Read an essay that examines aspects of the Still Point: definition, physiology, contra-indications, technique, unpredictability, psychological issues and a bibliography.
This moving image shows the cranial rhythm in transition as it responds to application of a SP technique: from an irregular rhythm at left, to a Still Point where there is no movement, shown in the centre of the image, followed on the right by an improved rhythm with full amplitude and normal rate.
INTRODUCTION
“During the still period, which may last anywhere from a few seconds to several minutes, all parts of the body become quiescent, and then a profound relaxation occurs.” (Manheim p17)
As still point (SP) induction is a physiologically-based method, certain technical details are necessarily involved in any discussion of its effectiveness. It is not assumed that the reader is familiar with this approach, so while these details will be described briefly where appropriate, a textbook should be consulted for more specific information.
Before proceeding to a description of the still point phenomenon, it is necessary to take a step back and place this concept in context. A still point is a variable period of time when the usual pulsations of the Cranial Rhythmic Impulse cease temporarily. Therefore to understand a still point one must first understand the CRI.
WHAT IS THE CRANIAL RHYTHMIC IMPULSE (CRI)?
The term CRI was coined by Woods in 1961 to describe the observed phenomena of cyclical slow body movements. It is generated by the body and can be palpated by the hands of a therapist who feels these movements at most surface locations. The CRI “is considered to be a fundemental, physiological action motivating the mobility throughout the entire mechanism of fluid, membranous, nervous and osseous tissues.” (Magoun p24) In classical cranial osteopathic theory deriving from the work of William Garner Sutherland (1873-1954), this movement phenomena is thought to originate from the functioning of the Primary Respiratory Mechanism (P.R.M.).
The P.R.M. is a term that Sutherland used to describe five inter-related physiological factors. These are: the fluctuation of the cerebrospinal fluid, the function of the ‘reciprocal tension membrane’ inside the head, the inherent motility of the brain and spinal cord, the articular mobility of the cranial bones and finally the involuntary mobility of the sacrum between the ilia (hip bones).
This model was proposed by Sutherland in 1939 and is the orthodox cranial osteopathic theory. Since the 1970’s this model has been challenged on several fronts but remains the dominant explanation for the slow bi-phasic pulsatile movement phenomenon of the CRI. The CRI is under-researched and is largely unknown outside of osteopathic and related body-oriented therapies such as massage. The answer to the question posed above may eventually prove to be far more involved and comprehensive than is generally recognised, even by therapists currently working in this field.
EVIDENCE OF THE STILL POINT PHENOMENA
A still point is a period of time when the movement of the CRI is not apparent. This temporary cessation of motion can last from a few seconds to a minute or two. It is thought that still points occur spontaneously as well as being able to be induced.
Still points have been recorded and measured in several experimental studies, such as those by Upledger and Karni, Zanakis and colleagues and also Norton and colleagues. “One subject in this study exhibited what the examiner described as a “still point” in the middle of an experimental session. The characteristics of this subject’s CRI changed dramatically after this episode…” (Norton et al 1992 p3)
HOW TO CREATE A STILL POINT
Apart from naturally occurring, spontaneous S.P.’s, there are four methods used to engineer a still point: palpation induction, positional induction, self-induction and triggered induction (by memory association with significant words etc).
PALPATION INDUCTION
In monitoring, the therapist passively palpates the CRI with their hands at the contact location chosen. The aim is to determine the preferred direction of CRI movement, that is, in which CRI phase the tissues have greater ease of mobility. It will be assumed here that palpation is at the ankles and that contraction (also known as expiration, extension and internal rotation) is the phase of greater ease.
