The following information is taken from a Medial Guide to Complementary & Alternative Medicine "Complementary and Alternative Medicine in Rehabilitation" by Eric Leskowitz, Chapter 1 by John E. UpledgerCST is a gentle hands-on method of evaluating and enhancing the function of the CranioSacral system (the membranes and cerebrospinal fluid, which surround and protect the brain and spinal cord). CST helps relieve pain from physical injury, emotional trauma and may be very effective with children. The treatment uses a soft touch to facilitate profound physical/emotional changes. The subtle body movements that accompany the pumping action of the cerebrospinal fluid are palpated and accentuated. This results in improved functioning of the nervous system, relaxation of traumatized muscles and organs, more appropriate alignment of the skeletal frame, and the release of accumulated mental and/or emotional trauma. The body’s CranioSacral system (a physiological system like the cardiovascular and respiratory) provides the physical environment in which the brain and spinal cord develop and function. Imbalance in this system could result in anything from learning disabilities and loss of motor coordination to chronic pain and disease.

In essence, CST works with the natural and unique rhythms of our different body systems to pinpoint and correct problem sources. This requires a sensitive touch rather than a heavy hand. If the source of dysfunction is within the CranioSacral system itself, noticeable improvement may be achieved after the first visit. And for those undergoing CST for health maintenance, there may be a sensation of simply feeling better after each session. Craniosacral therapy (CST) is a gentle, hands on method of whole body evaluation and treatment that may have a positive impact on nearly every system of the body.  Whether used alone or with more traditional healthcare methods, it has proven clinically effective in facilitating the body’s ability to self heal.  CST often produces extraordinary results. CST helps normalize the environment of the craniosacral system, a core physiological body system only recently scientifically defined.  The craniosacral system extends from the skull, face, and mouth down to the sacrum and coccyx.  It consists of a compartment formed by the dura mater membrane, the cerebrospinal fluid contained within, the systems that regulate the fluid flow, the bones that attach to the membranes and the joints and sutures that interconnect these bones.  Because the craniosacral system contains the brain, spinal cord, and all related structures, and restrictions or imbalances in the system may directly affect any or all aspects of central nervous system performance.  Fortunately, these problems can be detected and corrected by a skilled therapist using simple methods of palpation.  By using about 5gm of pressure, or roughly the weight of a nickel, the CST practitioner evaluates the system by testing for ease of motion and the rhythm of cerebrospinal fluid pulsing within the membranes.  Specific treatment techniques are then used to release restrictions in sutures, fasciae, membranes, and any other tissues that may influence the craniosacral system.  The result is an improved internal environment that frees the central nervous system to return to its optimal levels of health and performance.

THE SCIENTIFIC FOUNDATION OF CRANIOSACRAL THERAPY

In its most basic sense the craniosacral system functions as a semi-closed hydraulic system that bathes the brain and spinal cord and their component cells in cerebrospinal fluid pumped rhythmically at a rate of 6 to 12 cycles per minute.  To accommodate these pressure changes, the bones of the cranium and sacrum must remain somewhat mobile through life.  The joints and there sutures do not fully ossify as was once believed.  William Sutherland introduced this premise in the 1930’s. In the mid-1970s, Michigan State University (MSU) asked me to uncover a scientific basis for Dr. Sutherland’s belief.  From 1975 through 1983, I was professor of Biomechanics at MSU’s college of Osteopathic Medicine, where I led a team of anatomists, physiologists, biophysicists, and bioengineers to test and document the influence of the craniosacral system on the body.  Together we conducted research-much of it published-that formed the basis for the modality I went on to develop and name Craniosacral Therapy, or CST.  We discovered that corresponding changes occur in dura mater membrane tensions as cerebrospinal fluid volume and pressure rises and falls within the craniosacral system.  These changes in turn induce accommodative movements in the bones that attach to the dura mater compartment.  When the natural mobility of the dura mater or any of its attached bones is impaired, the function of the craniosacral system and the central nervous system enclosed may be impaired as well.

