Interior Banner

Osteopathic Cranial Treatment
For Infants and Children

A Patient Information Publication by Osteopathic Medical Services Inc.


Dr. Dale Alsager

Dr. Dale Alsager, D.O., Ph.D.

The Cranial Concept:

The discovery of the "cranial rhythm", an intrinsic rhythmical movement of the bones of the skull, was made by William Gamer Sutherland, D.O. in the 1920s. For years, this discovery was questioned and doubted even within the osteopathic profession until the 1940s when patients, recognizing the benefits of treatments, demanded more doctors be trained in this specialized field. The Academy of Applied Osteopathy published a teaching manual for osteopathic physicians on the subject in 1942. Recent Magnetic Resonance Imaging (MRI) studies (Zanakis et al, 1994) leave little doubt that this cranial movement does exist, is independent of breathing and bean rate, and is the same basic cranial rhythm mechanism described by Dr. Sutherland.

Dr. W.G. Sutherland

Dr. W.G. Sutherland (1873-1954)
discovered the cranial rhythm.

It is believed that the cranial rhythm starts with microscopic expansion and contraction at the cellular level within brain tissue. This fascinating concept proposes that the rhythmic pulsation of individual neuron cells is somehow communicated to each cell in the brain and is precisely synchronized. This synchronized movement (expansion of the entire brain mass) creates an outward force to surrounding structures and cerebrospinal fluid. The fluid is contained within the brain and spinal cord in a closed system, which interconnects by way of a system of small ducts, canals, and spaces called ventricles. Pressure is applied outward and downward, through the hydraulic effect of the cerebrospinal fluid, to the bones of the skull and the sacrum bone located at the end of the spinal column in the pelvis. This rhythmic cranial motion can be palpated on the outside of the skull and the sacrum. The effect on the soft tissue (myofascial) structures can be palpated as a "to and from" motion in other regions of the body as well.

"Cranial treatments focus on re-establishing normal motion and position ..."

Dr. Sutherland and his colleagues in the osteopathic profession conducted exhaustive anatomical research and determined that the suture lines (where the skull bones join together like shark's teeth) contain blood vessels, connective tissue and nerve tissue throughout life and therefore remain vibrant and capable of movement (Ratzlaff, 1978). The shape and beveling of these sutures has been meticulously researched and mapped by the osteopathic profession. They are designed in an ingenious manner which allows flexion of the cranial bones if a force comes from the inside, but presents as a solid wall to protect the brain if a force impacts from the outside.

Cranial treatment

The "cranial rhythm" can be palpated by a physician trained in cranial osteopathy. The objective of osteopathic diagnosis of the cranial motion is to determine whether the movement is "normal" or "abnormal". Trauma to the cranium, or malposition of the cranial bones, results in an abnormal, asymmetric motion and/or an abnormal rate of the cranial rhythm. Cranial treatments focus on re-establishing normal motion and position, using very small, and precisely directed, corrections to cranial bones and suture lines by use of the physician's hands.

Factors Contributing To An Abnormal Cranial Rhythm:

Any trauma from a fall, accident, or impact to either the head or sacrum can jam suture lines together, resulting in cranial rhythm dysfunction. These dysfunctions can persist for years after an injury if not corrected.

The first cranial trauma – a difficult birth – is believed to be the most significant and influential of all traumas to the skull over an individual's lifetime.

Several Factors Contribute To A "Difficult Birth":

Long Labor: Any labor over eight hours is considered in this category.

Arrested Labor: Any labor where there is no progressive movement of the baby’s head through the birth canal for a period in excess of two hours is considered an "arrest" and is, potentially, an emergency situation. Heart rate and vital functions of the baby must be monitored closely during this period and, if vital functions are compromised, intervention such as Caesarian section may be necessary.

Abnormal Presentation: Breech presentations, or any occurrence where there is an interruption to a smooth delivery of the baby's cranium through the birth canal, can result in significant increased pressures being applied to the baby’s cranial mechanism by powerful contractions of the uterus.

Prolonged Engagement: "Engagement" refers to the position of the baby’s head in the cervical canal in preparation for birth. If this occurs early, it is often associated with nocturia (night time urge to urinate) by the mother and this signals the start of a prolonged period of engagement. This can provide excessive pressure, for an inordinately long period of time, on the cranial-sacral mechanism of the baby.

