The effect of a profound still point is the most remarkable thing I have encountered in 40 years plus of studying and practising a range of bodywork modalities. It results from hand skills belonging to the bodywork field that should be fostered and researched
A Still Point (SP) is a variable period of time when the usual slow pulsations of the Cranial Rhythm (CR) temporarily halt. It lasts from a few seconds to half a minute. To understand the SP phenomenon, we first need to take a step back and examine the cranial rhythm
The term Cranial Rhythm Impulse (CRI) was coined in 1961 by Woods 1 to describe slow cyclical movements of the human body, as observed by cranial osteopaths. Sutherland pioneered this field but he did not name the movement itself, instead focussing on the mechanism that created it
It is a non-muscular, body-wide movement cycle, used for assessment purposes at the body location being touched, as well as a motor force that can be recruited during treatment
How slow is it? The rate of the CR is around 5 cycles per minute, but this figure is debatable, as faster rates have been quoted. See Table 1 https://craniofascial.com/post-number-1/ Most research has been subjective and a reliable number is yet to be determined
What body parts are moving due to this rhythm? Hands trained to palpate these subtle changes can feel the positioning of individual body parts moving in a slow cyclical manner, with some locations more mobile than others
For example, the CR moves single midline bones like the sacrum, occiput, sphenoid, frontal and vomer with a flexion movement, followed by an extension movement, and so on
The sacrum also flexes and extends, the change to its position causing the sacroiliac joints on each side of it to transmit this motion to each ilium, and then via the ball and socket joints to each leg, causing them to externally rotate, then internally rotate and so on
The change in direction of movement from the sagittal to the transverse plane here is like the function of a differential in a car, with flexion translating to external rotation
In contrast to these flexing and rotating movements, palpating each temporal bone with the fingers reveals a more complex motion, a flaring away and out on a 45-degree axis from the seated therapist, before flaring towards and in. The upper teeth can be felt to widen and then narrow as each maxilla bone rotates
What causes the cranial rhythm?
The originator of manual cranial therapy was an American osteopath, William Garner Sutherland (1873-1954), who observed, theorised and experimented, first on himself and then with his patients for four decades before publishing The Cranial Bowl in 1939 2
He interpreted certain anatomical features of the head, borrowed from the work of Swedenborg 3, to propose a Primary Respiratory Mechanism model. This is composed of
- Fluctuations of the cerebrospinal fluid produced in the cranial ventricles,
- The functioning of the Reciprocal Tension Membrane (see Illustration 8 on p 12) which are the inner folds of the dural membranes attaching inside the head,
- The inherent mobility of the brain and spinal cord
- The articular mobility of the cranial bones, and the final point which Sutherland added to Swedenborg’s scheme:
- The involuntary mobility of the sacrum between the ilia (the hip bones)
While competing theories have developed since then to explain this palpable movement cycle, Sutherland’s original notion of a cerebrospinal fluid pump in the head remains the most viable. Evidence of the CR exists in the cranial osteopathic literature and elsewhere including a recent study by Rasmussen 4
The cranial rhythm contradicts orthodox anatomy and physiology. Anatomy books state that cranial fusion occurs around 18 years of age, making mobility impossible after that, so there is controversy on this key point. Likewise, medical science and physiology has not recognised the cranial rhythm as yet
The CRI “is considered to be a fundamental, physiological action motivating the mobility throughout the entire mechanism of fluid, membranous, nervous and osseous tissues” Magoun 5
Osteopathy has not been part of medical science historically, and there are slow-moving cultural and political barriers to recognition of the cranial rhythm, despite a wealth of osteopathic and other research in the last 70 years
The cranial rhythm is poorly recognised outside of cranial osteopathy and similar bodywork practices. There are numerous research complications currently and the eventual information obtained about its nature may prove to be more involved than is indicated by current theories
The palpable movements involved with the CR have been the focus of research, whether conducted by hand or machine, while electrical and magnetic interactions with the CR have not been researched
Evidence of still points
Scientifically valid objective evidence to document a still point relies on measurement of the cranial rhythm before, during and after the cessation of movement. As this technology is not yet mature and available, there are difficulties in documenting what is felt in the hands
Still points have been recorded and measured in experimental studies by Upledger and Karni 6 and Norton, who wrote “One subject in this study exhibited what the examiners described as a “still point” in the middle of an experimental session. The characteristics of this subject’s CRI changed dramatically after this episode” 7
The cranial therapy literature makes mention of spontaneous, naturally occurring SPs. While this is likely to be a homeostatic mechanism, particularly by a stressed organism running out of compensation options at the time, further research using objective measurement is required to validate this
