Craniopathic Correction

Craniopathy is the study of the musculoskeletal system of the skull and its relationship to cerebrospinal fluid (CSF) flow in the brain and cord. The basic theory behind craniopathy is called the craniosacral primary respiratory rhythm. According to this theory there is a fundamental rhythm comprised of combined neurological, cardiorespiratory and musculoskeletal waves. It further maintains that CSF movement in the brain and cord is affected by and driven by these waves. Current research, especially phase contrast upright MR angiograms such as those being done by Dr. Noam Alperin of the University of Florida continue to confirm these long held craniopathic claims.

Craniopathy endeavors to reduce mechanical strains of the skull, especially its base, which is the most important joint area in the skull. Although the joints of the cranial vault, called sutures, close with advancing age the forces acting on those joints continue throughout life. The sutures speak volumes about fluid mechainics in the brain and skull, called cranial hydrodynamics, which I discuss thoroughly in my book. In contrast to the membranous bones, the base the skull, which is made of cartilagenous bone is supposed to continue to remain active and move in concert with the upper cervical spine throughout life. Craniopathy uses a multitude of corrective procedures applied to the facial bones, the bones of the cranial vault and the bones of the base. It also uses specific circulatory techniques designed to drain the skull, such as fourth ventricle bulb compression technique to create a pressure gradient, as well as stuffed sinuses. All of the circulatory techniques are interesting in light of the latest research into CCSVI. Cranial hydrodynamics are extremely easy to feel, as well as affect in infants, babies and young children because their skulls are still open.

Craniopathic correction of the occiput and base of the skull is very similar to upper cervial chiropractic except that the corrective procedures are performed for the most part with the patient supine; that is, face up. Some corrective contacts apply light sustained pressure to the transverse process or posterior arch of the first cervical vertebral called atlas, similar to upper certain methods currently used for upper cervical correction. Sometimes the mastoid bones are also used, which some upper cervical have likewise employed in the past. Additionally sphenobasilar and occipital corrective forces are also used in a similar way, as well as stairsteps and figure eights. Whereas, some upper cervical practioners use sound waves to apply force, craniopaths apply strain and counterstrain positions along with natural and enhanced respiratory rhythm and forces.

Having been trained in both, my opinion is that there are very few truly qualified craniopaths when it comes to serious neurological conditions. In contrast to upper cervical correction which is based on precision x-ray analysis of the strain, analysis of the strain in craniopathy is based mostly on the feel of the treating physician, which is very subjective. The strains are also categorized according to unique terms that are hard to substantiate using today’s technology or even visual inspection. Terms such as sphenobasilar side bending and torsion strains, or temporal bulges for example may be true but hard to prove. Physical anthropological studies would have to be done to determine the validy of such claims. The other problem is most practitioners analyze the strain with patient lying down. In contrast to most craniopaths, because of my background in applied kinesiology I always used specific postural analysis based on plumb lines, pelvic and shoulder levels as well as depth of curve analysis according to AK protocols put forth by Dr. David Walther.

Nonetheless, despite its drawbacks, when performed by qualified experts, especially when combined with specific correction of the pelvis at the opposite end of the nervous and musculoskeletal system, which can be extremely helpful in reducing traction tension from a tethered cord or a pressure conus type condition the use of Dr. DeJarnette’s sacrooccipital blocking technique used with proper respiratory enhancment, is an excellent option in the hands of highly seasoned and skilled practioner with set pre and post objectives and goals. It is a perfect compliment to upper cervical care. Unfortunately, upper cervical practioners don’t use or even consider anything other than the upper cervical spine.

Because of the lack of skilled practioners, I would recommend for now, however, that patients with serious neurological types of problems considering chiropractic care, to find a highly qualified upper cervical practioner who have a better certification and clinical protocols, rather than taking a chance on the uncertainty of craniopathy and questionalble analysis of unclear strains. Upper cervical care has a proven track record and excellent science and research to back it up. Craniopathy does not and there far too many variables, too many unqualified practioners and highly subjective analysis.

