Melinda Roland

MA, PT, LAc, OMD, Dipl-Ac, CST-D

Videos:

TOUCH
The Healing Legacy of Dr. John E. Upledger.

 John Upledger, DO, initially developed CranioSacral Therapy (CST) so that a therapist would work one-on-one with a client. Over the years he expanded the therapy in many ways - sometimes he would have multiple therapists working with one client, other times he would work with a client in water, and sometimes he would have dolphins assist the therapists when working with a client

Russel Martin of Say YES Quickly Productions heard about the work Dr. Upledger was doing with dolphin-assisted CranioSacral Therapy.  The documentary Touch, is one of the many outcomes of his interest in this aspect of CST.

I hope you will enjoy watching this touching documentary that explores the effects of dolphin-assisted Craniosacral Therapy.

http://www.upledger.org/touch

Additional videos can be accessed in the Ricky Williams Concussion Program section

Articles:

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The Missing Puzzle Piece:  Upledger Craniosacral Therapy in the Treatment of Post-Concussion Syndrome
Melinda Roland MA., PT., LAc., OMD., Dipl-Ac., CST-D.

Traumatic Brain injury (TBI) is defined as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury”. (CDC).   Concussion is considered a mild TBI, and is a complex pathophysiological process affecting the brain that may or may not involve a loss of consciousness.

Concussion can also occur via biomechanical forces taken in elsewhere in the body, such as a hard fall on the sacrum, a hard hit to the body, or the forceful movement of the head without any direct contact with an object such as in a whiplash injury.  The forces generated are transmitted to the head and brain as well as the entire body, causing the brain to move, often violently, within the cranial vault, with ensuing injury.

Post-concussion Syndrome, or PCS, describes a group of symptoms (3 or more) that persist after a concussion, sometimes for months or years.  Common complaints include headache, cervical pain, photophobia and visual dysfunction, noise sensitivity and tinnitus, dizziness, balance and coordination problems, and fatigue.  In addition, cognitive changes (memory impairment, especially short term memory, difficulty concentrating, confusion, fogginess), and behavioral changes ( anxiety, irritability and depression), and insomnia are often seen in PCS,  Some of the symptoms such as cognitive and behavioral changes and sensitivities to noise may not develop for days or weeks after the injury occurs.  Interestingly, the severity of the initial injury does not appear to predict the risk of developing the complex of symptoms that is Post-Concussion Syndrome. (JClinExpNeuropsych,v 37 (3) 2015)

There are many causes of PCS symptomatology.   Impact can cause structural damage to the brain, or interruption of neural communication.  “Immediately after biomechanical injury to the brain, abrupt, indiscriminant release of neurotransmitters and unchecked ionic fluxes occur…These ionic shifts lead to acute and subacute changes in cellular physiology. The resulting energy crisis is a likely mechanism for postconcussive vulnerability, making the brain less able to respond adequately to a second injury and potentially leading to longer-lasting deficits.” (JAthlTrain, v.36(3) Jul-Sept 2001)

Delicate structures responsible for vision or balance can be affected.  Resultant cervical dysfunction can create similar long-lasting symptoms. The interconnectedness of connective tissue and structure forms a matrix through which strain patterns can be transmitted throughout the body and the brain in all directions.

Typically, management of PCS involves symptomatic treatment. Medication, physical therapy, vestibular and vision therapy are traditionally used to diminish complaints and restore function.  However, clinically, we see significant and far-reaching results regularly in the treatment of PCS when the rehabilitation approach includes Upledger Craniosacral Therapy (CST).  In addition to being an effective treatment approach for boney, connective tissue, visceral, neural and meningeal stress, Upledger CST can enhance standard therapies by calming the sympathetic nervous system, allowing other therapies to be better tolerated. 

Upledger CST is a gentle, non-invasive manual therapy that detects and modifies restrictions in the craniosacral system (CSS) as well as strain patterns throughout the body.  The CSS consists of the meningeal membranes, including the dural membranes surrounding the brain and spinal cord, the osseous and fascial structures to which the meningeal membranes attach, the non-osseous connective tissue structures which are intimately related to the meningeal membranes, the cerebrospinal fluid (CSF), the ventricles and all the structures related to the production, resorption of the CSF, the meninges, and the CSS glia cells.