Still points can occur during treatment without the therapist intending it and some body locations are more susceptible than others. If the cranial rhythm amplitude is influenced enough by a given technique it may respond by stopping
Creating a still point
Success is more likely with certain clients. A calm and balanced client body appears less likely to respond to a SP technique than a mechanically stressed one. The literature is silent on this point though, implying a universal likelihood of success that has not been my experience
The procedure used for SP induction requires a combination of subtlety and assertiveness. Interpretation of the subtle rhythm is continued, including when the hands are exerting and maintaining strong internal rotation pressures at times
Some clients require little pressure to interrupt their rhythm, while others may need a more assertive approach, so it is a matter of clinical judgement how best to proceed
The therapist prepares by allowing enough time and taking care to be positioned well. Occasionally the elbows and upper forearms resting on the end of the treatment table, the fulcrum that hand pressure is based on, will need to be repositioned to enable comfort as continued pressure is applied, but this should be foreseen and minimised
The interaction between client and therapist during a still point induction can still be thought of as a type of dance. As this dance of release unfolds in a way that cannot be known beforehand, the therapist should be responsive as required
Apart from the spontaneous SP’s mentioned above, there are four ways to induce a still point, only one of which is clinically applicable as a more-reliable method; that is induction by sensitive trained hands that apply appropriate, changing pressures and at the same time monitor the changing movements of the cranial rhythm being palpated
Palpation Induction
While a still point can theoretically be induced from any given location where the cranial rhythm can be palpated by the hands or fingers, some locations are more practical and useful for this than others. See also the section concerning CV-4 below
For example, limiting the external rotation of each maxilla bone with pressures from fingers in the mouth, would be difficult and uncomfortable for client and therapist over time. Likewise, the movements of the sacrum could not be monitored and modified for the length of time required, due to therapist pain from pressure on the palpating hand underneath the supine body
While the therapist can apply pressure in easier locations that oppose the movement of the CR at either pole of the cycle, the mechanics of doing so is still limited by practicalities. For example, flexion of the occiput during the expansion phase can be exaggerated by the fingers following the motion in, with extension resisted, but not the opposite movement
During most release techniques the therapist’s hands or fingers follow the direction of release of the tissues being treated, whatever that direction is, like a dance partner being responsive to the timing and direction of their partner’s body movements
The difference here is that a more known end point is being aimed at. The therapist aims to gradually limit the amplitude of CR motion, forcing the movement to reduce down to a singularity with no movement. Doing this makes the client’s rhythm stop, then start afresh
Using the feet as an example, the process of palpation induction begins when the therapist resists movement during the expansion phase, having already followed the contraction phase movement in to its limit, the boundary at that time
By progressively ‘following and taking up slack’ during successive contractions, and continuing to resist each expansion movement, the CRI is slowly ‘cornered’. Its amplitude become more and more limited, to the extent that the rhythmic movements begin to falter. This typically takes 5 to 15 cycles
The actual mechanics of a foot still point procedure are described on page 6 of this CFT Level Two manual, but no text is a substitute to good hands-on training with a mentor to learn this subtle art. As client presentations can vary so much, experience is the best teacher over time
“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 becomes 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” 8
During the still point period itself, maintain the same pressure pattern that you applied leading up to the still point. Keep monitoring while waiting to feel the return of the rhythm
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 to the symmetry, amplitude, rate and quality of the rhythm is usually noted
Depending on the degree of improvement, the therapist may decide to either induce another SP on occasions 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” 9
Positional induction
Here the still point has not been planned for and executed deliberately, as with palpation induction. It is difficult to use as a reliable method in the way that palpation induction is. It is more of a coincidental effect as a result of fascial release and unwinding
In bodywork therapy settings, moving the passive human body around slightly and slowly on a treatment table can create noticeable effects. Modalities like Feldenkrais, Counterstrain, positional release and the somatoemotional release aspect of craniosacral use this capability
A still point occurs as a result of certain body positions being reached, either by chance or after following tissue strain patterns with indirect technique. The body position being referred to here is the same as what the client’s positioning was at the time when a major traumatic event occurred
The theory is that the client’s CRI shut down spontaneously because of the trauma. The ‘freezing’ response may occur with a motor vehicle accident, sexual abuse, a psychically threatening episode or other trauma