Cephalo-pelvic Disproportion: More than ever before, there is increased risk of the delivery of large babies to mothers with a small pelvis. These disproportions create additional pressure and risk of cranial dysfunction secondary to a difficult birth.

Forceps Delivery: Forceps, in the hands of an expert, can be a life saving device for the baby and/or the mother. However, if forceps are applied inappropriately, they can create abnormal and undesirable strain forces and may damage the cranial mechanism of the baby.

Vacuum Extraction: Like forceps, vacuum extraction is often heralded as "life saving" in cases of difficult births. Indeed, if they are properly placed, they can assist greatly in the movement of the baby’s cranium through the birth canal in a timely manner. However, vacuum extractors are difficult to position precisely on the cranium. For example, in cases where the vacuum extractors are placed off the midline, and are pulling only from the parietal bone on one side, a significant strain pattern and disproportionate positioning of the parietal bone, relative to other cranial structures, occurs. These babies are often born with a severe parallelogram-type head malformation that is referred to as quadracephaly.

Pitocin followed by Epidural: This is becoming a very popular method used by obstetricians in managing labor and birth pain. The most common reason is to schedule the birth for a specific time of day for convenience of the doctor and/or the mother. Pitocin causes contractions of the uterus. If it is applied too soon, or in too heavy a dose, it can result in very powerful force to the baby’s head prematurely. If the cranium of the baby is engaged in the pelvic region, without appropriate ligament relaxation and dilation of the cervical structures, the force can be injurious to the cranial mechanism. The epidural infusion of an analgesic medicine to block the pain removes the mother from sensations which ordinarily would signal that all is not well.

Caesarian Section: "C"-Sections, in some cases, are life saving and necessary operations. However, there are times when they are done for the convenience of the physician, the mother or family. One would think that delivery by c-section would remove a baby from any risk of cranial compression. Unfortunately, research indicates that a normal, natural birth process is necessary to precipitate a gradual introduction of the baby to the external environment. There is a surging action that occurs in the normal process of delivery that predisposes baby to the atmospheric environment gradually. It is believed this surging action may be important in initiating the cranial respiratory mechanism. This action does not occur during c-section and in fact, baby is exposed to sudden atmospheric decompression.  The cranium then experiences a sucking or negative pressure change. Babies born by c-section often have abnormally low cranial rhythms which do not benefit from the jump start mechanism that the cranium gets through the normal process of labor and natural delivery. The most important thing in labor and delivery is to achieve natural normal delivery over the shortest period of time. This is most advantageous to the baby and the most likely method of initiating a smooth, natural and normal cranial rhythm.

Can Anything Be Done To Make Birth Easier?

Regular osteopathic treatment throughout pregnancy: During pregnancy, a normal process takes place which allows gradual relaxation of ligaments in the pelvic area in preparation for birth. While this serves an important function during pregnancy, it can also cause excess joint laxity, and an increased tendency for hip bones and sacrum to slip out of position. Osteopathic treatments focus on the proper alignment of these joints and surrounding structures periodically throughout pregnancy and greatly facilitate the expectant mothers comfort, reduce complications, and facilitate easier labor. Dr. Alsager's unique McManis treatment tables contain a modification which allows patients to lay comfortably and safely face down for back and pelvic treatments throughout pregnancy.

Proper motion of the sacrum, symmetrical positioning of the innominate (hip) bones, as well as relaxation techniques for specific pelvic muscles, are of great assistance to the expectant mother. Osteopathic treatments not only facilitate an easier, more comfortable pregnancy, but also contribute significantly to easier and shorter deliveries.

Employ the least intervention reasonable during labor and delivery: The osteopathic philosophy dictates that, when possible, the most natural course for labor and delivery should be employed. The osteopathic physician's role is to aid the body’s natural functions and to allow a normal, natural birth to occur. Interventions, such as Caesarian sections, epidurals, Pitocin drips and other procedures should be used with great caution and only where a situation represents an imminent danger to mother and/or baby. The most successful outcomes are usually those in which the doctor and the mother allow, to the fullest extent possible without endangerment to baby and or mother, the normal birth process to unfold in a natural way.

Avoid cutting the umbilical cord until after the last pulsation: It is important during the birth process to avoid torque (twisting) in the umbilical vessels. Evaluations of newborn abdominal organs indicate that torque patterns can be transmitted to the baby and manifest as colic and other abnormal function in the baby’s abdomen and/or bladder. During the birth process, it is important to remember that blood is still being pulsed through the umbilical vessels to the child. Many physicians feel that it is important not to cut the cord prematurely in order to achieve the full effect of placental circulation. Effort must be made to avoid torque lesions which may be transferred via the umbilicus to the newborn child's abdominal and pelvic organs.