The brain and spinal cord are covered and protected by layers of tissue called the meninges.  The anatomy of the CSS includes the cranial vault, which is lined with the two layered dura mater, an endosteal layer firmly attached to the inner surface of the skull, and an inner meningeal layer.  In some areas, the dural meningeal layer reflects inward and forms partitions, creating the quadrilateral space that houses the brain.  The dural tissue or membrane forms a vertical partition that separates and contains the L and R hemispheres of the cerebrum (Falx Cerebri) and the cerebellum (Falx Cerebelli); the dura that forms the posterior horizontal partition (Tentorium Cerebelli)  acts as a mezzanine floor of sorts with the occipital and temporal lobes above and the cerebellum below.   “The falx sits like a mohawk hairstyle between the brain's two halves and is stiffer than the rest of the brain, like leather versus gelatin. Watching reproductions of the recorded impacts and additional simulations, the researchers saw that hits to the side of the head could produce vibrations in the falx, due to its stiffness. Those could then propagate down to the corpus callosum, creating the kind of tissue strain that is often implicated in concussion”. (Role of a Deep Brain Structure in Concussion, Stanford U., Mar 12, 2019. The authors went on to further describe C -shape waves produced in the falx by simulated strikes that moved the head towards the shoulder, and S-waves from those that caused the head to turn.  Upledger CST approaches this kind of membranous strain gently and effectively.

The second layer of the meninges is the arachnoid layer, which follows and attaches directly to the dural layer.  The innermost meningeal layer, the pia mater, follows the brain contours like shrink wrap.    With firm attachments at the foramen magnum and at C2 and C3 segments of the cervical spine, the dural tissue continues caudally to form a tube that surrounds the spinal cord, tethered only by ligaments, until anchoring at the 2nd sacral segment, exiting out of the sacral canal and blending with the periosteum of the coccyx.  The dura mater accompanies the spinal nerves as they exit the intervertebral foramina, forming dural sleeves that attach on the vertebral bodies. 

The cushioning cerebral spinal fluid (CSF) is located between the arachnoid and pia mater in the sub-arachnoid space.  The CSF surrounds, protects, nourishes and cleanses the brain and spinal cord.  It flows within the dural system, around and throughout the brain where the flow is regulated by glial cells, around the spinal cord to the dural sleeves, and it is affected by dural tension.

The deepest layer of the meninges, the pia mater, is firmly connected to the dura mater of the CSS via the arachnoid layer.  The innermost surface of the pia mater also has a direct connection to the brain itself.  It directly adheres to the brain’s matrix of glial cells via glial endfeet that form a membrane layer, call the outer glial limiting membrane.  These direct and significant connections provide a plausible mechanism by which trauma to boney structures lined with dura, and connective tissue strain from throughout the body can be communicated deep into the glial matrix that makes up the brain and supports its vulnerable structures.

Upledger CST mobilizes sutural restrictions and affects changes in mobility of structures that are within or are influenced by the CSS, as well as the important dural tissues that connect to them.  It facilitates the correction of boney and connective tissue dysfunction and strain and improves CSF flow.   It does so by using light touch mobilization techniques that require a high degree of palpatory specificity and sensitivity.  As a result, Upledger CST effectively treats strain patterns in the connective tissue network of the body, brain and spinal cord, enhancing function and easing symptoms.

Myriad structures are lined with dural tissue, and thus can be considered as both an origin of symptoms and as a focus for treatment. For example, all cranial bones, the nasal bones, and the orbit of the eye are lined with dura.  Cranial nerves for vision, hearing and balance, among others, travel through dural tissue or through mobile boney structures with profound connections to dura, and thus can be directly influenced by dural tension.  The jugular foramen, the opening through which 3 important cranial nerves (Vagus, Spinal Accessory, and Glossopharyngeal) must pass, is surrounded by a ring of dural tissue.   CN X, the Vagus nerve, is a primary parasympathetic nerve. Relieving dural strain can improves its function and can be important in restoring the autonomic flexibility so often compromised after concussion.   The myodural bridge consists of 3 deep suboccipital muscles that provide direction connection of C1 to dura.  The eyeball itself has a dural investment directly attached to its sclera.  The optic nerves, responsible for vision, is ensheathed in all 3 meningeal layers, and the Olfactory nerves, responsible for smell, are ensheathed by the pia mater layer.  The 3 motor nerves for the eye must traverse the tentorium cerebelli and are directly affected by abnormal tension in this tissue layer, creating visual issues like eye teaming and tracking difficulty.  These are just a few specific examples.

Because of the anatomical attachments and the continuity of fascia, it makes sense that Upledger CST treatment of involved structures can produce the far-reaching effects that we have seen clinically and in our research.

Our study was conducted in 2014 and 2015 with ex NFL players with diagnosis of PCS, to determine if specific manual therapy techniques could provide an intervention that would diminish long term symptoms in professional athletes with histories of concussion.  Upledger Craniosacral therapy, along with Barral Visceral Manipulation and Neuromeningeal techniques applied to these pts with post-concussive syndrome, provided significant results for future concussion recovery.  Statistically significant positive changes in cervical range of motion, memory, physical reaction time, quality of life, headache, pain levels and duration of sleep, were documented up to 3 mos after the intervention. (Craniosacral Therapy and Visceral Manipulation: A New Treatment Intervention for Concussion Recovery, Medical Acupuncture, vol 29, 4, 2017, Wetzler, Roland, Fryer-Dietz, Ahern).  These initial outcomes were inspiring and showed real promise for viable treatment options for TBI, concussion, and the secondary compensatory dysfunctions that occur following TBI. 