“As the position is exactly reproduced, the craniosacral rhythm stops and the therapist must stop the patient from moving again until the rhythm resumes. During this still period, a physical release usually occurs, and an emotional release may occur” 10
Effects like the rapid softening of an area, sighing, breathing changes etc that may occur do not necessarily or automatically involve a still point. It is only through monitoring that one knows whether the rhythm stopped or continued, as the therapist senses the contrast between movement and stillness
Such monitoring in volves a conscious awareness, but there is another way to sense a still point. This way begins unconsciously, first as a body feeling, before the feeling is noticed, at which point it becomes conscious
In this circumstance the therapist is working away when ‘something happens’ within the body, a change of energy flow. Thus prompted, the therapist then shifts their awareness and deliberately tunes in to look for the cranial rhythm or its absence
Triggered induction
The cranial literature makes brief mention of still points being triggered by or coincident to particular words heard by the client, or other things experienced during treatment that are personal associations with past trauma
The verbal nature of this type of trauma and it’s triggering later on would be specific to that individual’s past, as certain smells, sounds or other sensations might also be. Although this topic is anecdotal and presents research difficulties, it is worth mentioning in preparation for such a future clinical circumstance
The research solution to this and other cranial rhythm issues is the development of a portable lightweight device, several of which could be attached to certain body locations to monitor the CR on an ongoing basis. The data that matches with the time of the body reactions could then be studied
Self-induction
While any targeted limiting of the amplitude of the CR might create a SP in theory, a method to use a self-induction device as a home remedy is described in the literature 11 An object is placed under the head as a substitute for the fingers as used in the CV-4 technique (see below)
Although two tennis balls underneath the occiput are mentioned as a method to limit the CR, the occiput is narrower than the width of two balls, so contact with the temporal bone on each side is inevitable. How the effects of this might differ from the occiput-only CV-4 method is unclear
As well as the method above, therapists can use a SP technique with their own hands and head. It relies on sensing the expansion of the two parietal bones with accuracy, and for this reason is less suitable for clients
Lie supine with the arms, elbows and hands positioned so there is minimal strain involved. Two small pillows might prove useful for this. Use four fingers from each hand to contact each large parietal bone and feel for the slow expansion and contraction movements of the cranial rhythm
Follow both contraction motions in, medially, with pressure from the fingertips, and resist as the expanding parietal bones move laterally during expansion. By being sensitive to the movements felt in each hand and gradually increasing the pressure during contraction, the amplitude may be influenced enough to create a still point
CV-4 is an abbreviation for Compression of the Fourth Ventricle, the ’classic’ most-frequently mentioned SP technique, and is a particular palpation induction technique
The therapist’s hands are placed under the occiput, with contact on the dorsal (hairy) surface of the thenar eminences at the base of the thumb. The flexion movement (towards the seated therapist) is followed in, then the extension movement of the occiput is resisted as it subtly pushes against the hands
In this way it is theorised that the boundaries of the fourth cranial ventricle, a few centimetres inside the rear of the skull, are compressed by pressure on the occiput and that this compression leads to a still point
The understanding and acceptance of this contentious technique is such that is has become a false synonym, a de-facto term for a still point itself, not a technique aiming to achieve one. This is more than mere semantics though, it is about focusing on the actual effects of a technique, regardless of its intent or orthodox status
Sutherland called this method bulb compression. That this technique can work suggests that the CSF fluid pump model to explain the cranial rhythm may be more relevant than competing lymphatic-based and muscular-based theories
Invasive research methods would alter the functional integrity of the brain and hollow ventricular system, so it is a challenge for modern science to verify or modify Sutherland’s hypothesis
CV-4 is “a technic 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.” 12
This explanation by Magoun may be relevant for a CV-4 technique that compresses the back of the head, but it is unclear whether the same mechanism is responsible for still points induced from elsewhere in the body, where there is no local bulb compression
This still point model can be augmented by considering the functions of each vagus nerve. The floor of the fourth ventricle includes the nucleus of the dorsal branch of the vagus nerve in its structure. As these walls themselves are being moved by the pressure waves of the CR, the dorsal nucleus is also rhythmically swayed
A still point involves the temporary cessation of rhythmic movement, and the function of the nucleus of this unmyelinated ‘primitive’ branch of the vagus nerve may be influenced by the surrounding physical tension changes during this time
“The CV-4 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” 13 There are echoes of Porges’ polyvagal theory in this quote