The process of palpation induction begins when the therapist, having followed contraction to its limit, resists the body’s movements during the following phase of expansion. By progressively following and taking up slack during successive contractions, while resisting during expansion, the CRI is ‘cornered’ to a degree that the pulsatile movements begin to falter. This typically takes 5 to 20 cycles. “The still point has been induced by the therapist’s resistance to the physiological motion at the subject’s feet. It is usually heralded by gross irregularities of the craniosacral motion which become manifest throughout the whole system. The craniosacral system may shudder, pulsate or wobble. As the therapist persists in resisting the return to the neutral position of the physiological motion at the feet, the craniosacral system’s activity will ultimately shut down”. (Upledger and Vredevoogd p40-1)
During the still point period the therapist maintains the palpatory contact applied immediately before the S.P. but does nothing else, as there is no motion to resist. The resumption of the CRI is initially felt in the therapist’s hands as a weak stirring of motion that typically takes three or four cycles to regain full momentum. A beneficial change in the symmetry, quality, amplitude and rate of the CRI is usually noted. Depending on the degree of improvement and other client responses noted during the induction process, the therapist may decide to either induce another S.P. or gently disengage from palpatory contact.
“With practice you will know the moment to release – when the ‘still-point’ has been reached, all pulsation ceases and the area appears to settle. This might be heralded by the patient’s body language (a sudden visible relaxation) as an obvious relief from undue pressure, whereupon the patient sighs, twitches pleasurably or simply relaxes deeply”. (McCatty p158)
As the procedure used for S.P. induction is subtle, the therapist needs to prepare by becoming physically comfortable and ‘centering’. In this sense the still point induction procedure is relaxing and meditative for the therapist. The witnessing by the therapist of any behavioural or energetic changes (in the subject coincident with the still point) in a non-attached manner is somewhat like the observation of ones thoughts during meditation.
The example given above of still point induction at the feet can be replicated at many body locations. “We frequently induced stillpoints at the knees, the shoulders, the feet or the arms.” (Upledger p5)
POSITIONAL INDUCTION
As well as induction through the palpatory exaggeration/inhibition method described previously, another method sometimes produces S.P.’s. “As the position is exactly reproduced, the craniosacral rhythm stops and the therapist must prevent the patient from moving again until the rhythm resumes. During this still period, a physical release usually occurs, and an emotional release may occur.” (Manheim p16) The position referred to here is that of the subject’s body at the time when a major traumatic event (such as a motor vehicle accident, sexual abuse or a psychically threatening episode) has occurred previously and the subject’s CRI has ‘frozen’ spontaneously at that same time in response.
TRIGGERED INDUCTION
The literature makes brief mention of S.P.’s triggered by or coincident with particular words or other associations specific to certain traumatised individuals.
SELF-INDUCTION OF STILL POINTS
To the knowledge of this author, self-induction has never been systematically used in experimental or comparative studies. As an adequate description of this method exists (by Riley p310-1 in Upledger and Vredevoogd), it will suffice here to summarise the procedure as basically substituting a springy inanimate surface (such as tennis balls) for the therapist’s palpation pressures on the occiput of the supine client.
HOW DOES A STILL POINT WORK?
The classical type of induction involves palpatory contact at the occiput with an anteriorly directed force during the expansion phase of the CRI. In this type of induction the therapist’s contact position with the head is immediately adjacent to the outlet of the cerebrospinal fluid ‘pump’ – the cranial ventricles – thought to be involved in motivating the CRI (along with inherent brain motion) in Sutherland’s theory.
This method is called CV4 (compression of ventricle four) and is the sole induction method employed by many cranial therapists. Also known as bulb compression, this is “a technic (sic) to lessen the capacity of the fourth ventricle …Because the tentorium cerebelli is attached to the internal surface of the occipital squama, it is drawn more closely to the cerebellum, whose hemispheres are thereby brought down over the roof of the fourth ventricle, while the middle cerebellar peduncles are pulled up to elevate the floor, thus augmenting the squeeze both ways.” (Magoun p336)
As invasive procedures necessarily alter the functional integrity of the system, it remains a challenge to modern science to verify or modify this hypothesis that has not been substantiated by experimental or diagnostic imaging methods.
Although profound changes to the client’s sense of wellbeing and physiology can undoubtedly occur with still point induction, the ‘CV4 explanation’ is routinely accepted as fact when little evidence actually exists to support it. This author has noted the proximity of the hypothalamus anterior to the fourth ventricle and has wondered what effect the anteriorly directed force of the CV4 technique would have on that structure. Minute pressures on the hypothalamus itself (during surgery) have been observed to produce certain characteristic responses. The functions ascribed to the hypothalamus bear some similarity to the described effects of still points.