RESEARCH SUPPORTS THE EXISTENCE AND SIGNIFICANCE OF THECRANIOSACRAL SYSTEM

Studying bone specimens from live surgical patients ages 7 through 57 years, the MSU team was able to demonstrate definitive potential for movement between the cranial sutures.  Several other studies then laid the foundation for developing a model to explain the mechanism of the craniosacral system. One important factor contributing to the MSU research was the discovery of what appeared to be fascia hanging from the free border of the falx cerebri on some of the cranium dissections that were performed on both embalmed and unembalmed cadavers.  Under the microscope these tissues appeared to be nerve tracts running out of the falx cerebri with brain tissues attached to their free end. Further research indicated they were components of a nerve impulse/message delivery system between these identified intrasutural nerve receptors and the walls of the ventricles of the brain in which the choroids plexuses were located.  This research provided the basis for what our team named the pressurestat model, which explains the function of the craniosacral system as a semi-closed hydraulic system.  Our findings supported those published in Anatomica Himanica by Italian professor Guiseppi Sperino, who noted that cranial sutures fuse before death only under pathological circumstances.  As a springboard toward the clinical application of therapy on the craniosacral system, an interrater reliability study was devised.  Twenty-five nursery-school children were examined by  two of four examiners on each of 19 parameters.  The percentage of agreement varied from 72% to 92%, depending on the examiners and the allowed variance of either 0% if .5%. Subsequently, this same 19-parameter evaluation protocol was used to examine 203 additional school children.  A technician recorded the orally reported data for a statistician, who collected information from each child’s school file and historical data from parent interviews.  This information was compared with the craniosacral system examination findings.The results of these studies showed that the standardized, quantifiable craniosacral system motion examination represents a practical approach to the study of relationships between craniosacral system dysfunctions and a variety of health, behavior, and performance problems.  Other researchers have done similar studies related to psychiatric disorders and symptomatology in newborns.

CRANIOSACRAL THERAPY ENCOURAGES THE BODY TO SELF-CORRECT

CST is based on the idea that each patient’s body contains the necessary information to uncover the underlying cause of any health problem.  The therapist communicates with the body to obtain this information and helps facilitate the patient’s own self-healing processes.Thus the usual sequence of events carried out in conventional medicine is reversed in a CST session.  Rather than taking a verbal patient history, the therapist begins through palpation, that is, touch.  If the therapist is familiar with the patient’s history before the session, he or she may find only what is expected rather than sensing the subtle clues offered by the patient’s body, energies, and psyche.  For that reason, patients are generally asked to write their medical histories and bring them to the clinic for their files.  The therapist can then review the history later when he or she feels safe from the issue of suggestibility. Although avoiding initial history taking is controversial, CST has been practiced this way successfully by tens of thousands of therapists since these concepts were first taught at MSU in 1976. CST also diverges from conventional medicine in its approach to symptoms.  Rather than trying to simply relieve symptoms, CST practitioners work to find and resolve the primary dysfunction underlying the presenting symptom complex.  For instance, rather than seeing strabismus as a diagnosed condition to be corrected by surgery, the therapist searches for a cause within the intracranial membrane system and the motor control system of the eyes.  In this case the cause is often found to be an abnormal tension pattern in the tentorium cerebelli.  Quite often these tension patterns are referred from the occiput or from the low back and/or the pelvis. The CST “diagnosis” would be intracranial membranous strain of the tentorium cerebelli due to the occipital and/or low back and pelvic dysfunctions resulting in secondary motor dysfunction of the eyes.  Clearly in such a case the therapist would focus on the sacrum, pelvis, occiput, and then the tentorium cerebelli.  Correct evaluation and treatment would be signified by a “spontaneous correction” of the strabismus. A similar approach is used for almost any presenting problem, from TMJ disorders to recurrent bronchitis and spastic colitis.  The nature of the presenting problem is usually of the secondary importance unless immediate amelioration is critical, or if the patient does not understand CST.  If this is the case, the therapist may attend to immediate complaints while patient understanding is developing. 

HOW CRANIOSACRAL THERAPY DIFFERS FROM CRANIAL OSTEOPATHY

CST is often compared with cranial osteopathy, which was developed by Dr. William Sutherland, the “father of cranial osteopathy.”  Although Dr. Sutherland’s discoveries regarding the flexibility of skull sutures led to the early research behind CST and while both approaches affect the cranium, sacrum, and coccyx, similarities end at this point. Today, as in the beginning, cranial osteopathy remains focused on the sutures of the skull.  However, CST, as developed at MSU, focuses on the dura mater membrane system as the primary cause of dysfunction.  The bones of the skull are involved only as they serve as “handles” for the practitioner to use to access and affect the membrane system that attaches to those bones.  Another major difference between the two approaches is in the quality of touch.  CST practitioners generally evaluate and often correct imbalances in the system by using a light touch that has been scientifically measured between 5 and 10 gm, which is approximately the weight of a nickel resting in the palm of the hand. CST involves no invasive or directive forces but uses a gentle quality that often belies the effectiveness of the therapy.  Most patients say they feel nothing more than subtle sensations during a typical session.  In general, the manipulation used in the cranial osteopathy is often heavier and more directive.

