustaining the central nervous system, these

structures have a direct influence on functioning of the autonomic

nervous system[33]. The effects which can be brought about through

CST are achieved through gentle touch in the areas of the skull, face,

spine and pelvis[33]. Treatment is not primarily aimed at symptoms,

but determined by priorities established by the therapist during each

patient examination[33].

CST is mostly applied by trained craniosacral therapists but can

also be performed by osteopaths and other healthcare practitioners

who have undergone the appropriate training. CST is commonly

described as an alternative treatment approach, applying a gentle

manual force to address somatic dysfunctions of the head and the

remainder of the body. The interplay of diagnosis and treatment

is aimed at mobilising the cranial sutures which are abnormally

restricted to physiologic motion. Restrictions in the craniosacral

system are manually identified which include the bones, membranes

and CSF that surround the brain and spinal cord[34].

Focusing the attention on the treatment, all the subjects

experienced a state of rest and relaxation; for biodynamic CST, the

practitioner should have a great deal of tactile experience in injury

normalization.

Accordingly to the existing literature concerning the effect of the

classic CST on several central and cardiopulmonary diseases[1-16] and

the evidence-based medicine derived from these studies as well as

the anatomical and neurophysiologic links previously described, we

focus mainly on the following key points in a complete session cycle

of treatments: (1) Lateral venous sinuses; (2) Torcular heurophili; (3)

Cavernous sinus; (4) Sagittal sinus; (5) O/M horizontal and vertical

arms; (6) Third ventricle; (7) Fourth ventricle; (8) Lateral ventricles.

In particular, the third, fourth, fifth, sixth, seventh, ninth, tenth,

eleventh and twelfth cranial nerve nuclei lie on the fourth ventricle;

the SAN is substantially innervated by the ninth cranial nerve.

Considering that the intracranial circulation flows via the jugular

foramen, we assume that a method focused on the occipito-mastoid

suture release and petro-basilar articulation can relieve the nerve

and the big vessels in order to achieve the correct neurophysiology.

Similarly, the fourth ventricular filling and emptying in still point

techniques have a direct impact on the liquid homeostasis and

nourishment of the aforementioned nuclei, possibly improving

nerve impulses and, consequently, the hemodynamic and ventilatory

parameters.

Table 1 Main studies exploring the reliability of craniosacral therapy and

the effects on autonomic nervous system.

Authors, year

Green C

et al 1999[5]

Hanten WP

et al 1998[7]

Cutler MJ

et al 2005[10]

Wirth-Pattullo

V et al 1994[12]

Main conclusions

This systematic review found insufficient evidence to

support craniosacral therapy.

The results indicated that a subject’s craniosacral

rhythm is not related to the heart or respiratory rates of

the subject or the examiner.

The current study is the first to demonstrate that cranial

manipulation, specifically the CV4 technique, can alter

sleep latency and directly measured muscle sympathetic

nerve activity in healthy humans. These findings

provide important insight into the possible physiologic

effects of cranial manipulation.

Measurements of craniosacral motion did not appear

to be related to measurements of heart and respiratory

rates, and therapists were not able to measure it reliably.

PERSPECTIVES AND CONCLUSION

Finally, we can surely assert that this treatment can cause

parasympathicotonia and reduced orthosympathicotonia with direct

effects on the IML, together with possible vagal hypertonia; this

could directly reduce the FOF of SAN and AVN, peripheral vascular

resistance and ventilatory parameters, allowing a related heart rate

and heart rate recovery decrease. Even if further in-depth studies are

necessary to confirm our hypothesis and experiences, this therapeutic

perspective could potentially provide a robust tool to approach the

cardiovascular patophysiology.

CONFLICT OF INTERESTS

There are no conflicts of interest with regard to the present study.

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Peer reviewer: Liang-Miin Tsai, Professor of Medicine, Department

of Internal Medicine, National Cheng Kung University Hospital,

138 Sheng Li Road, Tainan 70428, Taiwan.