Changes in the continuity of fascia, restrictions in mobility of cranial structures, sutural restrictions, extensive dural connections (meninges attached to bone, neural and visual structures and to the glial matrix of the brain) provide a mechanism where by trauma can be communicated.   Upledger CST addresses these structures and dysfunction directly, providing a mechanism where by correction of such strain patterns is possible, facilitating reduction in symptoms, a greater functional ease and enhanced quality of life.

Upledger Craniosacral Therapy is an important tool in the evaluation and treatment of the structural, vascular, and neurologic tissue changes in concussion and PCS that occur throughout the body, brain and spinal cord.   It is not a substitute for traditional therapies and re-education, it is the piece that is missing.

CranioSacral Therapy and Visceral Manipulation: A New Treatment Intervention for Concussion Recovery

MEDICAL ACUPUNCTURE Volume 29, Number 4, 2017

 Gail Wetzler, PT, DPT, EDO, BI-D,   Melinda Roland, MA, PT, LAc, OMD, Dipl-Ac, CST-D,  Sally Fryer-Dietz, PT, DPT, CDT-D, SIPT Cert and Dee Dettmann-Ahern, PT, BI-D 

                                                                            Abstract

Background: Military service members and veterans face health issues related to traumatic brain injury (TBI), especially during combat, use of heavy equipment, and exposures to environmental hazards and explosives. There were 400,000 TBIs reported in deployed U.S. troops in 2012. Athletes are also subject to TBI. Studies have indicated that some manual therapies could be helpful for treating patients who have post-concussive syndrome.

Objective: This case series report describes the effects of CranioSacral Therapy (CST), Visceral Manipulation (VM), and Neural Manipulation (NM) modalities for treating patients who have post-concussion syndrome. The goal of this study was to evaluate these effects on immobility, pain intensity, quality of life, sleep disorders, and cognition in these patients.

Materials and Methods: This single-blinded case series was conducted at the Upledger Institute, in West Palm Beach, FL. The patients were 11 male retired professional football players from the National Football League and the Canadian Football League who had been medically diagnosed with post-concussion syndrome. Each participant received a morning and afternoon 2-hour session of these three specific manual therapies, which were capable of accessing and addressing the structural, vascular, and neurologic tissues of the cranium and brain—as well addressing far-reaching ramifications throughout the body following trauma. The main outcome measures were scores on the: Impact Neurocognitive Test; Dynavisiontm Test; Short Form–36 Quality of Life Survey, Headache Impact Test, Dizziness Handicap Inventory; a numeric pain rating scale; orthopedic range of motion tests (ROM); and vestibular testing. Hours of sleep were also checked. These outcome measures were registered at baseline, after treatment, and after a 3-month follow up. Results: Statistically significant differences were seen with a decrease in overall pain rating scale scores (P = 0.0448), and cervicogenic pain levels decreased (P = 0.0486). There were statistically significant increases in Dynavision Average Reaction Time (P = 0.0332), Memory Test (P = 0.0156) scores, and cervical ROM scores (P = 0.0377). Hours of sleep averaged 2 hours on the first day of treatment and increased to 4.0 hours at the end of treatment and were continuing to increase, as noted at a 3-month evaluation.

Conclusions: Ten sessions of specific CST/VM/NM therapy resulted in statistically greater improvements in pain intensity, ROM, memory, cognition, and sleep in concussed patients.

For complete article:   http://online.liebertpub.com/doi/pdf/10.1089/acu.2017.1222

Hope for the Treatment of Retired Athletes

By: Melinda Roland MA, PT, LAc, OMD, Dipl-Ac, CST-D & Sally Fryer Dietz, PT, SIPT, Cert

Attention to concussions has increased dramatically over the past 10 years, in part due to the media coverage of high profile athletes and the effect of multiple concussions and Post-Concussive Syndrome on long term health. According to the Centers for Disease Control and Prevention, the rate of reported concussions has increased 50% over the past 10 years, although actual numbers appear to vary between studies (1). Head injuries alone are estimated to occur once every 15 seconds and are considered to be the leading cause of death worldwide.....

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Craniosacral Therapy

By: Melinda Roland MA, PT, LAc, OMD, Dipl-Ac, CST-D

Craniosacral Therapy is a gentle, “hands-on” therapeutic modality shown clinically to have a profoundly positive effect upon brain and spinal cord function. Benefiting a myriad of conditions, Craniosacral Therapy has been used quite successfully in the treatment of neurodevelopmental issues, ADD, ADHD and other learning difficulties since 1975.   My mentor, Dr. John Upledger D.O.,O.M.M., developed Craniosacral Therapy after extensively researching and documenting the scientific basis, and has authored the definitive texts on the subject.  Much of Dr Upledger’s original research was with Autism, illustrating the positive therapeutic effects possible with this gentle but profound therapy.....

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