Minimizing The Effects Of A Difficult Birth

The Benefits of Crying:

The first cry: There are many theories and opinions about the first cry. However, there remains little question that crying expands the dural membranes, opens the alveolar sacs deep in the lungs, and ensures a prompt expansion and aeration of the lungs. It also provides a kick-start to the all-important cranial rhythm.

Subsequent crying: It is probable that crying for up to five minutes per day assists in the development of the cranio-sacral mechanism and may well be very therapeutic. It also assists in the development of the lung tissue (alveoli), as well as the muscles of respiration. If crying becomes excessive, or is caused by some discomfort, then the cause needs to be identified and corrected immediately.

The first breath: Many doctors believe strongly in the importance of the baby’s first breath. If the breath is strong, full and unrestricted, the baby’s entire respiratory mechanism operates efficiently and effectively. If baby's first breath is inhibited by myofascial restrictions, or rib dysfunctions from a difficult birth, pulmonary inefficiency results causing poor oxygen exchange, infections, weakness, lethargy, and irritability.

Breast vs. Bottle Feeding

The benefits of breast feeding far outweigh those of bottle feeding. It’s natural, convenient, nutritional, and provides important early immune function to the newborn. There is also evidence that the child will benefit considerably through improvements in cranial motion that are missed by bottle feeding. In the skull of the newborn, there is an important structure known as the cruciate suture, which, if set in motion, can stimulate Spheno-basilar symphysis motion, an important part of the cranial rhythm. The shape and length of the breast nipple is such that when a strong sucking action is applied in baby’s mouth, the nipple is used by the baby to compress the cruciate suture region thereby stimulating Spheno­basilar symphysis motion and improving the cranial rhythm.

The artificial nipple used for bottle feeding is insufficient in length to provide this important function. It is well known that breast fed babies are more calm, less stressed and generally happier babies than those counterparts who have been bottle fed. The benefits of breast feeding are well outlined in many references and leave little doubt that the advantages far outweigh the disadvantages. Breast feeding is strongly recommended unless there is a specific pathology or problem preventing it.

Osteopathic Cranial Manipulation, directed at freeing up cranial suture line restrictions, is the safest and quickest way to restore a normal cranial rhythm.

What Are The Benefits Of Cranial Manipulation In Children?

In Infancy:

The Occiput bone

The Occiput bone contains a hole
through which the spinal cord passes.
The joint (synchondrosis) between
the Occiput (below) and
the Sphenoid bone (above) is
a key "joint" deep within
the skull capable of many movements
and positions.

Spitting Up: This is a frequent problem with newborns where ingested milk and other materials are vomited by sudden, involuntary contractions of the stomach. One possible cause of this stems from compression of the occipital condyles against the underlying first cervical vertebra causing tension and/or irritation of the X, XI, and XII cranial nerves, which exit the skull near its attachment to the spinal column. The XII cranial nerve innervates the tongue and, in conjunction with the IX cranial nerve (Glossopharyngeal), controls the sucking and pharyngeal muscle movements. Very closely approximated is the X cranial nerve (the Vagus nerve) which innervates the stomach, esophagus, GI tract, lungs, and other structures in the abdomen. The XI cranial nerve influences the swallowing function of the muscles of the tongue, throat, and neck. Compression or damage to either one of these nerves during the birth process can result in problems with spitting up, tongue thrusting, swallowing, or sucking. These dysfunctions often respond quickly to cranial treatments which decompress the occiput and the first two cervical segments of the spinal column. Once the tissues are normalized and strain patterns in this area are removed, spitting up and sucking difficulties usually resolve immediately and breathing is restored to its fullest potential.

Colic: Colic frequently results from dysfunction or compression of the Vagus nerve which innervates the stomach and gastrointestinal tract. If this nerve is compressed or irritated through strain patterns from a difficult birth, colic can result and go on for a long period time if not corrected. Strain on the dural membranes at the base of the skull can be relieved quickly and easily by two or three cranial treatments which often result in a marked improvement of these symptoms in newborns.

