About Cranio Fascial Dynamics (CFD)
Cranio Fasical Dynamics
Cranio Fascial Dynamics (CFD) is the result of a revelation and extensive research and development by Jonathan Howat since 2004 to a point where it is now available for clinical application. His aspiration for the future of CFD is that it should be regarded as an option and a breakthrough treatment in traumatic brain and head injuries (TBIs).
The objective of CFD is to identify the cranial torque the body has been subjected to from birth and throughout life and looks to reverse this process by de-torqueing the brain, then brainstem and spinal cord through the fascial system to allow the brain to drain blood and lymph.
Underpinning this approach is the understanding that a benign asymmetric torque exists within every individual and its presence is dictated by the haemodynamic force set in motion during the 32nd week of foetal development. This haemodynamic motion determines the influences and controls the cranio-spinal fascia has over the brain, the brainstem and spinal cord throughout life, supporting, protecting and draining the entire structure in a homeostatic manner. The importance of mesenchyme and its prominence in the hierarchical development of embryogenesis and fascial system is key to maintaining homeostasis.
Traumatic forces of varying intensity applied to the body over a lifetime could disturb and corrupt this neurology and, in essence, change the dynamics of this harmonious structure. A benign asymmetric torque is superimposed by a traumatic torque. The traumatic torque is an event any individual can be subjected to and may have long term and devastating consequences. If not corrected, this traumatic torque begins a path of deteriorating circumstances that may eventually compromise the central nervous system and health.
There is cause and effect in all approaches to healing but to comprehend the complexities of how the body, through years of accumulated trauma, is able to maintain homeostasis to a point of collapse, is to understand the changes and protective defences this amazing and sophisticated organism uses to cope.
Brain drainage is a subject that appears to be given little consideration in today’s health regime. The irrigation system that runs the brain circulation does not discuss brain drainage as an important and essential issue. There is arterial blood into the brain and venous blood out of the brain, and when that occurs naturally and in equal quantities homeostasis is maintained. However, when a system cannot rely on the same inflow and equal outflow it must be ‘flawed’. This imbalance results in ‘stasis’ of brain tissue and has physiological consequences.
The head and neck are treated as separate entities, but the contents – spinal cord, medulla oblongata, pons and midbrain – are a continuous unit, and when subjected to trauma, the ramifications can be enormous. When dealing with a head and neck injury, both play a vital role on the adjacent drainage vessels that remove blood and lymph from the brain. Any trauma directed to these two areas result in the exit vessels being compromised, occluded or distorted, as well as being impacted by swollen tissue around them and the consequence is a reduction in vascular output.
Traumatic torqueing of the brainstem – the medulla oblongata, the pons and the midbrain – has dramatic neurological consequences to the major neurological pathways from the cortex to the spine and include the complex pathways of the cerebral and cerebellar peduncles to and from the cerebellum. Also, be aware that the ascending and descending spinal tracts either traverse the brainstem, have their sensory termination in the brainstem or their motor origins above or in the brainstem and when that is traumatised, the neurological implications can be complex.
In our sophisticated environment, there are many additional interferences that the body must contend with including chemical toxicity, the exposure to automation and electromagnetic influences. The interplay of these additional interferences means the systems of physiology have fewer ways to process and eliminate the waste that accumulates in the brain.
The physical manifestation of these vessels not being able to facilitate drainage, can cause the stagnation of venous blood with cytotoxic waste accumulating at the base and in other areas of the brain. The cytotoxic waste amasses; it does not naturally biodegrade and the interaction between these chemicals and brain tissue can be devastating, hour by hour, day by day and year by year, possibly leading to tau protein deposition and chronic traumatic encephalopathy (CTE).
The medical procedures of inserting stents and shunts to achieve brain drainage with success in recent years have met with applause when successful, but could be considered a huge interventional risk and invasion of delicate tissues and brain components notwithstanding the added jeopardy of anaesthesia.
In terms of embryological development, the hierarchical chain of events show the most important days of embryogenesis.
Day I. The fertilization of the egg and sperm cell signifies conception – the zygote
Day 16. The formation of the primitive streak – the future brain and spinal cord
Day 18. The formation of mesenchyme, the fascial formation – the ’Clingfilm’ that surrounds and encapsulates every aspect of the embryo.
Day 23. The formation from the pharyngeal arches of the four pairs of mixed cranial nerves. The trigeminal nerve (5), the facial nerve (7), the glossopharyngeal nerve (9) and the vagus nerve (10) make up the ‘survival kit’ of the final foetal performance at birth. The ability for the new born to suckle.
The trigeminal nerve, controls the jaws to find the nipple.
The facial nerve moves the facial muscles to latch onto the nipple
The glossopharyngeal nerve pushes the nipple against the roof of the mouth
The vagus nerve then sucks, swallows the milk, digests the milk and removes the waste from the nutrition, while maintaining the heart rate and the breathing, as well as all the other necessary activities of the body. This is the ‘survival kit’.
MESENCHYME – the fascial formation, is the precursor to the endoderm, the mesoderm and the ectoderm; a process known as gastrulation taking the single cellular structure to a multicellular structure, from a three vesicle formation to a five vesicle formation, as growth and embryological development takes place.