In my opinion, craniopathy should belong in the domain of upper cervical care corrective courses since it includes the upper cervical spine and the base of the skull. It also offers a seasoned skilled practioner of specific upper cervical a wide array of additional tecniques to treat unusual and complicated case associated with genetic and other malformations, such as upper cervical fusion and other craniocervical anomolies, that current methods, might not be as effective on. Craniopathy is also great for day old infants strained at birth, and senior senior citizens with issues that might preclude upper cervical care as an options or when x-rays are not practical or available. It also compliments care for certain types of facial issues, such as TMJ and sinus problems to name a few.

The practice of combining craniopathy with specific upper cervical methods, such as high quality sacrooccipital technique further reduces the mechanical strains of the axial skeleton, brain and cord from both ends.

42 Responses to Craniopathic Correction

  1. good points and the details are more specific than somewhere else, thanks.

    – Norman

  2. Dear Dr

    Apoligies in advance to the forum and to the Dr for the long message xxxx

    At the age of 20 I had a car accident – whiplash was my only injury …following this I then suffered migraines this was relieved by two Ice packs one of the top of the head and the other based of the neck then followed by tablets latter years’ immigrain (over the counter meds)
    Migraines terrible on the right side to include my right eye, my nose this would feel ice cold but my right nostril felt even colder when inhaling. Head pain came from the top of my head with a little pulsing thing going on but over my right eye (top of my forehead) I would feel the most pain like something was waiting to burst.

    1993 2nd and final pregnancy – daughter born 3 months early (prolapse cord) the pregnancy was terrible permanent right hip/leg pain felt like I had a finger in my right butt this was to carry on but the limp went after the birth but hip /butt pain remained.
    Following the car accident I always had this cracking in my neck like I had bubble wrap in the nape of my brain stem and twisting it with that sound of repeated cracking is what I heared from my neck area when turning my head left /right I also have what is known as a widow’s peak

    Overtime I did attend physio for head pain as the right side of my neck felt taught i had my back cracked three days later the following happened…
    2009 whilst sitting watching T.V my right leg then arm went numb went to casualty this was believed to be a mini stroke then consider being a slow progressive stroke any how after all the stroke test/scans, bloods were rule out MRI reveals MS
    2009 MRI showed T2 hyperdensity in Left cerebral hempisphere with two smaller lesions more posteriorly on the leftside and one in the right fronto-temporal region. Repeat MRI six weeks later showed the right fronto temporal lesion to have disappeared and the left cerebral hemisphere to be shrinking . However a new lesion had appeared in the right cerebral hemisphere.
    CFS has shown isolated CSF oligoclonal bands low in numbers
    2010 MRI There is a focus of abnormal signal within the white matter adjacent to the body of the left lateral ventricle with signal change extending caudally into the corticospinal tract. 4 further foci of signal abnormality are present within the white matter bilaterally. Appearances are consistent with demyelination.
    CCSVI august 2010 via a right formal vein puncture 6 french sheath. Initial venography on both sides of neck showed entirely normal appearances of the internal jugular venous circulation on the right, but showed a focal narrowing in the mid third on the left with some collateral venous filling. The central venous anatomy appeared normal with no collateral filling or flow diversion to suggest significant azygos narrowing. The left sided jugular narrowing was ballooned successfully using 6mm balloon with improvement in flow and reduction in collateralisation post plasty.
    My MS symptoms at onset of attack was paralysation on the right side to include sensitivity all the way down the right hand side to include only the right hand side of head. This repaired within six weeks left with minor mobility problems none to the naked eye.
    I how ever have never had another migraine since the attack of MS but have been left with a red rash mottled in its appearance and hot it is troublesome along with a hot ear.
    Do you think I would benfit from upper cervical chiropractor screening
    Kind regards margaret age 43

  3. Sorry Dr I had lock jaw for 8 months after the birth of my daughter

  4. good points and the details are more precise than somewhere else, thanks.

