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Functional, Structural, Craniosacral and Craniostructural

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This post explores the differences between functional, structural, direct, and indirect techniques. You can review those concepts with this other post if you are unclear about their comparison and contrasts. It will be essential to understand those terms before reading the rest of this post.

Further, it discusses the difference between the more functional approach of craniosacral and craniostructural techniques.

Bio-mechanical cranial techniques focus on quality, balance, and movement amplitude. These therapeutic changes happen through introducing external forces to change structure and function. Traditional osteopathic cranial tends to be light, indirect, and functional. Craniostructural techniques tend to be firmer and more direct. Also, craniostructural techniques offer a very different level of structural cranial work.

Although direct techniques are usually associated with structural techniques and indirect techniques are often associated with functional techniques, it is not always true.

Direct vs. Indirect Techniques

Indirect techniques tend to balance motion. They are usually much lighter and quicker. Direct techniques create space and increase the range of motion. By expanding the direction of the restriction, they also balance the movement.

The impact of direct and indirect technique on flexion and extension

Here’s a brief illustration showing the different effects of direct techniques and indirect techniques.

  • The top bar shows the full range of motion.
  • The second bar shows a case with restricted flexion.
  • The third bar shows the case after indirect treatment (toward the direction of ease) of restricted flexion. This approach improves the balance of movement without much change in the total range of motion.
  • The bottom bar shows that case after direct technique (toward the direction of bind) of restricted flexion. This approach improves range of motion and improves balance.

Direct, Functional Techniques

Direct, functional techniques can be handy in quickly re-establishing function. For example, chiropractors and osteopaths often use quick, light techniques to free up binding joints. Similarly, therapists often use gentle sustained direct pressure to re-establish joint play.

Cranial therapists employ this approach when distracting sutures. Gentle suture separation often restores function while reducing local swelling and tenderness. Decompression techniques like temporal distraction and frontal lift are complex in their effects. However, extended or firm pressure can render them as direct techniques.

Direct functional techniques are handy to quickly and systematically balance the craniosacral system. Balancing a torsion or strain pattern can often be as simple as releasing a few jammed sutures. CranioFunctional Organization is a process for systematically balancing the craniosacral and somatic systems. It removes functional problems, like binding joints, without making structural changes, like lengthening fascial membranes. Functional Organization offers quick relief. However, it is usually less lasting in its relief.

Direct Structural Techniques

Structural techniques take longer or employ firmer pressure as they change the shape and length of structures. Simple sutural releases involve longer, firmer releases until the suture has changed in the articular structure. This is about lengthening the fibers that cross the joint, not just re-establishing joint play.

Remodeling bones is a direct, structural technique as well. It is easier in young children but possible through direct technique in adults.

But, why?

Cranial releases create changes in the musculoskeletal systems of the body. Some are more general, like correcting pelvic tilt with SBS patterns. Some are more specific, like releasing a particular trigger point in the adductor with sutural releases.

Structural releases in the cranium create lasting changes in its ability to self-correct. In turn, this creates lasting changes in myofascial structures of the body that functional work does not.

Hancock’s CranioStructural Techniques

Hancock coined his approach as “CranioStructural Techniques.” The name seemed to imply that the approach was more active and that Primary Respiration changes through structural techniques. This is contrasted with other craniosacral approaches that change the craniosacral function by working through The Tide.

His manuals on “CranioStructural Techniques” are focused on the functional organization of the cranium, not structural change. However, he also saw the postural (gross structural) changes in the body that resulted from these craniostructural techniques. As mentioned above, some of those changes were global, and some were specific to a trigger point. So, “structural” didn’t just apply to the technique but also refers to the postural structure.

He called his advanced work “CranioStructural Integration” as he compared it to Rolf’s Structural Integration. He would speak of how craniums that had regular osteopathic cranial had very even joint play. But, at the same time, those craniums had strong structural imbalances and limited range of motion. The balanced structure through increased range of motion improves the system’s ability to pervasively self-correct.

Structural cranial releases create lasting changes
in the body’s ability to self-correct.

Case of CranioMuscular Shoulder Work

Those corrections in posture, trigger points, and other musculoskeletal problems became lasting changes with structural releases. For example, look at this post about releasing rotator cuff trigger points. When taking time to understand the correlation, go through structural releases, and test to see that they last, bodies become better at self-correcting.

In the story about the golf swing, it became apparent that the rotator cuff problem was returning after I treated the local joint and trigger points. So, I ferreted out the structural restriction.

Interestingly, this was not a pattern that I learned when working with Hancock. Years later, I spoke with Hancock and Barber. They confirmed that they had found the same structural pattern for rotator cuff muscles.

Structural Release Process

Anyway, the structural release process involves a more extended and more involved release of the suture. I worked the suture until the muscle engaged strongly. Then, I had the client stand, walk around the table a few times and try his golf swing. When the pain would return, I would put him back on the table and see that the muscle weakened. After the third time, the pain was gone from the golf swing. As well, the muscle remained strong after he laid down. Then, I used functional techniques to balance the craniosacral system.

That session was over 12 years ago. I still see the client from time to time. The shoulder pain has not returned.

Structural approaches in the cranium take trigger point work, postural correction, and pain relief to a new level of lasting relief.

Functional Follow-up

IMHO, structural work without functional organization it is just unkind to the patient. I’ve had many patients come in and talk about the settling period that they go through after osteopathic treatment. It has happened to me as well. I’ve had the osteopath tell me that the next few weeks are going to be uncomfortable as the “work settles.” But that’s another story for another post.

Structural releases create a body that is better at self-correcting. Functional Organization balances the body and creates relief. Structural releases can create functional imbalance and should be followed by Functional Organization.