Ultimately, the fascial system envelopes and controls the entire central nervous system. The spinal cord and every pair of spinal nerve root are encapsulated by spinal dura which then becomes the cranial dura, supporting and maintaining the brain and all its components in a balanced configuration, this permits homeostasis within the cranium. Every nerve and circulatory vessel is surrounded and protected by the dural meningeal system which is a continuous fascial connector to all the aforementioned components. When this system is allowed to function normally then the body is maintained in a homeostatic environment.
The cranial dura consists of the meningeal dura covering the surface of the brain, and is made up of: the pia mater, arachnoid mater and the dura mater. The meningeal dura is continuous with the meningeal layer covering the spinal cord and is attached to the foramen magnum. The periosteum of the spinal column is a continuation of the dura mater and also anchors at the foramen magnum, then becomes part of the cranial dura mater. Within the cranium the dura mater is the periosteum and the endosteum, which in a ‘new born’ baby encapsulates islands of osseous bone which later become the cranial plates joined to their opposite number by the sutures of the cranium.
The dura mater in the brain forms the falx cerebri (which encapsulates the superior and inferior sagittal sinuses) and the falx cerebelli (which encapsulates the occipital sinus), the two vertical membranes that separate the left and right cerebral hemispheres and the left and right cerebellar hemispheres respectively. The third dividing membrane is the tentorium cerebellum (which encapsulates the transverse sinus, the sigmoid sinus posteriorly at the occiput, and the superior petrosal sinus laterally at the petrous portion of the temporal bone), a horizontal membrane, which separates the cerebral hemispheres from the cerebellum and the diaphragma sellae, which surrounds the hypophysial stalk of the pituitary. These are known as the reciprocal tension membranes (RTM) which support and separate the various brain components, effectively balancing the brain. These vertical and horizontal membranes form and encapsulate the straight sinus and the confluences of the sinuses. All these afore mentioned sinuses are responsible for draining the brain.
Arterial inflow into the brain comes primarily from the common carotid artery – splits into the external carotid supplying the face, neck and the internal carotid artery which enters the cranium through the carotid canal, feeding the anterior part of the circle of Willis. The two vertebral arteries penetrate through the atlanto-occipital membrane before entering the cranium through the foramen magnum, and join to form the basilar artery supplying the posterior part of the circle of Willis. These two arterial supplies are encapsulated by dura, as is the circle of Willis.
The venous outflow is comprised of: the superior sagittal sinus, feeding into the confluence of the sinuses, then into the right transverse and sigmoid sinuses, then into the right inferior jugular vein exiting through the right jugular foramen. The inferior sagittal sinus, feeds into the confluence of the sinuses through the straight sinus, then into the left transverse and sigmoid sinus into the left internal jugular vein exiting through the left jugular foramen.
All of these sinuses are encapsulated by the tentorium cerebellum, both at the lateral borders through the petrous portion of the temporal bone and the posterior border at the occiput. The anterior inferior drainage includes the cavernous sinuses and the inter-cavernous sinuses that drain through the basilar plexus, partially through the superior and inferior petrosal sinuses to the jugular bulb then into the internal jugular veins, and the balance into the anterior and lateral vertebral venous plexuses at the foramen magnum to flow into the anterior and posterior internal vertebral venous plexuses of the vertebral bodies.
DURAL MEMBRANE ACTIVITY
At about 32 weeks of gestation the venous drainage system comes into being. Gray’s Anatomy describes the venous drainage system, with larger vessels found in the superior sagittal sinus and right transverse sinus than those on the inferior sagittal sinus and the left transverse sinus. Research indicates that a larger volume of venous blood leaves through the right vessels than their counterpart on the left, giving a greater propensity to the right side of the brain. This haemodynamic means that as there is a greater volume exiting the brain on the right side and therefore driving the brain into a counter clockwise motion. This helical motion of counter clockwise activity means that the meningeal dura is also driven in a counter clockwise direction, producing a ‘rifling effect’ in the vessels, it propels the venous blood through the vessels in a dynamic that prevents the vessels from clogging up.
This counter clockwise motion is also evident in the formation of the cranium, bearing in mind that the osseous islands – the future cranial plates – encapsulated in periosteal dura, influence the position and final outcome of the cranium. The larger ocular orbit on the right and the smaller ocular orbit on the left are the bye products of the sphenoid bone being driven in a counter clockwise motion. When the sphenoid – the central bone of the cranium – shifts in this direction, it also has a bearing on the tentorium cerebellum, changing the horizontal membrane at the sphenoid body (attachments to the anterior and posterior clinoid processes), the lateral boundaries at the temporal bone and the posterior boundaries at the occiput. This dural membrane activity is referred to as a ‘benign asymmetric dural torque’, in other words a normal physiological function.
With cranio fascial benign asymmetric torque, the cranium moves in a counter clockwise direction while the pelvis moves in a clockwise direction. This reciprocity must remain constant in order for the entire system to behave in a homeostatic manner. When reciprocity fails, the system will start to compensate and adapt and the homeostatic function becomes compromised and the system will break down, mostly effecting the central nervous system.
