Craniosacral Therapy Benefits vs. Precautions - Dr. Axe

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Craniosacral Therapy for Depression, Neck Pain & Headaches


Craniosacral therapy

The term craniosacral therapy (or CST) refers to how this treatment approach addresses abnormalities of fluid and membranes connecting to both the cranium and sacrum. The sacrum is a triangular bone in the lower back situated between the two hipbones of the pelvis that connects to the spine, and the cranium is the skull, the bony structure that provides a protective cavity for the brain, forms of the head, and supports the structure of the face.

Given that the craniosacral system includes structures of the central nervous system — the skull, cerebrospinal fluid, the membranes of the brain and the spinal cord — it’s not surprising that CST can have a positive impact on mood regulation, pain tolerance, stress response and relaxation. The musculoskeletal system, vascular system, endocrine system and sympathetic/parasympathetic nervous systems all influence activities of the craniosacral system.

While there’s still some debate regarding how craniosacral therapy works to reduce pain, discomfort and a variety of other symptoms, one theory is that fascial (tissue) restrictions within the craniosacral system lead to abnormal motion of the cerebrospinal fluid, increasing pressure placed on certain nerves and causing tightness in connective tissues. This may contribute to problems including increased inflammation, fibrosis, tissue stiffness (like a stiff neck), inflexibility/reduced range of motion and chronic pain.

While there’s no guarantee that it will work for everyone who tries it, there’s evidence that CST can help decrease common ailments, including anxiety, depression, fibromyalgia symptoms, headaches, neck pain, back pain and even symptoms of colic or discomfort in infants and babies.

What Is Craniosacral Therapy?

Craniosacral therapy (or CST) is a non-invasive, manual therapy performed on the head, skull and sacrum by certain trained chiropractors, osteopaths, physical therapists and massage therapists. Craniosacral massage involves light adjustments, which is why CST is referred to as a “subtle therapy.” CST practitioners take a holistic approach to helping their clients, combining mind-body practices including soft tissue adjustments, massage, “healing touch,” deep breathing and other relaxation techniques.


What are craniosacral treatment sessions like? They typically last about 45 minutes to 1.5 hours, in which the craniosacral therapist treats the patient while they lay down in a relaxed, prone position on their back. Treatments typically consist of the practitioner first evaluating the patient by using their hands softly to massage and feel the patient’s skull and sacrum. This allows the therapist to evaluate “craniosacral rhythms” and detect what may be contributing to symptoms like pain or tension.

The therapist then manipulates bones of the sacrum and cranium to help reach deeper layers of fluid and membrane. The hands are the only “instrument” used in CST, which work to apply very mild, manual traction on the patient’s cranial bones in order to intervene in functions of the autonomic nervous system and to help to release bone and membrane restrictions.

How does craniosacral therapy work? The underlying belief behind CST is that the human body is capable of self-healing, given the right tools and circumstances. In addition to reducing pain and tension held in the body, CST can increase someone’s understanding of their own “inner energy” and healing potential. Gaining self-awareness of one’s own body and senses is considered to be an important part of staying in good health, since this allows someone to identify their body’s stress signals at an early stage in order to intervene.

One theory behind craniosacral therapy is that touch involved in manual therapies provides rhythmical, small vibrations that help different parts of the body to communicate more effectively, especially different parts of the central nervous system (CNS). CST applies touch to various bones of the skull, face and backbone that helps to gently move cerebrospinal fluid while also provoking a relaxation response, both physically and mentally. Cerebrospinal fluid is the fluid that surrounds and cushions the brain and spinal cord. This is still some debate whether CST actually helps fluid to circulate, or if it’s simply pumped almost entirely by functions including respiration (breathing).

Specific craniosacral therapy procedures that therapists use include: still points, compression-decompression of temporomandibular joint, decompression of temporal fascia, compression-decompression of sphenobasilar joint, parietal lift, frontal lift, scapular waist release and pelvic diaphragm release. “Still points” are quiet intervals between manipulations that happen about every three to four minutes and last up to one minute, during which the patient quietly rests.


CST may offer benefits for people with any of the following symptoms: anxiety, depression, migraines and/or headaches, neck and back pain, stress and tension, motor-coordination impairments, infant and childhood disorders, brain and spinal cord injuries, fatigue, TMJ, fibromyalgia, scoliosis, ADHD and many others.

Below you’ll find more about five of the most common ailments that therapists use craniosacral therapy to help treat.