    – Norman

  5. Dr Flanagan do you have a contact in the UK for a upper cervical chiropractor xx

    • Drs Flanagan says:

      There is a Dr. Heidi Grant in London I believe who is a highly regarded NUCCA doctor. She also completed three years post graduate work and is a certified as a chiropractic neurologist. Let me know if that works for you. If you can’t find her phone number let me know. MFDC

      • I have sent an email requesting an appointment – I will keep you and the forum posted.
        I would like to take this opportunity to thank you for all your help and support to the MS community.
        New roads and new beginnings!!!!!

      • Drs Flanagan says:

        Your quite welcome. Good luck and be well. MFDC

  6. foto says:

    I love your blog keep up the good work

  7. Very nicea fantastic blog long time looking for. been my salvation for my web Posicionamiento Web

  8. Kelly Hoover says:

    Dear Dr. Flanagan,
    I have a 21 year old son who was diagnosed with MS about a year and half ago. He suffers from bilateral optic neuritis so severely that he has lost his independence ( he had to turn over his drivers license recently and needs assistance with daily tasks) A crushing blow for a young man who once had the world by the tail! He has had treatment for CCSVI (70 % stenosis of his left jugular) and seen some improvement in mental clarity and fatigue. We are firm believers in this theory, however I am still not satisfied and refuse to stop researching possible additional causes/treatments to help him! I know there is answer out there and I want to do everything possible to assure his quality of life!!
    Austin was in a bicycle accident as a teenager and lost consciousness for several minutes and I have read on your site that trauma of this sort may be a cause.
    Needless to say, I am extremely interested in looking into upper cervical chiropractic care to possibly help his condition. Do you know a doctor in the Midwest (we live in Ohio, but are willing to travel) that you would recommend contacting?
    Thank you so much for your drive and dedication!
    I consider people like you a gift from God!
    With much appreciation,

    • Hello Kelly,
      There is a possiblity your son can be helped. I tried to reach you but haven’t heard back from you. Where do you live in Ohio? What cities or towns are nearby?

      • Kelly Hoover says:

        Hi Doctor,
        So happy to hear from you!!!!
        We live in the Cleveland area.

        Thank you for your reply!

      • Drs Flanagan says:

        Hello Kelly,

        I have the names of two NUCCA doctors. One is Dr. Keith Denton. He is one of the best in the business with excellent credentials and the highest level of certification in NUCCA. He has been in practice for 28 years. He is located in Monroe, Michigan. His phone number is 734-241-6923. The other doctor is located in Willoughby Hills, Ohio. His name is Dr. Michael Polsinelli. The doctor has passed the second level certification and has been in practice for eight years. He is also a good choice. However, considering the serious nature of your son’s condition, his young age and what is at stake, I would strongly recommend you see Dr. Denton first.

        I am very interested in your son’s case so please keep me posted. MFDC

  9. Kelly Hoover says:

    Fantastic!! Thank you so much for the recommendations! ! I will be calling/contacting Dr. Denton in Michigan and will definitely keep you posted on Austin!

    Again, I am so very thankful for your taking the time to reach out and assist me/us!. Thank you from the bottom of my heart!!!!

  10. Tom C says:

    Hello Dr. Flanagan,

    I live in Jacksonville FL , I have MS, and my walking and balance are getting bad fast. I am interested in CCSVI and also upper cervical care. Is their anyone you could recommend. I’m only a few hours from University of Florida.

    Thank you,

  11. Donna Lewis says:

    I live in Toronto, Ontario Canada , I have MS, and my walking and balance are getting bad fast. I am interested in CCSVI and also upper cervical care. Is their anyone you could recommend.

  12. Dr. Flanagan,
    Once again excellent blog post. For Tom C…I am a NUCCA doctor in Vista California and would highly recommend Dr. John Dunn in Florida. He is one of my mentors and a Board Certified NUCCA Doctor.
    God Bless,
    Dr. Davis

  13. David Shores DC says:

    Dr. Flanagan,

    I am very glad to have found your site and blog? I agree completely with your assessment on the subjective nature of cranial techniques and at the same time have seen tremendous value using them in my practice. Do you have an opinion on Bio Cranial, Cranial Spinal Integration types of cranial correction to restore cranial respiration?( BTW I am not trained in these techniques.)