Irritability: Strain on dural membranes attached to the inside surface of the skull bones can cause stress and dysfunction at a number of regions within the central nervous system. During early development, these strain patterns and dysfunctions can manifest in the form of irritability. Babies with such strain patterns often exhibit symptoms such as excessive crying, fussiness, excessive startle reaction to noise, anxiety, fear, and emotional upset. Frequently, when these strain patterns are corrected through cranial manipulation, the irritability resolves.

Restless Sleep: Strain patterns occurring through uncorrected cranial bone compression can result in inability of the baby to achieve restful sleep. Uncorrected strain patterns result in neurotransmitter imbalances and developmental abnormalities which can affect the sleep center in the baby's brain. Under these conditions, irritability and other symptoms result. Cranial treatments may correct these symptoms.

Poor Sucking Response: Some babies have difficulty from the beginning in developing a strong sucking reflex. Sucking is a function of the IX and XII Cranial Nerves which exit near the base of the skull. Compression and strain patterns developed during birth, if uncorrected, can result in a poor sucking response with subsequent colic, spitting up problems, and irritability. Cranial treatments which address decompression of the XII cranial nerve at its exit from the skull can result in a remarkable change in sucking behavior.

Overriding Sutures: A suture line is the area where two cranial bones contact one another. The cranium of a newborn baby is amazingly flexible and resilient. Sometimes, in order for the cranium to exit the birth canal, cranial bones (which are merely calcified plates within dural membranes at birth) are capable of overriding each other in order to reduce the volume and size of the cranium while it passes through the birth canal. It is common to see the sutures overlapping each other in newborns. They usually correct on their own within one or two days, following a natural, uncomplicated birth. If they fail to correct in this period of time, intervention through cranial treatments is warranted, otherwise permanent damage, or malformation of the skull, may result.

Plagiocephaly

Side bending and rotational
dysfunctions can occur at
the sphenoid basilar synchondrosis,
causing internal strain patterns
within the skull, and a deformed
skull known as plagiocephaly.

Plagiocephaly: This refers to a deformity of the skull which results from strain patterns that occur during the birth process. Often, the skull is pressured on one side more than the other resulting in a parallelogram deformity where the cranium and the brain stem do not line up properly following birth. One side of the skull will be protruding superiorly with the opposite side protruding inferiorly. Properly directed cranial treatments to newborns and infants can correct these deformities and result in nicely molded and well formed physical features.

Torticolis: This is a condition caused by unusual strain forces coming down from the top of the head at an angle, forcing the base of the skull and neck to one side and back during birth. This strain pattern produces an abnormal stretch on one side of the neck and compression on the other. Temporary paralysis and damage to nerves and muscles on one side can result in muscle spasms which pull the neck and ear down toward one shoulder. If this is not corrected, it can result in a condition where the neck is permanently bent severely to one side with the head being turned in the opposite direction. There are numerous cases of torticolis in adults that can be traced back to birth. These strain patterns, if treated early after the birth injury, can be corrected, thus avoiding permanent disfiguring.

Lacrimal Duct Obstruction: Abnormal drainage from one eye of a newborn is a condition commonly seen. It results from lacrimal duct obstruction on one or both sides. The most common cause is rotational strain patterns that occur in the bones surrounding the eye orbit. Torsion patterns within the soft tissues result in crimping or strains on the lacrimal duct mechanism which results in blockage. Eyes are then prone to infection. This situation can often be corrected and/or prevented by re-positioning the bones surrounding the eye orbits and correcting the strain patterns. Often when these cranial treatments are completed, the lacrimal ducts regain normal function and frequency of eye infections drops considerably.

Nasal Congestion: Nasal congestion in newborns and infants is often the result of direct, sustained compression of bones and structures in the nasal region during the birth process. These forces and regions can be decompressed following birth so that drainage of the nasal sinus structures, including the Eustachian tubes, are facilitated. Normal drainage and function in this region results in fewer allergies, colds and middle ear problems, such as otitis media.

Molding the cranial membranous mechanism: The skull of a newborn child is a very moldable, flexible structure. Cranial treatments applied early are often very effective in remolding a misshaped skull in order to achieve a well-rounded and nicely proportioned cranium. Both direct and indirect treatments are very effective in achieving this, usually within a series of eight to twelve treatment sessions. There are now published case reports which indicate that treatments over a longer period of time can improve the shape of abnormal cranial phenotypes, such as Down Syndrome. (Sorrel, M.A., 1995). Osteopathic cranial treatments have been shown to effect such a change in physical appearance, that by age four or five they no longer appear physically "different" from their peers.

