Positive Health Online

Drop of Water

“Nothing in the world is as soft and yielding as water.

Yet for dissolving the hard and inflexible, nothing can surpass it.

The soft overcomes the hard; the gentle overcomes the rigid.”

Lao Tzu  –  Tao Te Ching

Treating fluid systems is an essential component of osteopathy, as good circulation is fundamental to health. Human beings contain a lot of water; 80% of newborns and 60% of an adult is water. As seniors, we essentially dry out, with water comprising as little as 50% of us. Bones are highly vascular and contain as much as 20% water. Blood, lymph, cytoplasm within cells, interstitial fluid in the extracellular matrix of our connective tissues, and cerebrospinal fluid (CSF) are all examples of vital fluids within our systems. These fluids facilitate the delivery of nutrients and the removal of waste in the body, and as osteopaths, we are greatly concerned with any obstruction to the healthy flow and perfusion of the tissues by these fluids.

Fluid in the Body by Age

AT Still, the founding father of osteopathy, said, "The role of the artery and vein is universal in all living beings, and the osteopath must know that and abide by its rulings, or he will not succeed as a healer.”

 He recognized that the unencumbered flow of fluid dynamics has a huge impact on an individual’s health. This is a foundational principle of osteopathy and is integral to optimising the body’s self-regulating and self-healing capacities. Healthy fluid flow and tissue perfusion are essential for maintaining wellness. When fluids stagnate or become static, toxins and metabolic waste can accumulate, leading to inflammation and poor nutrient absorption.

One example of fluid stagnation is lymphedema, a condition where the interstitial spaces—fluid-filled areas spanning tissues and organs—accumulate lymphatic fluid, causing swelling and tissue changes. Lymphedema can affect the arms, legs, face, chest, neck, and oral cavity. This accumulated fluid, containing proteins and lipids, can lead to tissue changes such as adipose tissue deposition and fibrosis in chronic cases, often resulting in inflammation. In other words, poor lymphatic drainage can eventually cause tissue hardening, fibrosis, and functional impairment.

Lymphedema in Arm

When working well, the lymphatic system flows throughout our body, transporting large proteins, fats, and white blood cells to or from our tissues. Recent discoveries have identified lymphatic vessels within the dural membranes of the central nervous system (Licastro, E., Pignataro, G., Iliff, JJ., et al). The brain and spinal cord are continuously cleansed through the rapid production and absorption of cerebrospinal fluid (CSF). Previously, this circulation of CSF was believed to be a “closed” system. However, recent research shows that CSF is directly connected to the lymphatic system found throughout the rest of the body.

Circulation of the Cerebrospinal Fluid

The entire nervous system is surrounded by CSF, which cushions the brain, spinal cord, and peripheral nerves. CSF flows through the cerebral ventricles, deep within the brain, up and down the spinal cord, and extends out to the peripheral nervous system within the nerves' endoneurium space (Ligocki, AP. et al). Among its many functions, CSF helps cleanse the nervous system of toxins, particularly during sleep. This is when the glymphatic system activates, essentially washing the brain. When CSF flow is stagnant, it can contribute to the buildup of proteins such as amyloid and tau, which are linked to Alzheimer’s disease and dementia (Xie, Lulu, et al).

Osteopathy is concerned with addressing stasis in these fluid systems and promoting fluid exchange across the body. Techniques such as diaphragmatic breathing can aid circulation. Slow, controlled breathing through the nose, filling the abdomen, and exhaling through the mouth engages the abdominal muscles and increases venous return to the heart by creating negative pressure in the chest cavity during inhalation. This relaxation also induces vasodilation, promoting blood flow.

Fluid pumping techniques, including pedal, diaphragmatic, thoracic outlet, and occipitoatlantal approaches, use gentle, rhythmic compression and traction to stimulate fluid movement, particularly in the lymphatic and circulatory systems. Techniques like soft tissue massage, manual lymphatic drainage, fascial unwinding, balanced ligamentous tension, and craniosacral release can further improve fluid flow by easing restrictions in these tissues.

In craniosacral and biodynamic osteopathy, the fluids in the body can be considered a single unit of function and can be palpated. Using the knowledge of anatomy and physiology, we can understand what is under our hands and what we are feeling. Although we know these fluids are in separate systems and compartments, we can experience them as a single fluid body in constant communication, interchange, and renewal.

Techniques such as CV4—a gentle compression of the fourth ventricle – induce a still point in the CSF rhythm. This ebb and flow of CSF, which typically cycles at 8-14 cycles per minute, can vary among individuals. When the fluid resumes its fluctuations after a still point, it often does so with a more pronounced rhythm and vitality, enhancing the perfusion of other body fluid systems and promoting overall balance.