PERFORMING THE CRANIOSACRAL EVALUATION

During an initial CST evaluation, the therapist senses subtle motions while looking for any restriction impeding free motion of the craniosacral system and various body regions, tissues, and organs, as well as the body’s energies.  The whole body responds to the rhythmical activity of the craniosacral system, which is evaluated for amplitude, quality, rate, and symmetry/asymmetry of response.  Similar evaluations are conducted on the vascular and respiratory systems.  The bodily responses, or lack thereof, to these systemic activities are significant factors in the search for the primary dysfunction.Another integral part of the initial CST evaluation involves the myofascial system.  Fascia runs like a continuous web of tissue throughout the body and remains somewhat mobile under normal circumstances.  Gentle traction applied on the fascia in arbitrary directions from various positions helps localize restricted areas.  These areas of restricted mobility are then interpreted to be sites of either current problems or residue form previous Active lesions/problems are differentiated from inactive residual effects by a technique known as “arcing,” which I developed with biophysicist Zvi Karni at MSU.  By using mechano-electrical monitoring, we discovered that energies both within and off the body are palpable to the skilled therapist.  Arcing requires the therapist to sense the energetic waves of interference produced by the active lesion/problem; these waves tend to be superimposed over the normal subtle physiological motions of the body, organs, tissues and energies.  Practitioners then trace these waves to their source by manually sensing the arcs that they form. The source of the waves is considered to be the core site of the underlying problem or lesion, which may actually be quite distant from the location of the patient’s symptoms.  Usually the active lesion/problem disrupts gross physiological activities, as well as more subtle energy functions and patterns, such as acupuncture meridians. As sites of dysfunction and disruption are discovered, the therapist may attempt to restore mobility to the involved tissues and energy fields.  More often than not these attempts will be partially if not completely successful.  In either case the result is often the appearance of a deeper problem or lesion for which the dysfunction just treated has served as an adaptation.  The therapist then follows these clues layer by layer until the primary problem is disclosed.  This may occur during the first evaluation or it may require more than one visit to bring the deepest underlying problems to the surface.  In CST, it is necessary to clear the entire body of any mobility restrictions to achieve the highest level of craniosacral system function. Most of this evaluation is carried out before the complete evaluation of the craniosacral system itself.  Skilled therapists are encouraged to move in and out of the various body systems and regions, including the craniosacral system, as their judgment and intuition suggest.  Peripheral body problems often refer into the spinal cord via their nerve root connections.  The effect of these referrals on related spinal cord segments includes an effect on the dura mater, which is key to the function of the craniosacral system.

CORRECTION OF THE FACILITATED SEGMENT

CST includes the concept that the dura mater membrane within the vertebral canal (dural tube) has the freedom to glide up and down within that canal for a range of .5 to 2 cm.  The slackness and directionality of the dural sleeves allow this movement as they depart the dural tube and attach to the intertansverse foramina of the spinal column.  When nerve roots refer increased levels of impulse activity into the spinal cord from their peripheral domains, a facilitated condition of the related spinal cord segment occurs.  A condition of the hyperactivity in that facilitated spinal cord segment sends out impulses to the related dural tube and dural sleeves.  The result is a tightening and loss of mobility of the dural tube related to the involved segment(s). Clinical observation suggests CST is effective in releasing dural tube restrictions to normalize the activity of facilitated spinal cord segments.  To locate these areas of restricted mobility, the evaluator tests the mobility of the dural tube and releases restrictions as they are found using gentle traction techniques.  These releases are mandatory; if a peripheral restriction is released but the dural tube restriction and facilitated spinal cord segment are not, the peripheral problem usually reoccurs.  Once the peripheral body and the dural tube have been treated for restrictions, the therapist can focus on the cranium and sacrum.  During this time the therapist also helps correct both primary and secondary dysfunctions of the skull bones, facial bones, hard palate, and sacrococcygeal complex.  All related sutures and joints are very gently mobilized through the use of the bones as handles on the dural membranes inside the skull and spinal canal.  After mobilizing bony restrictions, the therapist then focuses on correcting abnormal dural membrane restrictions, irregularities in cerebrospinal fluid activities, and dysfunctional energy patterns and fluctuations related to the craniosacral system.  At this stage the patient often moves from a phase of having obstacles removed to one of self-healing with the therapist simply facilitating the process.  In essence the patient moves out of the realm of “fighting disease: into one of enhancing health.  This self-healing is why CST is such an excellent preventive medicine modality-it mobilizes natural defenses rather than focusing on the etiological agents of disease.  