Osteopathic treatments soon after birth are very effective at correcting dysfunctions of the breathing mechanisms and help to ensure physiologic development of the baby to its full potential.

In Childhood

Developmental Delays: Developmental delays may be caused by imbalances in neurotransmitters and neurosensory brain dysfunction.
These imbalances may be caused by birth trauma, strain patterns and dysfunction related to structural stress and/or uncorrected cranial dysfunction. Osteopathic cranial treatments may help prevent developmental delays.

Learning Disabilities: Developmental delays often result in, and manifest later as, learning disabilities in a school environment. Frequently, these are the result of vision problems, undetected hearing problems, or cognitive disabilities which may or may not be related to structural strain patterns resulting from a difficult birth. Cranial treatments focus on identification and correction of these dysfunctions at the earliest possible age and can be very helpful.

Chronic Recurrent Ear Infections (Otitis Media): This is a very common problem that seems to have reached epidemic proportions in America. Infants and children have a very short and wide Eustachian tube (the structure responsible for drainage of fluid from the middle ear to the throat). Because of easy compressibility of these structures in the upper neck in infants and children, crimping or blockage of the Eustachian tube occurs frequently. If there are strain patterns and malposition of cranial bones and/or upper cervical vertebrae, this is more likely to happen than not. Cranial treatments focus on correction of abnormal positions of these structures and reduction of myofascial strain patterns to facilitate optimum drainage. Cranial treatments should be the first line of treatment for chronic otitis media and may eliminate the need for surgical intervention, such as the placement of "tubes" in a child's eardrums.

The maxillary bone

The Maxillary Bone: Holding the upper
teeth and the large maxillary sinus
cavities, proper function and position
facilitates improved bite, sinus drainage,
and symetrical facial features.

Chronic Sinusitis: Normal motion of cranial bones in infants and children is necessary for proper drainage of the sinus cavities in facial bones through small openings into the nasal pharynx. Malposition or improper movement of the bones containing the sinuses (the frontal bones, the ethmoid bones or the maxillary bones), can result in defects in drainage. Stagnation of fluid and phlegm within the sinuses can occur which provides an opportunity for bacteria to grow and multiply. When this happens, recurrent sinus infections occur. Cranial treatments, directed at the normalization of the movement of these facial bones, can facilitate improved drainage and significantly reduce the frequency of chronic sinusitis in children.

Scoliosis

Early Childhood Scoliosis: Scoliosis is an abnormal side bending curvature in the spine. It occurs more frequently in young girls than boys, and can progress rapidly resulting in severe disfigurement and dysfunction if not treated early. When it occurs in childhood, there is often an underlying cause in the muscular skeletal system. In other words, scoliosis is often a symptom of something else wrong. Frequently, it is associated with an abnormal position of the sacral bone at the base of the spine, or abnormal growth in one of the long bones of the leg, resulting in an "unlevel" sacrum or pelvis. The backbone will then curve in an "S" or a "C' pattern to compensate for the "tipped" pelvis or sacrum.

Cranial strain patterns at the spheno-basilar symphysis at the base of the skull are often associated with scoliosis. A tough connective tissue called "Dura" attaches firmly to the inside of the skull, to the body of the second cervical vertebra, and to the body of the second segment of the sacrum thus establishing a direct physical connection between cranium, neck and sacrum. Cranial and sacral treatments focus on identification and treatment of these abnormal strain patterns and are important interventions for the best possible prognosis. Dr. Alsager's clinic specializes in the early diagnosis and treatment of childhood scoliosis.

ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactive Disorder): The exact cause of these personality dysfunctions is unclear, however, there is a question of birth trauma as a possible underlying factor. There is a high correlation between these conditions in childhood (and even in adults), and a difficult birth. It is quite possible that chronic strain patterns, or restrictions in cranial motion may result in an imbalance of neurotransmitters or changes in brain chemistry which can result in these personality disorders later in life. Cranial treatments aim to "fix" the house within which the brain "lives" and often result in an increase in function of the brain and spinal nerves. Young patients receiving regular cranial checkups and osteopathic treatments frequently display calmer personality, less anxiety, less anger, longer sleep habits, and reduced stress, compared to children who do not.

Clinical studies indicate that only 8% of births are without osteopathic cranial lesions. In other words, approximately 92% of births are found to have specific cranial, sacral, or other osteopathic misalignments or strain patterns as a result of the birth process. It follows that 92% of newborns would benefit by early osteopathic evaluations and treatment to correct these abnormalities.