With the CV-4 technique there is difficulty positioning the base of both thumbs under only the occiput, difficulty in holding a sometimes-moving head steady and difficulty monitoring the cranial rhythm using only the base of the thumbs (dorsal surface of thenar eminences)
In contrast to the above, with induction performed at the ankles there are no difficulties in positioning the hands, no need to hold anything steady and no undue difficulty in monitoring the cranial rhythm, as the palmar surfaces of both hands and fingers are wrapped around each ankle, creating maximum contact and control
By palpating at the ankles, the CR movements coming from the sacrum are amplified by the long-lever effects of the legs, and rendered easier to feel and respond to, in that the movements involve just external and internal rotations that are relatively easy to feel
CV-3 is an extension of the CV-4 theory detailed above
If the CV-4 technique leads to changes in the function of the fourth ventricle, such as CSF pressure dynamics within it, and the rhythmic movements of its walls, then these changes would transmit to the cerebral aqueduct immediately above it, and the third ventricle that it connects to, all of which are hollow structures containing CSF
The walls of the third ventricle contain the circumventricular organs, eight hormonal and neurological structures, some well-known, such as the pituitary and pineal glands, others obscure, such as the intriguing sub-commissural organ (SCO) including Reisner’s fibre which dangles in the cerebral aqueduct, its secretions dissolving in the CSF 14
The function of these glands is known, the sensing of sodium for salt balance, a vomiting centre, the detection of peptides in the CSF on so on, but “the functional role of the SCO is still open to discussion” 15
The pulsatile third ventricle contains cerebrospinal fluid surrounded by specialised glands and neural tissues, all involved in homeostatic regulation. A still point may activate a synergistic rebalancing of their cumulative functions
The thalamus in the centre of the head sits along each side of the 3V and is usually continuous, meaning there is a bridge of tissue from the left portion of the thalamus through to the right portion, in the middle of the otherwise-hollow third ventricle
This is called the interthalamic adhesion (IA), also the massa intermedia or connexus interthalamicus, and is usually represented in textbooks with sagittal views of the brain as a small oval shape in the centre of the head
70% of individuals have an IA, however the remaining 30% do not, and possess a third ventricle not penetrated by this structure. An internal connection between the left and right walls of the ventricle reduces its volume and suggests less flexibility compared to a fully hollow ventricle
An interthalamic adhesion may limit lateral expansion of the walls of the third ventricle during the expansion phase of the rhythm. While the implications of this for CSF flow and still points are speculative, the ‘biological architecture’ is suggestive of a difference between the two anatomical groupings that research could explore
Summary of induction techniques
If a still point is to be induced, the cranial rhythm is always monitored before the technique, and monitoring is continued. A SP is not an automatic response of the body though, as the cranial rhythm often persists regardless of being constrained
My own experience is that the more balanced and calm the body is, the less likely it is that a still point will occur. Distorted chaotic bodies are quite likely to respond however, and this technique may reduce both nervous and tissue strain
Only the palpation induction method is reliable as a clinical tool, depending on the type of client, as explained above. If a still point does result, the effects are usually noticeable and are less frequently innocuous
Effects of Still Points
Commonly lasting 5-10 seconds, the body has a passive calm quality during a SP. “… all parts of the body become quiescent, and then a profound relaxation occurs” 16 No matter where the hands or fingers are positioned to induce a still point, when it occurs the rhythm throughout the body stops
However, as the monitoring hands are only placed at particular locations, it cannot be stated with absolute certainty what occurs in other locations. Monitoring devices placed at various sites during a SP could be used to research the universal, body-wide effects of a still point
There are additional local effects to SP techniques being applied by the hands at a particular body location however. Tension in the pelvis would not be specifically released by a sphenoid or parietal technique, but a technique that resisted the rotation of the legs, thereby limiting sacral movements, would do so
The cranial literature mentions the following potential effects, but these should be regarded with an open mind until properly researched:
Softening hypertonic connective tissue – Lymphatic stasis and oedema
Lowering fever from acute systemic infections – Regulating labour (uterine inertia)
Degenerative arthritic conditions – Cerebral and pulmonary congestion
Chronic pain syndromes – (down)Regulating of nervous system tone
Unpredictability
Often described as variable, the data about the cranial rhythm is based on case studies and is subjective. What is a normal cranial rhythm? Reliable information about still points is hampered by poor recognition amongst therapists, inconsistent definitions and practical procedures, and notably the lack of an objective measurement device
What can we expect regarding still points? How should variations be interpreted? Medical science has yet to recognise the manual cranial therapy field developed since Sutherland’s time, and no reliable database exists for the cranial rhythm or still points