    Thank you,

    David Shores DC

    • Hello Dr. Shore,
      Craniopathic manuevers can be very effective but it requires a logial analysis and approach. I am not familiar with Bio Cranial or Cranial Spinal Integration. I learned classic HIO in school, which shaped my thinking about craniopathy. I learned my basic craniopathy and pelvic categories in years spent in AK courses. I incorporated Dr. DeJarnettes craniopathic and pelvic methods into my AK procedure. I later added classic circulatory and other maneuvers based on Magoun’s work. In addition to standard orthopedic and neurological tests, I use AK posture analysis based on David Walther’s work; static and range of motion palpation with careful attention to the upper cervical spine; palpation of origins, insertions and bellies of muscles for myopathy; classic AK muscle testing using Walther’s AK procedures; prone and supine leg length analysis, along with Derefield and crossed Derefield checks. I also do some provocative muscles testing including pitch, roll and yaw. That’s the short list. I developed my own unique method for upper cervical correction that is a blend of HIO and cranial base maneuvers along the lines of Blair’s theory regarding misalignment and assymetry.

  14. David Shores DC says:

    Thank for your detailed answer. It sounds like you had a very well rounded, thorough and logical approach to address the complete patient. There are some similarities in our work. I use a similar approach to DNFT for skull corrections using muscle testing and leg checks along with other bio-response indicators. I too use the Blair listings for upper cervical work. Your upper cervical work sounds very interesting! I am going to read your book before I start asking questions that you have covered elsewhere.

    Again, Thank You!

  15. David Shores DC says:

    I’m sure you are aware that Life West has an upright MRI. Are you aware of any research on CCSVI going on there?

  16. David Shores DC says:

    Good morning Doc,

    I am looking to improve my skills in cranial correction. In your opinion who do you think has the best training?

    Thank you!

    • Hello Dr. Shores,
      Unfortunately I can’t answer that question for you. I am no longer in the loop. My craniopathy approach evolved from my training in HIO. I still think in terms of listings and lines of correction. I learned craniopathy during several years spent in Applied Kinesiology courses. The class also had a couple of dentists who got me interested in Dr. Gelb and TMJ correction. In addition to craniopathic maneuvers, AK also works on all the muscles of the skull, jaw and hyoid bones. The myofascial approach is very useful in certain cases. The best book to familiarize yourself with AK methods is, AK Vol. II Head, Neck and Jaw Pain and Dysfunction – The Stomatognathic System,” by David Walther. It’s got fantastic illustrations of the cranial nerve routes if your are interested in working on optic neuritis, Bell’s Palsy or trigeminal neuralgia cases. I also read, Osteopathy in the Cranial Field 3rd Ed., by Magoun, which gave me a historical and classical perspective of craniopathic maneuvers. I liked the classic circulatory maneuvers. I took some SOT classes, as well as I prefer some of DeJarnette’s approach to cranialsacral work such as fossa testing, knee palpation, crest signs, dollar signs and leg checks. My favorite book however, is the Atlas of Manipulative Techniques for the Cranium and Face by Alain Gehin. It is an encyclopedia of all the maneuvers. There are many terrific maneuvers to choose from to suit your particular style. The problem is choosing and applying the correct maneuvers. Most craniopathic diagnostic systems and listing are highly subjective and impossible to demostrate on x-ray of MRI. In contrast, upper cervical misalignments and Chiari malformations with cerebellar descent are easy to see and understand. Craniopaths could learn a great deal from the latest upper cervical research. In this regard, I use basic x-rays, MRI, posture analysis, orthopedic, neurological and kinesiological exams to determine what’s wrong. I then apply the best maneuvers to correct the problem and accomplish the goal. There is no point in working on the vault or face when the problem is in the base. You need to develop an organized approach to the cranium, which comes from understanding what your are dealing with. That’s my short answer.

