Cranial Osteopathy
with Physiologically Guided Imagery
1. What is Physiologically guided imagery in Cranial Osteopathy?
It is a manual therapy involving visualization, palpation, and rebalancing of anatomical structures that elicits a local and systemic response in the patient’s central nervous, autonomic, and endocrine systems, thereby reducing or eliminating pain and enhancing the body’s homeostatic response by addressing the primary cause of the dysfunction.
2. How is the patient treated?
The patient is treated by rebalancing their nervous and vascular systems through a sequential response dictated by these systems on the anatomical structures. Signal transmission between the osteopath and the patient occurs through the connection of their respective extracellular matrices and through the osteopath’s physiological and kinesthetic imagery focus.
3. How does the osteopath know what to focus on?
Through very light palpation (approximately 10 grams per cm²), the osteopath will be able to kinesthetically obtain local and global information about the patient’s body. The osteopath need only follow and locate this sequential information received through palpation from the patient’s body and through the cognitive focus that assesses this information. The osteopath’s work is complete when they no longer sense movement of the patient’s anatomical structures projected onto their own hands.
4. How does the osteopath interact with the anatomical structures of the patient’s body in order to achieve a healing effect?
Palpation can facilitate communication through neurological pathways (stimulation of neurons) and through the similarity and continuity of the extracellular matrix between the patient and the osteopath, which includes transduction microstructures (integrins, cadherins, syndescans, Ca2+ channels, fibroblasts). Palpation with a physiological focus may trigger leukocytes (mast cells, neutrophils, cytokines [TGF-beta1, TNF -alpha, interleukins, prostaglandins), and matrix metalloproteinases (MMPs), which will act within seconds on inflammatory and immune processes and on the remodeling of the extracellular matrix.
The osteopath may focus on macroscopic anatomy (organs, blood vessels, or others) or molecular anatomy.
The osteopath’s and the patient’s bodies function as a unified whole through palpation; the extracellular matrices of both operate as a continuum through the same physiological language. When the osteopath focuses on a structure within the patient’s body, the nervous system will restore homeostasis to that structure. The effect of this procedure on symptoms will reduce or eliminate localized pain; the overall effect will be a parasympathetic response—that is, an increase in vagal tone. The osteopath will follow the sequential anatomical and physiological indications of the body’s various structures until reaching the cause of the primary dysfunction, thereby eliminating the symptoms.
With this therapy, it will be possible to correct posture and eliminate pain, with results evident from the very first consultation.
5. What are the side effects of cranial osteopathy with physiological focus imaging?
It is usually a completely painless and even relaxing process. Patients often report afterward that they felt some movement in the structures previously focused on by the osteopath. Rarely, during homeostatic rebalancing, very mild transient pain may occur, which is characteristic of the physiological remodeling taking place.
Cranial osteopathy with physiological focus imaging is a highly safe and gentle practice, as it respects the body’s homeostatic system; for this reason, iatrogenic effects are virtually nonexistent. Cranial osteopathy with a physiological focus is likely one of the safest and most conservative therapies available.
6. Cranial osteopathy with a physiological focus is a non-conventional therapy, but can it serve as an alternative or complement to other therapies?
Although osteopathy is a holistic practice, it can be complementary to other therapies; for example, osteopathy can be used in cases of post-endocarditis (an inflammation of the endocardium: the innermost membrane of the heart) following a viral or bacterial infection. This inflammation, caused by viruses and bacteria, leads to fibrosis and adhesions in the left ventricle, cardiac fibroblasts, and interstitial valve cells. These structural changes may result in reduced cardiac contractility several weeks after the original infection. On the other hand, fibrotic cardiac dysfunction is difficult to treat with medication, and therefore osteopathic intervention may serve as an alternative.
Often, when a patient consults an osteopath, it is as a last resort; not infrequently, the patient has already consulted various specialists in different areas of conventional medicine and undergone numerous imaging or biochemical tests, none of which have provided a solution to their pain or disconfort. In such cases, osteopaths may not be just an alternative—they may be the last resort.
7. Why is it called Cranial Osteopathy and not simply Osteopathy?
Both Cranial Osteopathy and Joint Osteopathy follow the same principles; the main difference lies in the gentleness of the methods. Cranial Osteopathy relies solely on the body’s homeostatic capabilities and does not use mechanical processes involving large ranges of motion or force.
8. Why is Osteopathy different from other therapies in its theoretical principles?
Osteopathy upholds the unity and oneness of the body. The homeostatic capacities of the body as a whole are paramount in Osteopathy. We believe that the body has the capacity for self-healing. Osteopathy emphasizes the principle of proper vascularization and nervous system function as the most important process for eliminating dysfunctions.
9. Do osteopaths treat conditions such as cancer, viral, bacterial, and fungal infections, or physiological organ failures?
Osteopaths are legally authorized to treat holistic dysfunctions of the body. An osteopath aims to eliminate a symptom by addressing its underlying cause; for example, lower back pain may be caused by stenosis of the sphincter of Oddi, and as long as that structure and all associated organs and structures remain out of balance, the lower back pain may persist. Osteopaths may play a complementary or alternative role in cases of dysfunctional health conditions.
10. Osteopaths are commonly recognized as professionals who treat or improve musculoskeletal conditions—so how can it be said that they improve vascular, visceral, or neurological dysfunctions?