The benign asymmetric torque (counter clockwise motion) shows the EX as the externally rotated dural membrane on the external right frontal bone, bringing the sphenoid anterior and superior, and the left external temporal bone (also brings the left occiput external) bringing the sphenoid posterior and inferior. The IN indicates the internal rotation of the left frontal and right temporal (also brings the right occiput internal). This dural membrane activity is a ‘pulsing motion’ filled function that exists in a normal physiological brain.
INTRODUCTION OF TRAUMA
Trauma at birth is considered to be any artificial intervention that hastens or holds back the natural birth process. Uterine Sweeps, pharmaceuticals, inductions or instrumentation at birth may be traumatic. These traumas can change the status of the dural meningeal membranes and influence their distortion on the underlying components that they control. The cranial dural membranes, as already explained, effect the arterial inflow of blood and the drainage of venous blood, changing the intra cranial pressures and disturbing their homeostatic boundaries. This is the ‘hair in the mouth’ syndrome, which is minute in its presence, but very irritating to all the tissue it comes into contact with – a sensory overload.
The trauma, is usually a change in the torque of the intra-cranial membranes, that once disturbed and never rectified, lays the foundation for a litany of changes to an otherwise harmonious system. In the years to come, with additional trauma through life, the results in the neurological imbalances can be responsible for the devastating syndromes that plague old age. Part of the drainage imbalance and inefficiency, involves the cytotoxic accumulation of non-biodegradable factory generated drugs and vaccinations that amass during a lifetime, which the body is unable to rid itself of, and there is evidence to suggest that this cytotoxic waste is attributed to the breakdown of the myelin insulation that protects the neural components in the brain.
External forces applied to the cranium come either as a diaschisis type force, a force in the same counter clockwise direction as the benign asymmetric torgue resulting in a stretching of nerve pathways and distorting communications, or a necrotic type force, force in the other direction – clockwise trauma, which is more devastating, as it may result in strangulation and tearing of nerve fibres, pathways and conduits. Both these forces are superimposed on the benign asymmetric torque and could produce serious complications to the membranes in general and to the brain components in particular.
The advent of birth trauma is an invasive component in creating traumatic asymmetric cranial torque, and must never be under estimated in cranio-fascial distortion and its consequence.
When looking at the coronal and transverse sections of the brain, one will notice the central position of the ventricular system made up of the two lateral, third and fourth ventricles. The roof of the lateral ventricles – the corpus callosum, the floor of the lateral ventricles – the caudate nucleus, and the lateral supports of the third ventricles – the thalamus and the hypothalamus, are all vital components of the Limbic system and Basal ganglia – the central brain components. The disturbance to their juxtaposition from traumatic torque possibly changing neurological circuitry and peripheral boundaries, could severely impact on systemic integrity.
Cervical whiplash presents as a trauma not only to the cervical spine, but to the brain. The drainage potential for venous blood becomes seriously hampered by the damage to the upper cervical spine. There is damage to the atlanto-occipital membrane effecting arterial inflow into the brain through the vertebral arteries, damage to the outflow of venous blood through the vertebral venous plexus and the anterior and lateral vertebral venous plexuses, and potential damage to the internal jugular veins through the jugular foramen between the occiput and the temporal bones; all this may result in tearing of vital support fascia between the vertebral bodies and the facet joints and the dural meningeal covering of the spinal cord and the internal cranial components.
The influence of cranio-fascial traumatic torque, illustrates how internal brain components can be changed, their communication pathways distorted, and how the ventricular system loses its ability to drain and support the central part of the brain. A loss of ability to drain means the ventricular system can become congested, changing its peripheral boundaries and gradually impinges on the supportive organs around it. If one considers the thalamus and the hypothalamus, the ‘junction boxes’ that relay information from the brain to the spinal cord and vice versa, distortion of the ventricular system which is surrounded by the thalamus and hypothalamus, may change those pathways and physiology.
THE TENTORIAL INCISURA
This is a separation of the tentorium cerebellum at the anterior part of the straight sinus, which produces two sheathes that surround the medulla oblongata, the pons and the brainstem, and attach at the anterior and posterior clinoid processes of the sphenoid body. They act as a pair of scissors, surrounding the central brain components, and when the sphenoid bone torques, the ‘blades of the scissors’ then create a twist to those components, and may distort many of the underlying parts, including the neural pathways and nerve conduits with drastic effects.
This is probably the most influential membrane in the cranium changing arterial inflow and venous outflow as well as the numerous neurological pathways in its course.
The application of Cranio Fascial Dynamics allows the brain and spinal cord to de-torque in its own time through the fascial system. One has to assume the importance of mesenchyme and it prominence in the hierarchical development of embryogenesis and fascial system as key to maintaining homeostasis. The Howat 8 Step Protocol is designed to ensure that the fascial system becomes the primary concern in re-establishing support and balance of all the primary central brain organs that make up and sustain the ventricular system, along with all the adjacent organs, the neural pathways and nerve conduits these are vital to neurological integrity and communication.