1. Promotes Relaxation & May Reduce Anxiety or Depression

CST is considered one type of “mindfulness-based treatment approach,” due to how it helps patients feel calmer while focusing their attention on their breath and away from their thoughts. One of the most beneficial things about craniosacral massage is that it often helps people to relax, reduce muscle tension in their body, and deal with various types of stress better.

Craniosacral therapy involves finding certain”pressure spots” or points of tension in the craniosacral system and gently manipulating them in order to reduce tension and increased relaxation. Many practitioners purposefully provide CST treatments in calm, comfortable environments that have a peaceful ambience, helping to facilitate pain relief and decrease symptoms associated with anxiety or depression. CST sessions are usually very comfortable, as the maneuvers are slight and gentle. Clients can also focus on breathing deeply during treatments to further help them relax by increasing activity of the parasympathetic nervous system.

A 2011 descriptive outcome study that was published in the Journal of Alternative and Complimentary Medicine reviewed the effectiveness of Upledger CranioSacral Therapy (UCST) treatments received by 157 patients being treated for a variety of reasons. Patients sought help for reasons including dealing with headaches and migraine, neck and back pain, or anxiety and depression.

The results showed that 74 percent of patients reported a “valuable improvement in their presenting problem,” 67 percent reported an improvement in general well-being and secondary symptoms tied to pain or chronic stress, and 70 percent were able to decrease their medication use or discontinue use altogether.

2. May Help Lower Neck Pain

One of the difficult things about studying the effects of craniosacral therapy is that treatments are so “subtle” it is often hard to determine whether they are directly causing any measurable changes in the body. However, proponents of CST point out that just because CST’s effects cannot always be precisely measured doesn’t mean that certain benefits don’t exist.

One 2015 study published in the Clinical Journal of Pain that compared CST to light touch for neck pain found evidence that CST offered more benefits. The study involved 54 blinded patients that were divided between two groups: one receiving “sham treatments” and one receiving CST.

CST patients reported significant and clinically relevant effects on pain intensity at week eight of the study and again at week 20. At the week 20 follow-up, 78 percent of participants within the CST group reported “minimal clinical improvements” in pain intensity, while 48 percent reported other “substantial clinical benefits.” It was found that there were significant between-group differences reported at the week 20 follow-up, as the CST group experienced greater differences from the start of the study regarding levels of pain when moving, functional disability, physical quality of life, anxiety and overall improvement.

Additionally, at the eight week follow-up, pressure pain sensitivity and body awareness were significantly improved by participants in both groups (this was not reported by either group at week 20). Also importantly, no serious adverse events were reported by participants in either group.


(Gua sha therapy has also been shown to help with neck pain.)

3. Can Help Reduce Headaches

Factors such as emotional stress, tension in the neck or jaw, frowning and clenching the teeth or forehead can all contribute to headaches, as well as pain in the face, neck and shoulders. Craniosacral massage can help to reduce pressure surrounding the head and also decrease migraines or tension headaches tied to high stress levels.

A 2012 randomized clinical trial that was published in the journal BMC Complimentary and Alternative Therapy tested the effects of CST on migraine pain intensity and frequency over an eight week period. Adults with moderate to severe migraines were randomly assigned to two groups: those receiving eight weekly CST treatments and those receiving eight weekly low-strength static magnet therapy (LSSM) treatments.

Results showed that both treatment groups appeared to benefit from their treatments, but that the CST group experienced greater reductions in mean headache hours per day 30 days following treatment. A between-group difference was also found at the four week follow-up point, when the CST group reported greater significant differences in headache-related disability, headache intensity and medication use.

By the end of the eight weeks, headache intensity was reduced more in the CST group compared to the LSSM group, but the difference was not statistically significant. After eight weeks of treatment, pain-killing medication use decreased substantially in both groups.

No data is available about how craniosacral therapy may alleviate cluster headaches.

4. May Help Manage Fibromyalgia Symptoms

Findings from a 2011 study that was published in Evidence Based Complimentary and Alternative Medicine points to the fact that craniosacral therapy can contribute to improvements in quality of life and decreased anxiety in patients with fibromyalgia.

The study included 84 patients that had been diagnosed with fibromyalgia who were randomly assigned to either an intervention group receiving craniosacral therapy for 25 weeks, or a placebo group that was receiving simulated treatments with disconnected ultrasound for 25 weeks. Measurements included changes in anxiety, pain, sleep quality, depression and quality of life at baseline and then again at 10 minutes, 6 months and 1-year following treatment.