Through touch, and with the appropriate kinesthetic training gained over several years of practice, the osteopath will be able to perceive, via Cranial Osteopathy with Physiological Focus Imaging, the dysfunctional anatomical structures within the patient’s body. We believe that this cognitive and tactile communication is facilitated by the extracellular matrix of both the patient and the osteopath: they communicate through touch because they share exactly the same physiology. The hands are the osteopath’s eyes, receiving information from the patient’s various organic structures in accordance with that organism’s specific homeostatic needs and the sequential order of regulation that the patient’s own body intends to convey. The osteopath is a facilitator of homeostatic processes. By focusing on each structure indicated by the patient’s body, the osteopath ensures that the healing principle associated with the nervous system is applied. This system dynamically rebalances the body’s various structures—both micro- and macroscopically—in real time. For example, the heart functions simultaneously with the liver, the kidneys, the spleen, and the digestive, hormonal, molecular, and cellular systems. This simultaneous balance of the various structures that make up the whole organism is ensured by the autonomic nervous system in conjunction with the central nervous system; the latter receives and coordinates information from the autonomic nervous system. The brain has specific representations of the peripheral body; the brain is somatotopic. The enteric, endocrine, and vascular nervous systems depend on the coordination of the autonomic and central nervous systems.
By focusing visually and through touch on each structure indicated by the nervous system, the osteopath will bring about a rebalancing of that structure. The nervous system knows how to rebalance specific structures through their relationship with the whole, by tracing back to the root cause.
The nervous system possesses the principle of healing, but it also exerts a structural effect through inflammatory and immune changes in the extracellular matrix. The extracellular matrix is the backdrop against which all the body’s physiological processes take place; all cells, without exception, are connected to this matrix. Remodeling processes result from the immediate inflammation produced by neutrophils, mast cells, fibroblast activation, inflammatory factors, transcription factors, and molecular ligands, as well as changes in cell membranes—processes that are constantly remodeling the extracellular matrix and eliciting epigenetic and genetic responses which, taken as a whole and in sync, we believe are coordinated by the nervous system.
We believe that the nuclei of the reticular formation in the brainstem play a central role in the body’s vital processes: posture, wakefulness-sleep, mood, excitability, pain assessment, states of consciousness, and cardiovascular and visceral regulation. The phylogenetic age of the reticular formation is estimated at over 500 million years.
Our intervention as osteopaths may be of particular importance in the processes of maintaining posture and alleviating pain—the most common reasons for which we are consulted.
By mentally focusing on an anatomical structure, osteopaths may trigger a response from the nervous system and a potential alteration of the extracellular matrix.
11. When did Cranial Osteopathy emerge, and what were its principles?
William Garner Sutherland, the founder of Cranial Osteopathy (1939) and a disciple of Andrew Taylor Still, the creator of Osteopathy (1874), conceived the existence of a primary respiratory mechanism that would be associated with the circulation of cerebrospinal fluid and craniosacral oscillations. The term “primary respiratory mechanism,” as it relates to myocardial-pulmonary respiration, may not be far from reality, since the primary respiratory chemoreceptors in the medulla oblongata oscillate due to fluctuations in the cerebrospinal fluid in which they are immersed. It is these respiratory chemoreceptors that fundamentally govern the cardiorespiratory system. W.G. Sutherland posited that it would be possible to rebalance dysfunctions by regulating the primary respiratory mechanism.
12. Can a cranial osteopath, using a physiological focus, correct dysfunctions in any structure of the body and rebalance its physiology?
Although homeostatic capacities are ubiquitous in every human organism, they depend on comorbidities, age-related degeneration, iatrogenic effects resulting from the quantity of medications taken, the number of surgeries undergone, and mental states. In principle, the extracellular matrix and the nervous system converge and manage all dysfunctional variables; hence, the specificity and potential success of osteopathic work may stem from this.
13. Is Cranial Osteopathy with Physiological Focus Imaging a natural and conservative therapy?
Yes. It is likely one of the most conservative and natural therapies in existence.
14. What is the Nervous System?
The nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS comprises the brain and the spinal cord, while the PNS consists of all neural structures located outside the CNS. The CNS receives, integrates, and responds to sensory information, in addition to generating motor responses to coordinate behavior and maintain homeostasis. In Margetis K, Reddy V, Singh P. Anatomy, Central Nervous System. [Updated Jan. 31, 2026]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
15. What Is the Extracellular Matrix?
“The extracellular matrix (ECM) is a three-dimensional, non-cellular macromolecular network composed of collagens, proteoglycans/glycosaminoglycans, elastin, fibronectin, laminins, and various other glycoproteins. The matrix components bind to each other, as well as to cell adhesion receptors, forming a complex network in which cells reside in all tissues and organs. Cell surface receptors transduce signals from the ECM into cells, which regulate various cellular functions—such as survival, growth, migration, and differentiation—and are vital for maintaining normal homeostasis” in Theocharis AD, Skandalis SS, Gialeli C, Karamanos NK. Extracellular matrix structure. Adv Drug Deliv Rev. 2016 Feb 1;97:4-27.
16. What Is the Autonomic Nervous System?
The autonomic nervous system provides widespread innervation to nearly all organ systems in the body. To understand the fundamentals of autonomic function, knowledge of the neuroanatomy of the autonomic nervous system is necessary. Often thought to control the ‘fight-or-flight’ and ‘rest-and-digest’ functions, the autonomic nervous system has an intricate network of connections to finely tune the systemic response to almost any situation. Although traditionally viewed as two distinct systems (sympathetic and parasympathetic), the enteric nervous system is now considered a third component of the autonomic nervous system.” In Gibbons CH. Basics of autonomic nervous system function. Handb Clin Neurol. 2019;160:407-418.