  17. Sarra says:

    Hello Dr. Flanagan<
    Yesterday afternoon I received your book in the post 'The Downside of Upright Posture'.This morning I am only on page thirteen. I put your book down and came to my desk to google 'craniopaths', looking for someone in my area. I found myself first hit at your website!
    At 36 years of age ( I am now 41) I began having difficulty walking. At 38 my difficulty walking grew worse. The motor program in my left leg is unpredictable, uncooperative and unreasonable. I've seen 2 neurologists and have had two MRI's. The first neurologist sent me on to the second as she said I was beyond her scope of care. I remembered during a visit with her discussing my first MRI she mentioned ( my recall is foggy) that discs were degenerating in my upper neck at a rate that was not alarming but more advanced than it should be for my age. That's what peaked my interest in your book when I came upon it on the internet so I ordered it. My second neurologist (back and forth with the diagnosis) ruled out MS, alot of my symptoms are similar. At 39 I was told I have a "fluke, out of the blue, untreatable neuro-degenerative brain disorder". I would continue to get worse likely to be needing a walker or wheelchair in the next few years. It's been 2 years and if anything I have improved. For the last 6 months a naturopath has been tackling my allergies (which came out of nowhere very aggressively at age 35). Once the allergies have been addressed he intends to implement other therapies.But for now sniffing around the computer I glean what I can for my benefit.
    Like I said above, I am only on page 13 of your book and probably running off ahead of myself. Do you think I would benefit from upper cervical treatment?IIn the past I was keeping up with forums about CCSVI but not for some time. As I was told I do not have MS, I was also told CCSV1 would not benefit me. Would upper cervical treatment and/or craniopathy be an opportunity for me?
    I live in Niagara-on-the-lake, Ontario, Canada. If you can recommend a doctor for upper cervical treatment and/or craniopathy it would be greatly appreciated.
    I thank you for your time, book and any information you are able to pass on.

  18. Hello Sara,
    I discuss the likely roles of spondylosis (degeneration), scoliosis/kyphosis (abnormal curvatures) and stenosis (narrowing of the spinal canal) in MS in my book. You have significant degeneration (spondylosis) of the spine. Spondylosis decreases the size of the spinal canal. Currently, it isn’t considered to be a problem unless the canal gets so narrow that it makes contact with the cord. The space between the canal and cord, however, which is called the epidural space, contains the vertebral veins. In addition to draining the cord, the vertebral veins are used to drain the brain during upright posture. It is my opinion that spondylosis affects blood and CSF flow in the cranial vault (head) and spinal canal. It can also cause local pressure problems on the cord, which I suspect you have. An upright cervical MRI with flexion and extension views, as well as phase contrast cine MRI would be ideal to diagnose your problem. I don’t know anyone in your area but I would certainly recommend that you consider upper cervical care such as NUCCA. The Cox 7 Spinal Decompression Table and certified practitioner is another consideration. In either case, the pressure in the cervical spine needs to be addressed and decreased. There are minimally invasive surgical solutions as well.

    • Sarra says:

      Hello Dr. Flanagan,
      Thank you so much for your detailed response. Being labelled ‘untreatable’ is a confusing predicament, I am to anticipate no intervention except that which I seek out for myself. The message above (and your book) offer a real way forward for me. Also being told your disorder is a ‘fluke, out of the blue’ leaves you clambering round aimlessly… oops! I guess I won the bad lottery. You’ve given me something for my brain to chew on and a sense of direction. I continue on with your book and will research all of the above suggestions and where they are available.
      And kept prompting me to cancel my order for your book as they were having difficulty getting me a copy. It took nearly 3 months.. but I had this niggling feeling I should hold out!
      Thank you again for the generous response,

  19. David Shores DC says:

    Hi Doc,

    Thank you for all the helpful information on craniopathic correction. A patient gave me a copy of AK Volume 2 that I am currently reading. I will check out the others when I get done.

    Thank you!

    David Shores DC

  20. I was recommended this blog by my cousin. I’m not sure whether this post was written by him as nobody else know such details about my difficulty. You’re amazing! Thanks!