The relationship of the occipital condyles to the hypoglossal and vagus nerves: There are four occiput bones at the base of the skull at birth, which later join to form a single occiput bone. The relationship of these four bones to the hypoglossal, glosso-pharangeal, and vagus nerves on each side of the base of the skull needs to be assessed early following birth. The most important intervention is to establish a release of the pressure against the X, XI, and XII cranial nerves. Early decompression of these structures following birth, allow normal function of important digestive, swallowing, and sucking activities.

S2 and S3-4 interosseous strain patterns: These are most commonly found at the sacrum on the left side. The sacrum is in five pans at birth and later fuses to form one bone. Osteopathic treatments can assure proper positioning of the sacrum relative to the lumbar and hip bones and can greatly facilitate function and development. Sacral leveling treatments in children will prevent structural abnormalities, such as scoliosis, later in childhood.

Persistent bedwetting and other bladder dysfunctions: Often torsion patterns in the uracus ligament and connecting pelvic fascia can result in dysfunction of the bladder and its (valve) sphincter in childhood. Bladder repositioning, by osteopathic manipulation of the uracus ligament, can often facilitate improved function and help achieve normal developmental milestones.


Blood vessels on the inside of the parietal bones

The impression made by blood vessels on the inside of the parietal bones illustrate the close correlation between bone position and blood flow within the skull. Small changes in structure (position) can make big differences in function where blood flow to the brain is involved.

The orbits (eye sockets): These are made up of seven bones on each side of the skull surrounding the eye. Proper positioning of the bones will help maximize eye development and function. Other benefits include reduced lacrimal duct problems, eye muscle strain, visual defects, headaches, and sinusitis.

The temporal mandibular joint

The temporal-mandibular joint.
Improper position causes
"jaw click" and TMJ pain.

Temporal-mandibular joint (TMJ) problems: TMJ involves the articulation between the mandible (jaw bone) and the temporal bone of the skull. The mandible functions like a hinge that attaches on each side of the skull at the temporal bone. If a strain pattern is present which pulls the occiput inferior or posterior on one side, the temporal bone will follow. If the temporal bones are not properly aligned on each side of the skull, the "hinge" cannot operate symmetrically. The joint will then have to dislocate partially, or move asymmetrically, in order to accommodate the articular surface of the temporal bones. Later in life, this manifests as a "jaw click" and may result in chronic joint inflammation and pain. These problems can be prevented by proper alignment of the temporal bones early in life. Dr. Alsager provides treatment for all ages suffering from TMJ pain using osteopathic cranial manipulation and custom built intra-oral appliances.

Training in Cranial Osteopathy

Instruction in cranial osteopathy was initiated by William F. Sutherland, D.O. in the 1940's and has remained the hallmark of training in the cranial field. The Cranial Academy, 8606 Allisonville Road, Suite 130, Indianapolis, Indiana, remains the primary accrediting agency for training in cranial manipulation. Recognized courses in cranial manipulation are scrutinized by The Cranial Academy which sets a very rigorous standard of performance and qualification for the osteopathic profession.

The Sutherland Cranial Teaching Foundation, 5116 Hardwood Drive, Fort Worth, Texas, 76109, is the only other accredited teaching facility for doctors.

Note that there are many other practitioners (dentists, physical therapists, massage therapists, acupuncturists, chiropractors, and others) who advertise "cranial-sacral" treatments. Some have learned skills on their own initiative, and others through correspondence and/or weekend short courses. Some of these therapists provide good service and quality treatments. However, there are many who are inappropriately or inadequately trained and provide ineffective treatments. It is important for consumers of cranial therapy to recognize that the gold standard for cranial manipulation training is membership in and/or training provided by The Cranial Academy or The Sutherland Cranial Teaching Foundation. These courses and certificates are only made available to qualified physicians. This is the best assurance that the cranial treatments you are paying for, or receiving for your child, will provide maximum benefit.

Dr. Alsager has completed both basic and advanced courses sponsored by The Cranial Academy. He regularly attends continuing medical education courses to supplement and update his training in this specialized field. Dr. Alsager has also performed as a Teaching Assistant at the Kirksville College of Osteopathic Medicine in Kirksville, Missouri, for Basic Cranial Manipulation courses sponsored by the Cranial Academy.


Dr. Dale Alsager

Dr. Alsager has completed both basic and advanced
courses sponsored by The Cranial Academy.