It is worth noting that still points induced with a palpation contact elsewhere than from the occiput appear to be equally effective as those achieved using the CV4 method. The explanation given by Magoun, involving a squeeze on the fourth ventricle by the tentorium, would appear to be irrelevant to a non-CV4 induced S.P.
When the total functioning of the P.R.M. is inhibited by the therapeutic resistance of S.P. induction by the therapist, the normal kinetic effects of the CRI on the walls of the ventricles are altered. As these walls themselves form part of many mid-brain structures and cranial nerve nuclei, it is plausible to assume that a change in the tension of these structures may produce functional changes in brain physiology.
It is known that the third ventricle is penetrated bilaterally by the thalamus in approximately 70% of individuals.
This interthalamic adhesion (also known as the massa intermedia) forms a continuous bridge of neural tissue across both sides of the third ventricle.
The existence of an interthalamic adhesion in 70% of subjects would alter flexibility in the transverse plane of the third ventricle, as the interthalamic adhesion would be less pliant than than the open fluid-filled space present in 30% of human brains.
What exact effect this anatomical variation has on the CRI, and still point induction for those individuals possessing an interthalamic adhesion, is currently a matter of speculation.
Although a well-defined explanation of how still points work and achieve the clinical effects observed is currently lacking, most authors on this subject agree that S.P.’s appear to reset body homeostatic baselines.
UNPREDICTABILITY
As the CRI exhibits a complex, variable and possibly interactive nature (see Norton et al), for these and other reasons it is not possible to achieve a still point every time induction is attempted. An informal study by this author in 1997 revealed a ‘strike rate’ of 30% to 50%. Still point induction is often described as a ‘shotgun technique’ in that it is a broad-spectrum method with effects that are difficult to precisely predict in a given clinical situation. This author speculates that an individual’s susceptibility to achieving S.P.’s may have a direct relationship with pathology. In other words, a healthy person may not respond to an induction as there is little ‘backlog’ of adverse tensions present in their craniofascial system.
INDICATIONS, CONTRAINDICATIONS AND EFFECTS OF STILL POINTS
The few contra-indications for applying still point induction relate to situations where changes in intra-cranial pressure are potentially dangerous, such as is the case with aneurisms and cerebral haemhorrage. Common sense dictates that recent skull fractures should not be handled. Likewise, any adverse reaction should be responded to appropriately by the therapist. “Throughout any treatment there must be a constant consciousness of the manner in which the tissues are reacting, with appropriate modification as indicated.” (Magoun p105) “We have never done more than ten still point repititions during the same treatment session. However we know of no side-effect, other than extreme relaxation and sleepiness, which will occur.” (Upledger and Vredevoogd p41)
“Did you begin your treatment with 4VC?(sic) This is often an entry into the system you are trying to influence and should precede most treatments.” (McCatty p141) “The CV4 technique affects diaphragmatic activity and autonomic control of respiration, and seems to relax the sympathetic nervous system tonus to a significant degree…Autonomic functional improvement is always expected as a result of still point induction.” (Upledger and Vredevoogd p42)
A comparison with sleep states offers intriguing possibilities, but as the frequency and nature of S.P.’s during sleep is currently completely unknown, this research avenue must await the development of a simple objective monitoring device.
Other indications for the use of Still Points include: lymphatic stasis and oedema, fever (from acute systemic infections), hypertonic connective tissue, degenerative arthritic conditions, the regulation of labour (uterine inertia), cerebral and pulmonary congestion and chronic pain syndromes. Also see the comments above in relation to the hypothalamus and the circumventricular organs.
PSYCHOLOGICAL ISSUES
Just as with other relaxation methods, a great variety of individual responses to a given stimulus are possible with S.P. induction. Still point induction has historically had a clinical context and it is physiologic responses, such as perspiration, breathing pattern changes and involuntary movements that have predominantly been noted.
Although this author believes that S.P. induction is more physiologically-based than psychologically-based, and that therefore the subject’s co-operation is less important, there are nonetheless certain psychological influences at work, both conscious and unconscious.
