The ‘ten steps’ is a series of adjustments suggested by John Upledger to balance and improve the function of our craniosacral system. This series is the first treatment given by many practitioners of craniosacral therapy. Many find it helps alleviate problems related to stress and tension experienced by people in today’s hectic everyday.

Treatment consists of gentle, hands on manipulation of the cranial bones and sacrum, in order to free up restrictions within the craniosacral system.

erebrospinal fluid-CSF.

Diagram 1

Our craniosacral system consists of bones (cranium, vertebrae, sacrum and tailbone), connective tissue (dura mater, falx, and tentorium) and fluid (blood, cerebrospinal fluid). Our central nervous system–the brain and spinal cord–is surrounded by a water-tight envelope, containing cerebrospinal fluid-CSF. (Diagram 1.) The envelope is constructed of a tough membrane called the dura. This membrane, along with the spinal cord, leaves the skull through the foramen magnum, an opening an inch or so in diameter in the base of the cranium. The dura surrounding the spinal cord is called the dural tube. It is attached at two upper vertebrae, and again in the sacrum, but is otherwise free to glide within the spinal column. A primary function for this construction is to absorb shock from the outside environment.

The CSF also carries nutrition to, as well as waste products away from the central nervous system. CSF is simply, and ingeniously, filtered from the blood by the ventricles of the brain, and is circulated throughout the system in surges called flexion and extension, creating a craniosacral rhythm. This rhythm can be felt as a pulse almost anywhere on our body, and is intimately bound up with the harmonious and coordinated movement of the skull bones. The frequency of pulses in a healthy craniosacral system varies from 7-12 times per minute.

Problems arise when restrictions occur within the system. For example, a blow to the head can ‘jam’ two skull bones together, or change their normal patter of movement. Such displacement of skull bones (lesions) can likewise result in abnormal twisting or tension of the supportive membranes strategically placed within the brain–the falx and the tentorium. (Diagram 2). 

Diagram 2

Diagram 2

These structures tend to hold their new, unhealthy relationships, giving rise to stress, physical, and psychological symptoms.

Within our skull, nerves and blood vessels pass through small openings (called foramen) in the bones. If the bone has been moved by trauma, undue pressure may be applied to the nerve or vessel, and far reaching results may accrue. Insufficient blood flow to, or from, the brain can bring about headaches, ‘heavy’ feelings inside the head, problems with concentration or learning, dizziness, difficulty in reading, and more. Impinged nerves may cause problems with numbness, digestion, elimination, sight, muscle control, sensation, to name a few.

In my practice, clients are often reporting back changes having nothing to do with the symptoms I was treating, such as: “My feet are no longer cold!” “My sinus problems are gone!” “I’ve started dreaming for the first time in years!” “I sleep better now!” Such incidents are probably due to release of pressure on a nerve, or improved circulation. 


In the 1930’s, an osteopathic physician named William Sutherland was puzzling over the jagged edges of the skull bones, and hit on the idea that such a structure allows them to move, but not glide uncontrollably apart!

Mainstream medicine dismissed this notion for decades, and many anatomy books still consider cranial bones to be immovable. Sutherland explored the implications of bone movement for more than 20 years, founding a system of treatment known as cranial osteopathy.

Dr. John Upledger, in the 1970’s during research at Michigan State University confirmed empirically the movement of cranial bones, as well as the presence of nerves and blood vessels in the sutural membranes. While assisting in a spinal operation, he also experienced the actual movement of the dural tube up, and down, in the craniosacral rhythm.

He continued his work, building on Sutherland’s theories, and has been a leading force in contemporary craniosacral practice and development, establishing also a wide network for training of practitioners. His recent work includes more psychologically oriented approaches and techniques, including somato emotional release, therapeutic imagery and dialogue, and the forward-looking multiple hands/multiple therapists treatment. Upledger has authored many books on the subject.

Another important force in the craniosacral field is Hugh Milne, who advocates a more ‘psycho-spiritual’ approach, including also, for example, sitting quietly with the client, and sensing what he needs.

Alain Gehin, of France, is on the leading edge of new techniques in the field, and has authored a respected compendium of ‘techniques for the cranial bones.