    Best Regards Cindy

  21. a says:

    Dear Doctor, I am a retired Osteopath, who was diagnosed with progressive MS 8 years ago, who in Sydney would you recommend to see for Craniopathy?…..thanks Alexander

    • Hello Doctor,
      Unfortunately I don’t know anyone in Syndney who I would recommend you see for craniopathy. I don’t know what your particular situation is either, but in addition to a craniopathy or craniosacral approach I would also consider specific upper cervical if you can find a good doctor nearby. Aside from those approaches, I also believe there is a chiropractor in Sydney who uses a COX 7 Long-axis Flexion Distraction table, which is an excellent table for rehabilitating the spine, as well as moving blood and CSF in the brain and cord. Let me know if you find any of the above methods and need help deciding which one.

  22. Dear Dr Flanagan,

    I am an Altas Orthogonist and Board Certified SOT Craniopath practising in the UK. Would it be possible for us to communicate directly by email? I have an interesting case that I would like to discuss.

    Kind regards

    Iain G Smith DC

  23. Ang says:

    Hello Dr. Flanagan

    I am writing because I am seeing a Level 1 Nucca practitioner, as I know I have issues due to an accident in January of 1998. I tried to see the other Nucca practitioner in the office as he is in the process of being fully licensed, but was told I could not see him as he is booked solid.
    I was diagnosed with MS in 2001, I have had CCSVI procedure done 2x and saw great improvements both times, during the first procedure I could hear the bones in my neck moving when the right side was dilated. I also have an MRI report that notes narrowing on the right at C1-C2, as well as, after the first procedure being told I have considerable scar tissue in the IJV vein on the right.
    I had two accidents fairly close together, first was a quading accident where the quad rolled on top off my face when going through a cross ditch. At that time I suffered from a couple of deep cuts, one above my eyebrow and the other across my nose, this happened in October of 1997.
    The second accident happened on January 3rd 1998 in that accident my vehicle was an older truck with a lap belt only. My vehicle left the highway at highway speed and travelled about 200 feet down a mountain. I suffered a concussion and lap belt injury along with a severe gash to my head on the left side just on the edge of my hairline, requiring several stitches. I was taken to emergency at the local hospital and all they did was stitch me up and send me on my way? My GP did no follow up care after that accident even though my entire right side went numb. What he said was it is temporary nerve damage and will work its way out and it did, only to return a couple of months later. I kept trying to get my GP to refer me to a back specialist but instead he assumed it was MS and refused to look at any other options?
    He based his MS theory on the fact that I had Bells Palsy 3 years earlier. (which I now believe was the first sign of chronic Lyme disease) Talk about the perfect storm.
    Finally last year I was able to talk my GP into doing an x-ray on my spine because I have terrible pain in my ribs on the right side. He only requested L2 to S1 to be x-rayed, but on the report it was commented that T12 has some mild wedging and a rudimentary rib. (kind of half explains the pain I have on the right side of my ribs) Also on that x-ray it was noted that I had loss of disc height from L5-S1, again nothing was done
    I guess what I am asking of you is your opinion please I feel lost in this medical fupa and I am trying to figure it out on my own, which has been very difficult for me. I think so far I am doing the right things but maybe backwards. Any advice would be wonderful, also am I seeing the Nucca Practitioner that I should? Are you able to help me get in to see the licensed practitioner? I am going to a Clinic in Abbotsford BC Canada

    • Hello Ang,
      You have a history of significant serious injuries in 1997 and 1998 that are no doubt the source of your troubles. Except for numbness on your right side I don’t know what other signs and symptoms you have or what your brain and cervical scans look like. The Bell’s Palsey, which goes back to around 1995 may or may not be relevant. The doctor must have based his diagnosis on other findings as well. If not, it is a weak diagnosis. The x-rays of your lower spine are relevant and they correlate with your symptoms and history. Based on your history or trauma history, I can pretty much guess what your cervical spine looks like. You can start with the less experienced NUCCA doctor but you really should be seeing the senior doctor. Unfortunately, I don’t know the doctor and have no influence over his descisions. I suggest you try and schedule a brief consultation with the doctor and explain your concern and desire to have someone more experience handling your case in light of your condition and diagnosis, especially in the beginning of care. One way or another, which ever doctor you see you should be progressing steadily week by week. If not let me know. Keep me posted.

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