Articulated and disarticulated skull specimens are maintained at both Bellevue and Maple Valley clinics for patient education and demonstration purposes.

Contact an Osteopathic Physician Cranial specialist near you for cranial assessments and treatments.

SCIENTIFIC REFERENCES RELATING TO CRANIAL RHYTM

Arbuckle, Beryl: The cranial aspect of emergencies of the newborn. JAOA. May, 1948. P 507-510.
Cranial reinforcements from a manipulative standpoint: articulations, stress bands, buttresses. JAOA. 49.188. Dec. 1949
Effects of uterine forceps upon the fetus. JAOA. May, 1954
Subclinical signs of trauma. JAOA. Nov. 1958
Scoliosis capitus. JAOA. Oct. 1970
Baker. E.G.: DDS Alteration in width of maxillary arch and its relation to sutural movement of cranial bones. JAOA. February 1971
Becker, Rollin: Diagnostic Touch: it's principles and application. AAO Yearbooks. 1963-64-65
Whiplash injuries. AAO Yearbook. 1964.
Craniosacral trauma in the adult. Osteopathic Annals. May, 1970
Brierly, J.B. & Field, E.J.: The connections of the spinal sub-arachnoid space with the lymphatic system. Journal of Anatomy. 82(1948). 153-166.
Dovesmith, Edith: The growing skull and the injured child. AAO Yearbook. 1967
Fryman, Viola M.: The expanding osteopathic concept. Published by the Cranial Academy. 1960. (out of print)
Palpation, its study in the workshop. AAO Yearbook. 1963
Relation of disturbances of cranio-sacral mechanisms to symptomatology of the newborn: a study of 1,250 infants. JAOA, June 1966
The core link and the three diaphragms -unit for respiratory function. AAO Yearbook. 1968.
A study of the rhythmic motion of the living cranium. JAOA, May, 1971
The trauma of birth. Osteopathic Annals. May, 1976
Learning difficulties of children viewed in the light of osteopathic concept. JAOA. Sept. 1976
Gelb, H. Editor (17 authors): Clinical management of head, neck, and TMJ pain and dysfunction, a multidisciplinary approach. Publisher: Saunders, 1977. (Lay, E., Chapter 17–The osteopathic management of TMJ dysfunction).
Girgis, F.L.: Pritchard, J.L.: & Scott, J.H.: The structure and development of cranial bones sutures. Journal of Anatomy. 90(1956). p. 70-86
Greenman, Phillip: Roentegen findings in the cranio-sacral mechanism. JAOA. September. 1976
Handy, C.: History of cranial osteopathy. JAOA. January, 1948
Harakal, John: An osteopathically integrated approach to the whiplash complex. JAOA. June, 1975
Kappler, Robert: Osteopathy in the cranial field-history, scientific basis, and current status. Osteopathic Physician. February, 1979
Kimberly, Paul: Case histories. Osteopathic Profession. March, 1945.
Osteopathic cranial lesions. Journal of A.0.A. Vol. 47, No.5. 1948
Discussion of paper: The force behind the cranio-sacral mechanism. Journal of Osteopathic Cranial Association. 1948.
Implication of cerebrospinal fluid distribution in the therapy of the healing arts. The Biological Bulletin. October 1948.
The application of the respiratory principle to osteopathic manipulative procedures. Journal of A.O.A. Vol., 28. No. 7. 1949
Outline of the cranial concept. Ed. 2. Published by the author. 1950. (out of print)
Modus operandi of cranial lesions. Academy of Applied Osteopathy. Year book, 1951.
Cranial contribution within the academy. Academy of Applied Osteopathy. Year book, 1961.
Karr, Irwin: The trophic function of nerves. JAOA. October 1979.
Lay, Edna: The osteopathic management of trigeminal neuralgia. JAOA. January. 1975
Teaching cranial therapy lo undergraduates. Osteopathic Annals. May, 1976.
The osteopathic management of TMJ dysfunctions. Clinical management of head, neck, and TMJ pain and dysfunction, a multidisciplinary approach. Chapter 17, 1977.
Lay, E.: Cicora, R.A.: Tettambel, M.: Recording of the cranial rhythmic impulse. JAOA. October, 1978.
Lippincott. Howard: Osteopathic technique of W.G. Sutherland. AAO Yearbook. 1949.
Magoun, Harold I. Sr.: Clinical application of the cranial concept. JAOA. April, 1948.
