Craniosacral Osteopathy

Interoception (body awareness) is like a highly sensitive internal radar that constantly monitors the state of your body. Unlike the five traditional senses, which are directed outwards, this ‘sixth sense’ looks inwards and registers subtle changes: a slightly faster heartbeat, shallower breathing when tense, a feeling of fullness after eating, or the subtle tension in the neck muscles. Even your emotions, from joy to fear, become physically perceptible through this remarkable system of perception. Closely related, yet distinct, is proprioception – your ability to know where your body parts are in space. It enables you to touch the tip of your nose with your eyes closed or to walk confidently in the dark by sensing the position of your joints and the tension in your muscles. Interestingly, researchers have discovered a significant correlation: people with precise body awareness appear, on average, to be healthier and happier (Khalsa et al., 2018; Murphy et al., 2019). Well-functioning interoception can act as an early warning system, detecting physical imbalances before they lead to serious health problems (Farb et al., 2015). In contrast, many chronic conditions are characterised by impaired communication between the body and the brain. Interoception is inaccurate. Scientific studies have demonstrated such links in chronic pain syndromes (Di Lernia et al., 2016), functional gastrointestinal disorders (Simrén et al., 2017) and psychosomatic complaints (Schulz & Vögele, 2015). This becomes particularly evident in symptoms without a clear medical diagnosis: here, the problem often lies not in a mechanical ‘malfunction’ of an organ, but rather in the way bodily signals are processed and interpreted (Edwards et al., 2012; Van den Bergh et al., 2017). The insular cortex acts as the body’s translator. Imagine the brain as an interpreter who translates your body’s language into conscious sensations. When interoception is impaired, various ‘translation errors’ can occur: some signals are overemphasised, leading to hypersensitivity; others are barely noticed; and still others are misinterpreted (Craig, 2015; Quadt et al., 2018). These communication disruptions can trigger a cycle in which the brain responds to normal bodily sensations with excessive alarm reactions – which in turn can exacerbate physical symptoms (Payne et al., 2020; Schultchen et al., 2019). In this complex system, a specific area of the brain plays a key role: the insula. The insula functions as a translation centre that converts physical signals into conscious physical sensations and feelings. This is where the brain processes signals such as hunger, thirst, emotions and pain. Interestingly, certain nerve fibres in our skin – known as C-tactile afferents – respond particularly strongly to gentle, slow touches involving minimal pressure (McGlone et al., 2014; Olausson et al., 2010). These nerve fibres transmit their signals directly to the insular cortex. Brain scans have shown that gentle touches on the skin can directly influence activity in the insular cortex (Case et al., 2016). A study using functional magnetic resonance imaging by Cerritelli and colleagues (2020) shows that craniosacral therapy alters activity in the insular cortex in patients with chronic pain. After several sessions, the previously disrupted brain activity in this region returned to normal. These observations provide a plausible explanation for why gentle touch can have therapeutic effects. Craniosacral osteopathy utilises the C-tactile nerve fibres as a direct neurological pathway to the insular cortex and can thereby positively influence the impaired processing of bodily signals. In addition to stimulating the insular cortex, scientific evidence shows that osteopathic treatments can improve interoception – both at a subjective level (measured using questionnaires) and at a neurological level (measured using imaging techniques) (Cerritelli et al., 2020; Emmet et al., 2024; Edwards et al., 2018; Cathcart et al., 2019; Bordoni & Marelli, 2017).

Fascia are whitish connective tissue sheaths that surround every part of our body: muscles, organs, nerves and blood vessels. They form a continuous network from head to toe and contain a surprising number of nerve endings (Stecco et al., 2016; Bordoni & Zanier, 2014). What makes fascia unique is that it responds not only to physical strain but also to stress and emotions. Studies show that prolonged stress can cause the fascial tissue to thicken and harden, leading to pain (Schleip et al., 2019). The fascia contains specialised cells, known as myofibroblasts, which respond to targeted, sustained pressure – the kind of stimulation used in osteopathic techniques, amongst other things. Langevin and colleagues (2021) have demonstrated that fasciae alter their structure and composition in response to stress, injury or inflammation. This not only impairs their mechanical function but also the transmission of nerve impulses and, consequently, our body awareness. Osteopathic techniques act directly on this fascial system. A study by Tozzi et al. (2016) demonstrated that gentle touch can bring about measurable changes in tissue tension. When tension in the fasciae normalises, the transmission of physical signals to the brain also improves – we can perceive our bodies more clearly again. As the fasciae act as the body’s ‘information highway’, their improved structure and elasticity lead to more precise body awareness and, consequently, to better self-regulatory processes.

The architecture of our autonomic nervous system is based on two opposing yet synergistic states: the sympathetic nervous system, which mobilises energy, and the parasympathetic nervous system, which promotes recovery. Just as a vehicle needs both the accelerator and the brake, we need this physiological balance – yet the demands of modern life tempt many of us to remain constantly in ‘activation mode’ and to go about our daily lives with the accelerator pedal constantly pressed down. At the heart of the balance between activation and regeneration lies the vagus nerve, the backbone of our parasympathetic recovery system. It is the largest nerve connection between the brain and the body, running from the head through the neck and chest to the digestive organs. A remarkable feature of its physiology is that around 80 per cent of its signals travel from the body to the brain, continuously transmitting detailed information about our internal state (Paciorek & Skora, 2020). Recent studies provide concrete evidence of the physical effects of craniosacral osteopathy: the research team led by Girsberger (2014) found a significant improvement in heart rate variability following craniosacral treatments in patients with various conditions – a sign of increased activity of the vagus nerve. In addition, Miano and colleagues (2019) demonstrated that osteopathic treatments in people with back pain not only optimise the balance between tension (sympathetic nervous system) and relaxation (parasympathetic nervous system) in the nervous system, but can also improve oxygen supply to the brain. As the main nerve of our relaxation system, the vagus nerve plays a central role in many bodily functions. Its positive effect on fundamental bodily processes is well established scientifically: Healthy vagus nerve activity makes breathing calmer and deeper, helps to normalise heart rate and blood pressure, supports regular digestion and can dampen inflammatory processes – researchers refer to this as the ‘anti-inflammatory reflex arc’. Furthermore, when the vagus nerve is functioning actively, fewer stress hormones such as cortisol are typically released. As scientific evidence grows, further links are emerging: body awareness can improve, blood sugar levels can be regulated more stably, and emotional balance and sleep quality can be positively influenced. Current research is also investigating possible links to the immune system, to cognitive functions such as concentration and memory, to social interaction, as well as to tissue regeneration processes and muscle relaxation.

These three systems – interoception, fascia and the autonomic nervous system – do not function in isolation, but interact constantly with one another. This is precisely where craniosacral osteopathy comes in: through gentle touch, it stimulates the body’s subtle sensory channels and helps the brain to ‘translate’ the body’s signals more accurately once again. It is important to understand that this process does not involve direct ‘repair’ by the therapist, but rather aims to activate the body’s own regenerative mechanisms. The gentle stimuli provide the body with information and prompts, on the basis of which it can make adjustments itself. The basic idea can be succinctly summarised as: as much as necessary, as little as possible.