The results showed significantly greater improvements in fibromyalgia symptoms, including anxiety, pain, quality of life and sleep quality in the CST intervention group compared to the placebo group, both after the treatment period and again at the six-month follow-up. One year after treatment improvements in sleep quality were still reported, while other improvements were not, which suggests that this type of fibromyalgia treatment needs to be ongoing in order to have the most impact.

5. May Be Beneficial for Autism

The use of hands-on therapy approaches for the treatment of symptoms associated with Autism Spectrum Disorder (ASD) remains controversial, but there is some evidence that patients respond well to mind-body practices including healing touch, “energy medicine” and biologically based manipulative practices.

A preliminary study that appeared in the Journal of Bodywork and Manipulative Therapies introduced craniosacral therapy as one possible treatment option for symptoms of ASD based on findings that CST is already recommended by therapists/doctors due to how studies have found positive responses.

The authors of the study concluded that “there is worthy cause to further investigate how CST benefits Autism Spectrum Disorders (ASD).” The combination of conventional practice and complementary/alternative techniques is often called “Integrative Medicine.” More research is still needed, but it’s possible that CST may help to reduce symptoms associated with ASD including irritability, sensory abnormalities, difficulties with motor coordination, or hyperactivity by positively influencing the nervous system and promoting relaxation.

6. For Infants

Craniosacral massage may offer help for “unsettled babies” dealing with discomfort or other signs of physical and mental stress. Craniosacral therapy is sometimes used in pediatric healthcare when babies display some of the following signs and symptoms: colicteething symptoms, symptoms due to birth trauma (such as due to forceps extraction or an emergency C-section), trouble with breastfeeding or constipation.

How does pediatric CST work, and is it always safe? CST is considered safe for infants due to how gentle and noninvasive treatments are. Treatment can help to deeply relax babies, helping them to feel protected and nurtured, while potentially also alleviating compression in the nervous system that is leading to pain or symptoms. Sessions may benefit a baby’s sleep, digestion and moods by easing tightness in the baby’s mouth, head, back and neck.

Some studies have found that infants undergoing intervention with craniosacral therapy (IG) show no significant changes, but there’s a good deal of anecdotal evidence that many infants benefit in various ways, both physically and mentally, from treatment.


Certification programs for craniosacral therapy are offered by certain colleges or universities for students who meet qualifications. You can choose to take CST courses or complete a certification program even if you’re not already a physician, doctor, nurse, licensed massage therapist or another type of healthcare professional. CST courses can be beneficial for any”layperson” who is interested in using craniosacral adjustments for person/self use, or who wants to learn more about a technique that promotes relaxation and self-awareness.

However, keep in mind that in order to practice CST professionally and treat other people many states will require a license and completion of certain courses and exams. Qualifications to practice craniosacral therapy vary from state to state, just like with massage therapy, acupuncture, yoga, etc. To determine what type of training you need to complete in order to begin practicing CST, it’s best to check with your state licensing board to see what types of laws and restrictions apply.

You can visit the Upledger Institute International for more information on available craniosacral courses, including: CranioSacral Therapy 1 and 2, SomatoEmotional Release 1 and 2, and Advanced CranioSacral Therapy 1 and 2.


Overall there has been mixed findings regarding the effectiveness of craniosacral therapy, which means each person must make their own decision about whether it’s worth trying. For example, a 1999 review published in Complementary Therapies in Medicine found “insufficient evidence to support craniosacral therapy, and in 2006 a report published in Chiropractic & Manual Therapies stated similar findings, that “this treatment regime lacks a biologically plausible mechanism and shows no diagnostic reliability.”

CST is considered to be safe for the vast majority of people, but in order to reduce the risk for further aggravating symptoms, it’s not recommended that CST be performed on people with any of the following conditions in which an increase in intracranial pressure would cause instability: acute aneurysm, cerebral hemorrhage, recent spinal cord injury or severe bleeding disorders.

Final Thoughts

  • Craniosacral therapy (or CST) is a non-invasive, manual therapy performed on the head, skull and sacrum. CST is offered by trained chiropractors, osteopaths, physical therapists and massage therapists.
  • Benefits of craniosacral therapy may include help treating: anxiety, depression, migraines and/or headaches, neck and back pain, stress and tension, motor-coordination impairments, infant and childhood disorders.
  • There is still debate over whether CST is necessarily effective, or simply beneficial because it promotes relaxation, as well as how exactly it works.

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