Osteopathy in the cranial field. 1st Edition. 1951
As the twig is bent. Published by the Sutherland Cranial Teaching Foundation. 1959.
The work of our hands. Published by the Sutherland Cranial Teaching Foundation. 1959.
Osteopathic approach to dental enigmas. JAOA. October, 1962.
Whiplash injury: a greater lesion complex. JAOA. February, 1964.
The cranio-cervical junction. D.O. Magazine. September, 1964.
Osteopathy in the cranial field. 2nd Edition. 1966.
Entrapment neuropathy. (published in 3 parts). JAOA. Feb., March, April, 1968.
Pertinent approach to pituitary pathology. D.D. Magazine. July, 1971.
Idiopathic adolescent spinal scoliosis: a reasonable etiology. D.O. Magazine. February, 1973.
Temporal bone: trouble maker in the head. JAOA. June, 1974.
Trauma: a neglected cause of cephalgia. JAOA. January, 1975.
The cranial concept in general practice. Osteopathic Annals. May, 1976.
The dental search for a common denominator in craniosacral pain and dysfunction. JAOA. July, 1979.
Miller, Herbert: Head pain. JAOA. October. 1972.
Mines and Pinder, D.O.: Fetal cranial stresses during pregnancy and parturition. JAOA. October. 1954.
Mitchell. F. & Pruzzo, N.: Investigation of voluntary & primary respiratory mechanisms. JAOA. June. 1971
Retzlaff. E.W. and Associates: Cranial bone mobility. Research report. JAOA. May, 1975.
A preliminary study of cranial bone movement in the squirrel monkey. Research report. JAOA. May, 1975
Possible functional significance of cranial bone sutures. Report. 88th session American Association of Anatomists. 1975.
The structure of cranial bone sutures. Research Report. JAOA. February, 1976.
Craniosacral mechanism. Research report. JAOA. December, 1976.
The detection of relative movements of cranial bones. Research Report. JAOA. December, 1976
Nerve fibers and ending in cranial sutures. Research Report. JAOA. February, 1978.
Schooley, Thomas: Embryologic development of the central nervous system. Osteopathic Annals. May, 1976.
Sorrel, Margaret A: Osteopathic Treatment of Down Syndrome Children. The Cranial Letter, Vol. 48. No.2, May 1995.
Speransky, A.D.: A basis for the theory of medicine. International Publishers, Inc. 1943.
Sutherland, Ada S.: With thinking, lingers, the story of W. G. Sutherland, D.O. Published by the cranial Academy. 1962.
Sutherland, W.G.: The cranial bowl. Published 1939. Reprinted by the Cranial Academy. 1948.
Upledger, John E.: The reproducibility of craniosacral examination findings: a statistical analysis. JAOA. August, 1977.
The relationship of craniosacral examination findings in grade school children with developmental problems. JAOA. June, 1978.
Upledger, J.E. & Kami, Z.: Mechano-electric patterns during craniosacral osteopathic diagnosis and trea1menl. JAOA. July, 1979.
Wales, Anne: The work of W.G. Sutherland, D.O., D.Sc. (Hon). JAOA. May, 1972.
Wales, A.L. & Sutherland, A.S., Editors: Contributions of thought, a compilation of W.G. Sutherland’s lectures and writings (covering 1914-1954).
Weaver, Charlotte: Cranial Vertebrae. JAOA. 35:328. March, April, May, 1936.
Etiological Importance of cranial intervertebral articulations. 35:515. July 1936.
Symposium on plastic basicranium: traumatization of plastic basicranium other than obstetrical. 37:290. JAOA. March 1938
Woods, John & Woods, Rachel: A physical finding related to psychiatric disorder. JAOA. August, 1961.
Woods, Rachel: Structural examination in infants and children. JAOA. May, 1973.
Zanakis, M.F., Cebelenski, R.M., Dowling, D., Lewandowski, M.A., Lauder, B.S., Kircher, K. T., and Hallas, B.H.: The Cranial Kinetogram: Objective Quantification Of Cranial Mobility In Man. JAOA Vol. 94, No. 9, pg. 761, Sept. 1994.

For more information, contact:

Osteopathic Medical Services Inc.
Dr. Dale Alsager, D.O., Ph.D.,
Osteopathic Physician and Surgeon
Phone: 206-910-0907


Mailing Address

PO BOX 1010
Maple Valley WA, 98038


Phone
206.910.0907