The individual’s touch history is relevant. This is rarely fully conscious, or fully disclosed to the therapist in early treatment sessions. As some people do not tolerate gentle palpation, this should be borne in mind and respected, particularly when the reasons are obscure. Memories of prior situations, involving voice, physical positioning, images and so on may be unknowingly (sometimes to both therapist and subject) re-created during sessions. Prior abuse or trauma may thus be uncovered by the crossing of normal interpersonal boundaries that therapy involves.
Other variables in the relationship between therapist and subject, such as gender, age and physical size may be relevant in this regard. Behavioural responses vary widely, from minimal to wildly cathartic to gently euphoric. In a sense, S.P.’s affect energetic and unconscious issues in a direct manner, bypassing consciousness to some degree. In this regard the therapist should pay close attention to subsequent integration of the still point experience by the subject.
“The awareness, relaxation and sense of well-being that result from this therapy go very deep. The recipient feels the duality of body/mind starting to dissolve, feels more deeply connected to meditativeness. Because of its subtle nature, depth and attention to small details, a cranio-sacral session nurtures both the client and the practitioner. Both discover a new awe for the mysteries of life energy.” (Osho Training in Cranio-Sacral Balancing Touching the Inner Core of the Body/Mind Anonymous (1) p88)
CONCLUSION
Still Point induction, when it works successfully, is very time efficient in comparison to other relaxation methods. Ten minutes is often sufficient to bring about a significant change to tension levels.
The information available on the still point phenomenon is mainly anecdotal as no detailed study has been conducted to date. It should be remembered that S.P. induction is usually used in combination with other clinical methods in a treatment session, rather than as the sole technique.
The effectiveness of still point induction is difficult to assess. Many variables are involved, and with no accepted reference rate available for comparison purposes, this therapeutic option remains a matter of controversy at this stage.
There is also a wide range of subject’s responses and attitudes. One individual, having experienced a profound integrative still point, may value the technique highly, while another person, having not responded at all, may rate it poorly.
It appears that the more the subject is stressed, traumatised and displays an irregular rhythm, the more they will respond well. This author believes a successfully applied still point induction technique to be spectacularly effective in perhaps 10% of cases, useful and worthwhile another 20% of the time, and innocuous in the remaining 70%.
BIBLIOGRAPHY
Anonymous (1) Osho Multiversity Rebel Koln 1990
Ferguson AJ, McPartland JM, Upledger JE, Collins M, Lever R Cranial Osteopathy and Craniosacral Therapy: Current Opinions JBMT January 1998
Johnson AK, Gross PM Sensory circumventricular organs and brain homeostatic pathways FASEB Journal Vol.7 May 1993 p678-686
Magoun HI Osteopathy in the cranial field 3rd Ed. Journal Printing Co. Kirksville Missouri 1976
Manheim CJ, Lavett DK Craniosacral Therapy Slack Thorofare, N.J. 1989
McCatty RR Essentials of Craniosacral Osteopathy Ashgrove Bath 1988
Norton JM, Sibley G, Broder-Oldach R Characterisation of the Cranial Rhythmic Impulse in Healthy Human Adults AAO Journal Vol.2 No.3 1992
Norton JM, Sibley G, Broder-Oldach R Documentation of the Cranial Rhythmic Impulse 1997
Sutherland WG The Cranial Bowl Free Press Mankato Minnesota 1939
Upledger JE, Karni Z Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment JAOA Vol.78 July 1979 p782-91
Upledger JE, Vredevoogd JD Craniosacral Therapy Eastland Seattle WA 1983
Upledger JE SomatoEmotional release and beyond Upl. Inst. Palm Beach Gardens FL 1990
Warwick R, Williams PL Gray’s Anatomy 35th Ed. Longman Edinburgh 1973
Woods JM & Woods RH A physical finding related to psychiatric disorders JAOA Vol.60 Aug. 1961
Zanakis MF, Marmora M et al Application of the CV4 technique during objective measurement of the CRI JAOA Vol. 96 No.9 Sept. 1996 p552 PO3
Malcolm Hiort November 1997 (revised November 2013)