A Case Study

Vertigo in an Olympic Diver

Mary Ellen Clark was a world-class platform diver who had won several major competitions, including a bronze medal in the 1992 Olympic Games in Barcelona, Spain.  Not one to rest on her accomplishments, she had set her sights on making the 1996 Olympic diving team and bringing home another medal.  She was in the best physical shape of her career.  In spite of her age (she turned 33 in 1996), Experts gave her excellent odds at accomplishing her goal.  Suddenly, Mary Ellen began experiencing vertigo, a condition that had ended the careers of several other divers she knew.  Vertigo is a devastating condition for anyone and particularly for a platform diver.  Each time Mary Ellen stood at the edge of the diving platform she felt off balance.  Once she hit the water, she would become confused and disoriented, occasionally causing her to mistakenly swim to the bottom of the pool. Mary Ellen saw many doctors and specialists and tried both traditional and unconventional treatment methods to find relief.  Yet there seemed to be no solution to her problem.  She was unable to train for 9 months because of the devastating effects of the vertigo, and she had all but given up her dream of remaining on the Olympic team. In September 1995, Mary Ellen came to see me at The Upledger Institute Healthplex clinical services in Palm Beach Gardens, Florida.  I started our first session by conducting a whole-body evaluation using my hands to test the mobility of the tissues and areas of restriction throughout her body.  I quickly found several significant “energy cysts,” or concentrated areas of foreign, disruptive, or obstructive energies, that likely resulted from traumatic blows to her body.  Mary Ellen often did 50 dives a day from the 10-meter platform, and she hit the water at speeds of about 35 miles per hour.  I used simple CST techniques to release her energy cysts manually without difficulty.In the second session the CST evaluation pointed to Mary Ellen’s left knee.  She confirmed she had seriously wrenched it during a trampoline accident while practicing a new dive.  At the time she paid little attention to the injury; she was accomplished at denying any presence of pain.  As the evaluation continued, however, it became clear that the knee injury had caused a chain of compensation through her pelvis and lower back.  Her spine had twisted to support her, which in turn caused her head to be improperly positioned on her neck. As I helped Mary Ellen correct these problems, she began to improve.  I continued to see her for at least one session each week for a straightforward combination of CST, knee and spine manipulation, pelvic rebalancing, and myofascial release.  Within 20 days of her first treatment, Mary Ellen resumed her physical conditioning.  Within 90 days she experienced a complete correction of the problem and was able to return to a full training schedule. At the Olympic Games in Atlanta, in July 1996, Marry Ellen Clark captured another bronze medal. 