CV4 in Cranial Osteopathy

DO Rollin Becker considered motion within the body and the fluids to be manifestations of the miracle of life. Where life is working as a unified whole mechanism to manifest health, to resist and combat disease, and to correct or adapt to trauma. As osteopaths, we use our refined sense of touch to diagnose and treat this fluid body in both a subtle and structural way.

Patient Case Study: Mrs. J

Mrs. J, a 64-year-old woman with a history of Type 2 diabetes, hypertension (managed with Ramipril and beta-blockers), and a prior episode of transverse myelitis as a result of an epidural she had 30 years ago when giving birth. This resolved after 3 years but continues to affect her bladder control. She presented with persistent left knee pain and had significant varicose veins in both legs, the left leg being the worst. She reported that the left leg veins were hot and itchy, and she was waiting for vein removal surgery. Three weeks prior, while on holiday, her knee pain had escalated to the point where she visited A&E due to an inability to bear weight because of pain or flex her knee.

During her initial assessment, Mrs. J’s left knee exhibited limited mobility, significant discomfort, swelling, and inflammation around the popliteal area. Palpation revealed tension in the left fibula and surrounding ligaments, and there was some pooling of blood in the lesser saphenous veins, causing distention to the vessel and significant oedema in the popliteal area, likely contributing to her varicose vein symptoms and inability to comfortably flex her knee. Palpating her whole system from the cranial base, there was stagnation through the fluid body through her whole left side. It seemed solid and lacked any normal healthy rhythm.

For her treatment, I combined cranial osteopathy with specific manipulative techniques and some home exercises. Each session began with CV4 (Compression of the Fourth Ventricle), a gentle cranial technique intended to enhance the rhythmic flow of cerebrospinal fluid (CSF), encouraging the body’s self-healing response.

Ann Wales DO, a contemporary and student of AT Still and William G. Sutherland, stated that “A successful response from the cerebrospinal fluid is an intensified interchange between all the fluids of the body. It is definitely evident that the reaction is systemic and includes the whole body, even within the bones.”

As Mrs J was a type 2 diabetic with hypertension, I needed to address the fluid dynamics systemically, allowing for a whole system improvement in fluid health and dynamic flow.

I then applied balanced ligamentous tension techniques to her left knee, fibula, sacroiliac joint, and ankle to relieve mechanical strain and optimise fluid circulation in the lower leg. Gentle harmonic articulation of her hip encouraged drainage of the lower extremity through the inguinal lymphatics, into the gut. Mrs J was taught to actively flex and rotate her hip at home and use diaphragmatic breathing to improve this drainage in between treatment sessions.

Over four treatments, Mrs J reported progressive improvements. By the final session, she could flex her knee comfortably and was no longer experiencing hot, itchy varicose veins. Her mobility and function were fully restored, and she decided against vein removal surgery. Additionally, she observed improved bladder control, likely influenced by the enhanced CSF flow and breathing, both of which supported the nervous system’s ability to regulate bladder function. Mrs J was delighted with her progress and resumed her activities without further knee discomfort.

This example demonstrates how a holistic approach can achieve lasting results by addressing both local and systemic factors within the fluids of the body.

References

Licastro, E., Pignataro, G., Iliff, J.J., et al. 2024. Glymphatic and lymphatic communication with systemic responses during physiological and pathological conditions in the central nervous system. Communications Biology, 7(229). https://doi.org/10.1038/s42003-024-05911-5

Ligocki, A.P., Vinson, A.V., Yachnis, A.T., Dunn, W.A., Smith, D.E., Scott, E.A., Alvarez-Castanon, J.V., Montalvo, D.E.B., Frisone, O.G., Brown, G.A.J., Pessa, J.E., & Scott, E.W. (2023). Cerebrospinal fluid flow extends to peripheral nerves. bioRxiv [Preprint]. https://doi.org/10.1101/2023.11.20.567884 . Update in: Science Advances, 10(36):eadn3259 . https://doi.org/10.1126/sciadv.adn3259 . PMID: 38045235; PMCID: PMC10690169.

Xie, Lulu, et al. 2013. “Sleep Initiated Fluid Flux Drives Metabolite Clearance from the Adult Brain.” Science 342(6157): 373–377. doi:10.1126/science.1241224   .

Becker, R.E. 1997. Life in motion. Ruda Press.

Still, A.T. 1902. The philosophy and mechanical principles of osteopathy. Kansas City, MO: Hudson-Kimberly Pub. Co.