Palpation of the cranial rhythm varies from client to client, and is also dependent on individual musculoskeletal restrictions, as well as the location where the rhythm is palpated
While the literature gives the impression that a still point will result from use of palpation induction, this is not always the case. My experience indicates a success rate of perhaps 50%. Stressed clients with fewer compensation options tend to be more responsive and more likely to twitch. A calm balanced body tends not to respond to SP induction
Indications and contraindications
The literature mentions potential benefits, but it is unclear when to employ SP induction and how to incorporate it. Should it be used sparingly or routinely? Opinions vary, with one enthusiastic author asking: “Did you begin your treatment with CV-4? This is often an entry into the system you are trying to influence and should precede most treatments.” 17
Discharging fascial and neural tone to relax the client is the most frequent indication given, with research needed to validate which effects are reliable as well as useful
Apart from the common-sense cautions that apply to other bodywork modalities, the only obvious contraindication is where a change in cranial pressures is not advised. The presence of a Chiari malformation involving a protruding brainstem would contraindicate occipital techniques
Otherwise, the chief clinical issue is the therapist’s choice of how best to proceed for an individual. Every technique is asking a question of the body, and the results can never be fully anticipated, so there is always an experimental aspect involved
Psychological issues
These comments apply to light touch generally as well as to SP techniques. A variety of individual responses to touch is normal, but sustained light touch, with the client choosing to stay passive and relaxed, is more likely to create a sensitive neural and psychic environment compared to more kinetic techniques with heavier pressures
The client’s touch history is important and this is not often communicated to the therapist in early sessions when it is needed most, or known consciously by the client. In this sense light touch can reveal deeper issues. Some people do not tolerate gentle palpation and this should be respected, particularly when the reasons are obscure
We are skilled at solving somatic problems and sensing mood and energy changes, but bodyworkers also engage with the unconscious of our clients all the time in our interactions. Therapy involves crossing the interpersonal boundaries of normal life, and this can increase client vulnerability, which needs to be understood and managed
The unknowing triggering of traumatic memories, including the subsequent processing of that trauma, can be recreated during sessions and is always a possibility to be aware of. Even sessions not involving trauma will soften and deepen the sensitivity of most clients
As bodyworkers we should never forget we are not psychological professionals, no matter our good intentions. We see clients in acute distress sometimes, or unsettled and coping poorly. There are many psychological issues in the clinic beyond the scope of this section
Conclusion
Every bodyworker should be aware of the existence of the cranial rhythm, and the possibility to therapeutically halt it with a SP technique, but it is poorly represented in texts and classrooms, so there is a lack of both awareness and clarity
The effects of a profound still point is the most remarkable thing I have encountered in 40 years plus of studying and practising a range of bodywork modalities. It is a hand skill belonging to the bodywork field that should be fostered and researched
The motion of the cranial rhythm throughout the body contradicts the old ‘only muscles create movement’ orthodoxy and has many applications in assessment and treatment for therapists
Development of affordable portable CRI measurement devices will transform this field in the future, with repeatable observations allowing clinical correlations to be made, creating a deeper understanding of this inherent rhythm
References
1 Woods and Woods
2 Sutherland
3 Jordan
4 Rasmussen
5 Magoun p24
6 Upledger and Karni
7 Norton 1992
8 Upledger and Vredevoogd p40-41
9 McCatty p158
10 Manheim p16
11 Upledger ibid p310-311
12 Magoun p336
13 Upledger ibid p42
14 Johnson
15 Rodriguez p63
16 Manheim p17
17 McCatty p141
18 Osho p88
Still point bibliography
Ferguson AJ, McPartland JM, Upledger JE, Collins M, Lever R Cranial Osteopathy and Craniosacral Therapy, Current opinions, JMBT, Jan. 1998
Johnson AK, Gross PM Sensory circumventricular organs and brain homeostatic pathways FASEB Journal, May 1993 p670-686
Jordan T Swedenborg’s influence on Sutherland’s ‘Primary Respiratory Mechanism’ model in cranial osteopathy, JAOA 2009
Magoun HI Osteopathy in the cranial field, 3rd ed. Journal Printing Co. Kirksville, MO 1976
Manheim CJ, Lavett DK Craniosacral Therapy, Slack, Thorofare, NJ 1989
McCatty RR Essentials of Craniosacral Osteopathy, Ashgrove, Bath 1988
Norton JM, Sibley G, Broder-Oldach R Characteristics of the Cranial Rhythmic Impulse in Healthy Human Adults, AAO Journal Vol. 2 No. 3 1992
Osho Training in Cranio-Sacral Balancing. Touching the Inner Core of the Body /Mind
Rasmussen TR, Meulengracht KC Direct measurement of the rhythmic motions of the human head identifies a third rhythm, JMBT Oct. 2020
Rodriguez EM Cell biology of the subcommissural organ, Int.Rev.Cytology Vol 135
Sutherland WG The Cranial Bowl, Free Press, Mankato, MN 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
Woods JM, Woods RH A physical finding related to psychiatric disorders, JAOA Vol. 60 Aug. 1961
Malcolm Hiort
Director, Australian Craniofascial Therapy School
August 2023