A Case Study 

Intracranial Hemorrhage in a Newborn

Onar Bargior was born prematurely in Moscow, Russia, on February 7, 1991.  He suffered sever cerebral circulation impairment, intracranial hemorrhage, and encephalopathy.  He was diagnosed with infantile cerebral paralysis, spastic displegia, and hypertension-hydrocephalic syndrome.  Any stimulation produced muscle spasm that made his legs rigid and scissored, causing hyperextension of his truck and neck.  His arms became rigid with clenched fists crossed in front of his body.  Having almost no hip flexion, it was difficult for him to assume a sitting position. In March 1992, Onar was registered as an invalid who could neither stand nor sit without direct assistance.  His mother, Maiga, had tried to find help for her only son, yet medical treatment in Russia was limited and sporadic.  Onar spent much of his life merely lying on a bed.  Then a nonprofit medical relief agency in Waterville, Ohio, the International Services of Hope (ISOH), Offered Onar and Maiga hope,  ISOH specializes in bringing third world children to the United States for donated medical treatment not available in their own countries.  The organization has had remarkable success in securing life-saving and life-enhancing surgical and medical care for physically impaired or compromised children.  The agency arranged to fly Onar and his mother to New York for treatment at the Division of Pediatric Neurosurgery of New York University’s medical center.  Their clinical team evaluated Onar in Octoboer 1994.  However, the doctors determined he was not an appropriate candidate for surgery and the subsequent rehabilitative care because of his extreme spasticity and psychomotor delays.  The birth trauma and accompanying cerebral palsy had left his body too rigid to crawl or walk and had severely restricted the use of his right hand. Onar’s mother’s hopes were shattered.  Acutely aware of what this treatment meant to Onar, ISOH began to explore the availability of other medical care.  In their investigations a representative consulted with a New York physician who had heard of an innovative program of care available through The Upledger Institute.  ISOH contacted the Institute with the plea that the Institute was their “last resort.”  The alternative was to return Onar and his mother to Moscow without assistance. The Upledger Institute accepted Onar into a 2 week intensive therapy program beginning March 13, 1995.  This specialized treatment program is built around the use of CST complemented by physical therapy, visceral manipulation, acupuncture, massage therapy, play therapy, family counseling, and education.  Onar’s therapists consisted of a multidisciplinary team of physical therapists, occupational therapists, massage therapists, osteopathic physicians, and psychologists.  During Onar’s first session, one of his therapists found severe restrictions in his dural membrane system-the falx cerebri, falx cerebelli, and tentorium cerebelli membranes inside the skull and the dural tube inside the spinal canal.  She also found a compression of the sphernobasilar synchondrosis with a right sheer, ethmoid/frontal restriction with bilateral maxillary impaction and restrictions in the right temporoparietal suture, as well as the coronal suture.  There were fascial restrictions in the cervical area relating to the hyoid bone, the sternocleidomastoid, and the suboccipital triangle muscles.  The thoracic inlet and entire rib cage was restricted and rigid.  There were also respiratory diaphragm restrictions with a visceral component into the stomach, and pelvic diaphragm restrictions with compression at the L5-S1 vertebral juncture.  Treatment was applied to all of these areas.          
On the second day of treatment, Maiga reported that Onar had slept soundly, which was an unexpected and pleasant surprise, since he normally woke three or four times a night.  On awakening in the morning he asked when would he be returning to the clinic.  Throughout the program, Onar continued to show tremendous daily improvement, including an increased appetite, decreased spasticity, awakening without crying each morning, and increased range of movement of all joints.Originally, the staff in Moscow and New York described Onar’s psychomotor delays as so pronounced as to indicate mental retardation.   Consequently, we were expecting a child slow to respond, both interpersonally and intellectually.  What we found was quite the contrary.  He impressed us from the beginning with his ability to communicate-initially through smiles, laughter, and emotional engagement.  As he became more comfortable he began reacting in his native language, which was peppered with growing numbers of English words and phrases.Coming into the program, Onar preferred to move logrolling across the floor.  The day he struggled to push himself on on his knees was another great milestone.  He also began reaching for toys, and he developed the skills needed to play with stickers, little cars, and trucks. The intensity of these programs and the systemic nature of the therapy they provide usually results in physiological gains continuing for several months after the program has ended.  Because CST removes the restrictions that prohibit the body’s natural inclination toward health, the body experiences a period of reorganization.  Encouraged by such remarkable gains in Onar after just one treatment program, our staff decided to provide a second 2-week intensive treatment program after a 2-week period of rest.  The second treatment program began on April 10, 1995.  To the delight of all involved, Onar demonstrated continued gains of physiological movement and decreased spasticity.  On the second day of the program, when asked, “how are you today, Onar?” he answered in English: “I feel soft.” On the fourth day of the program he was able to place his feet flat on the floor.  By the end of the program he was crawling on all fours. One of our physical therapists noted that, after the second 2-week session, Onar was using his right hand to reach and grasp objects with relative ease and accuracy.  With minimal to moderate assistance, he was able to get into sitting, kneeling and high-kneeling positions.  He has not been able to perform any of these developmental gross motor movements before coming to the United States.  Overall, his contracted musculature or spasticity had greatly relaxed. When Onar first came to the clinic, his entire cranial system was extremely restricted and compromised.  By the end of his second intensive-treatment program his cranial system was moving with greater amplitude and symmetry.  This indicated that Onar’s system was operating more efficiently and fluidly without many restrictions on, and around his central nervous system.  In time Onar was able to sit for longer periods, crawl with reciprocal movement, crawl in high kneeling position with moderate assistance, and use his right hand without verbal prompting.  He also began speaking more clearly and displaying clarity of emotion and projection of love-traits most healthy children display. By the time Onar completed his treatment programs he had also finished the necessary testing and inoculations to begin attending school.  Maiga had worried that Onar might not be intelligent enough to get along in the world.  But School testing showed that Onar has a fine mind.  With opportunities for education, there is no telling what this child will do.  He has already contributed in a profound way to the lives of his therapists and friends.

