CranioSacral Therapy and Physical Therapy:

An Integrative Approach

By Mary Ruth Velicki, MS, DPT





As a traditional physical therapist, I specialized in the rehabilitation of adults with neurological disorders and developed courses in this area of practice for several physical therapy programs. But then debilitating pelvic pain pulled me out of my regular life. The ensuing decade-long healing journey changed me from a clinician of Western medicine who was skeptical of complementary therapies to a practitioner and patient with an integrative view of healing. Over the healing years, I discovered the connection between my body, mind, and spirit and learned how to use this connection to heal on all levels. CranioSacral Therapy (CST), developed by Dr. John Upledger, became a major route for this discovery. Subsequently, when I was feeling well and returned to treating clients, I witnessed the power of CST from the other side of the treatment table, too. This article, which is derived from those experiences, presents an integrative approach to physical therapy and describes the benefits of Upledger’s CST.


Changing Perspectives

For the first twenty years of my physical therapy career, I did not have a holistic perspective. Indeed, I considered most complementary treatments to be either invalid or less valuable than traditional PT practices. Although I appreciated that psychological and emotional factors could work on the periphery to increase or decrease symptoms, I thought that disease and dysfunction were primarily physical in nature. I regarded the body like a machine and doctors and therapists like highly educated mechanics.


I thought my views were the full truth. Now, I appreciate that my viewpoint reflected the philosophies underlying Western medicine, which are often credited to Rene Decartes, a seventeenth-century philosopher, scientist, and mathematician. Descartes advocated the analytic method and proposed that the objective realm was the only legitimate form of inquiry. He also introduced a version of the mind-body dualism philosophy in which the mind and body are comprised of unlike substances. The body is material, unthinking, and subject to mechanical laws, and the mind is immaterial, thinking, and not bound to the same physical constraints.


This perspective differed vastly from the Orthodox Christian view of the time, which considered the body and soul as one and attributed diseases to non-material forces, such as personal or collective wrong doing. With this view, the body had to remain intact for the soul to ascend to heaven, therefore dissection was prohibited. The adoption of Decartes’ philosophies, which enabled dissection, led to the study of anatomy and physiology and to great advances in medical science. However, this new perspective also minimized or negated the influences of the mind and spirit on the individual’s health and well-being and discounted or invalidated information that was not reached solely through analytical reasoning.


I have met many Western medicine-trained clinicians who advocate holistic healing and use an integrative approach. For most of them, the change in their perspective and in their practice were fueled by their personal experience. I am no exception. When the pain remained debilitating after trying most of the recommended Western medicine interventions at that time, I checked my skepticism and gradually added complementary treatments to my regime. These included yoga, meditation, massage therapy, acupuncture, Reiki, and two forms of holistic bodywork: John F. Barnes’ Myofascial Release approach (MFR) and Upledger’s CST. I experienced the benefits of all these therapies; I also discovered that the philosophies underlying these treatments often matched what I was experiencing in my own body, mind, and spirit.


Introducing CranioSacral Therapy 

Four years into healing, when my pain was no longer debilitating but still annoying, I attended weekly treatments with the CST instructor Karen Axelrod for about six months. As Karen tuned into my body responses and used her intuition to accurately find and treat restrictions throughout my body, I experienced my nervous system calming down and my pain levels dropping. During therapy, information that was important for my healing came into my awareness through body sensations, thoughts, emotions, and visual imagery. I even unearthed the repressed childhood trauma that was at the root of my pain condition, and I released some of the physical and psychological effects of this trauma.

Working with Karen using the CST approach was crucial for my healing, but the benefits of the approach were not limited to our interactions. I’ve had several profound healing experiences in different situations and with different therapists, and I often witness the powerful effects of this treatment approach with clients, too.


As a physical therapist, CST courses were a great way to develop a more holistic perspective because esoteric concepts are presented in an analytical way and through feeling and experiencing changes at the body level. The courses include instruction in manual therapy techniques to restore subtle movements in the spine, cranial bones, and the underlying meninges as well as in structures and fascia throughout the body. A cornerstone of the approach is the notion that people have internal wisdom and an innate ability to heal themselves and that the focus of treatment is to help people tap in to this natural potential.


With CST, the client and therapist optimally assume a calm, almost meditative, state during treatment, and the therapist tunes in to subtle responses of the body to guide treatment. There are many ways to gather information, but one of the main ways in this approach is to monitor changes in a subtle, body-wide motion called the craniosacral rhythm. In a full-body pattern, the pelvis and skull gently rotate up and down together in rhythm, and at the same time, the arms and legs roll in and out. While the client is talking or while their body is responding to treatment, the rhythm sometimes stops abruptly, which is considered a sign something significant is happening in the body-mind at that moment.


Benefits of Using CST in Physical Therapy

CranioSacral therapy is not only valuable as a complementary treatment, the approach can also provide physical therapists with skills that will improve their patient-care outcomes. What follows are three examples of how CST can enhance the practice of physical therapy.


Calming the Nervous System

The light touch, gentle CST techniques seem to be especially effective in calming the nervous system. During therapy, patients often move out of the sympathetic system’s fight-flight-freeze state and into the parasympathetic system’s rest-digest-regenerate state. Moving into the parasympathetic state can be an effective way to facilitate self-repair of the body, and decrease the perception of pain, especially for clients with an upregulated nervous system.

CranioSacral Therapy can help clients experience a new way of activating the nervous system. When they experience a decrease in their symptoms in this calmer state, they become motivated to practice other ways of quieting the system, such as diaphragmatic breathing and progressive relaxation meditation. In this way, CST can open up the possibility and hope for these clients to use their nervous system differently and motivate them to change.


Advanced Listening

The use of intuition is often discounted or considered invalid in the science-oriented practice of physical therapy. However, if you watch highly skilled therapists, you will notice that they often naturally combine what they know with what they feel and sense. With CST, the focus changes from working on a person’s body to working with the person’s body. Blending analytical knowledge with intuition leads to an advanced form of listening and responding that allows the clinician to adapt manual therapy to the client’s specific needs. When the therapist becomes grounded, still, and focused on the other person’s well-being, the therapist’s ability to gather information and customize physical techniques increases.


Addressing the Body-Mind Connection

For some clients, experiencing the physical work in the quiet state facilitated by CST will bring thoughts, beliefs, emotions, and even past trauma into their awareness. This previously subconscious information seems to be related to persistent activation of the sympathetic nervous system and to holding patterns in the musculoskeletal system. When this information is acknowledged by the patient and expressed either verbally, emotionally, or physically, it can lead to real changes in the structure of the body that cannot be accessed with traditional physical therapy alone. As a physical therapist, I simply provide support for the client without intruding upon or directing this independent processing. In the CST approach, this phenomenon is called SomatoEmotional release. Courses are available to help therapists become more comfortable and skilled in providing support for the client.


The Science and Art of Physical Therapy

It is time for physical therapists to expand their perspective from the mindsets set forth in the Middle Ages and combine their vast knowledge of the body with an appreciation of the mind and spirit. For many clients, like me, this holistic approach is necessary to move out of physical dysfunction and pain. As a step forward in this direction, I encourage my fellow clinicians to try CST and other complementary treatments, for it is often through direct experience that these more esoteric aspects of the body become valid. This type of discovery can not only help the therapist provide clients with information about complementary treatments, it can also help them develop advanced listening skills and learn new ways to alter the structure of the body. Physical therapy can then become not only a science that focuses on the function of the body but also an art that helps a person heal on all levels.


Mehta N. 2011. “Mind-body Dualism: A Critique from a Health Perspective.” Mens Sana Monographs, 9(1): 202-209.


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