CLINICAL APPLICATIONS of CRANIOSACRAL THERAPY

CST is well known for its multiple applications and positive results in thousands of cases like those of Mary Ellen and Onar.  By facilitating and enhancing the body’s self-corrective mechanisms, it has proved useful as both a primary and adjunctive treatment modality for a wide variety of dysfunctions, from coronary insufficiency to Crohn’s disease. The number of sessions required to achieve results depends on the complexity of the adaptive layers, patient defense mechanisms, and other factors.  After an initial hands-on evaluation is conducted, a recommendation can be made.  In general, if there is no change in condition after five or six sessions, CST may not be effective for that individual. Following is a partial list of condition types that have shown response to CST in clinical applications.  While research conducted at MSU proves the existence of the craniosacral system and its effect on health and disease, this information is based primarily on clinical observations over the last 15 years of practicing CST.  Although no formal outcome studies have been conducted, thousands of patients have reported their results to us, and what is noted here are observations of clear and compelling results and trends. 

CHRONIC PAIN SYNDROMES

Arthritis: Degenerative and Inflammatory

CST enhances fluid motion, releases muscle tonus and desensitizes facilitated segments, all of which contribute to joint rejuvenation.  Excellent responses have been reported, including some results that have shown normalized blood studies.

Headache Syndromes

CST is excellent at identifying and treating a wide variety of underlying causes for headaches, including migraine tension cephalalgia, fluid congestion, and hormonally related syndromes.  Sutural immobility seems to be a contributing factor in migraines for many patients.  CST addresses this problem, as well as autonomic and neuromusculoskeletal dysfunctions, both of which may be underlying causes of the migraine syndrome.

Pain Syndromes

All pain syndromes, including myofascial, neuromusculoskeletal, and radicular pain syndromes, have shown response to CST.  Because of its effects on the autonomics, CST desensitizes facilitated segments and enhances fluid exchange throughout the body and psycho emotional effects.  CST also addresses many of the neuromusculoskeletal, myofascial, and psycho emotional factors that may serve as contributing factors to chronic neck and back pain.

Reflexive Sympathetic Dystrophy

Reflexive sympathetic dystrophy (RSD) is a painful condition that results from the sympathetic nervous system going out of control.  The cause could be an injury, entrapped nerve, inflammation, toxicity, or any circumstance that might feed an abnormal amount of energy into the sympathetic nervous system.  Conservative medical treatment for this condition, which in extreme cases includes amputation of the painful area, has proven rather ineffective.  The key to helping the RSD patient is discovering and resolving the underlying source of the excess energy.  CST is well suited to finding and treating the underlying causes of RSD and subsequently resolving pain.

Spinal Dysfunctions

Spinal dysfunctions, including scoliosis, low-back (Lumbar and lumbosacral) instability, disc compression, postoperative complications, and others, have shown response to CST.  Once the underlying cause is determined, CST is effective in solving biomechanical, neurogenic, and facilitated segment problems.

Temporomandibular Joint Syndrome

Tempormandibular joint syndrome (TMJ) is a painful problem caused by the joints of the lower jaw becoming dysfunctional for any number of reasons.  Surprisingly, TMJ can originate from a craniosacral system restriction that results in an imbalance between the temporal bones on each side of the head.  Other causes include nervous tension that results in tooth grinding and/or jaw clenching, whiplash injury to the neck, or malocclusion of the teeth.  CST is highly effective at locating and alleviating the underlying problems.  It is also highly effective at mobilizing temporal bones.  

TRAUMATIC INJURIES