Cranial Osteopathy
with Physiologically Guided Imagery
1. What is Physiologically Focused Cranial Osteopathy Based on Imaging?
It is a manual therapy involving visualization, palpation, and, when necessary, rebalancing of anatomical structures, which elicits a local and systemic response in the patient’s central nervous system, autonomic nervous system, and endocrine system, thereby reducing or eliminating pain and enhancing the body’s homeostatic response by addressing the primary cause of the dysfunction.
2. What does the treatment address in the patient?
The patient is treated by rebalancing their nervous system through a sequential response guided by the osteopath’s palpatory perception of the patient’s anatomical structures. Signal transmission between the osteopath and the patient occurs through the connection of their respective extracellular matrices and the osteopath’s physiological and palpatory imagery focus.
3. How does the osteopath know what to focus on?
Through very light palpation (about 10 grams per cm²), the osteopath will be able to 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 anatomical cognitive focus that assesses this information. The osteopath’s work is complete when they no longer sense movement of the patient’s anatomical structures through their own hands.
4. How does the osteopath communicate 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, syndecans, Ca2+ channels, fibroblasts); that is, the pressure from the osteopath’s hands (mechanical stimuli) may generate biochemical and electrical stimuli in the microstructures of the patient’s body.
Palpation with a physiological focus may trigger leukocytes (mast cells, neutrophils, cytokines [TGF-beta1, TNF -Alpha, interleukins, prostaglandins), and matrix metalloproteinases (MMPs), which can act within seconds on inflammatory and immune processes and on the remodeling of the extracellular matrix.
The osteopath may focus on macroscopic anatomy or molecular anatomy.
We believe that the osteopath’s and the patient’s bodies can function as a unified whole through palpation. The extracellular matrices of both can function as a continuum through the same physiological language. When the osteopath focuses on a structure in the patient’s body, the nervous system can apply homeostasis to that structure. The effect of this procedure on symptoms may reduce or eliminate localized pain; the overall effect may 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 potentially eliminating the symptoms.
With this therapy, it may be possible to correct posture and eliminate musculoskeletal pain; results may be noticeable as early as the 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 targeted 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. Furthermore, fibrotic cardiac dysfunction is difficult to treat with medication, and therefore osteopathic intervention may be relevant.
* The treatment and differential diagnosis of possible endocarditis must be performed by a cardiologist.
7. Why is it called Cranial Osteopathy and not simply Osteopathy?
Both Cranial Osteopathy and Articular Osteopathy follow the same principles; the main difference lies in the gentleness of the methods. Cranial Osteopathy relies exclusively on the body’s homeostatic capabilities and does not use mechanical processes involving large ranges of motion or force.
8. Why does Osteopathy differ from other therapies in its theoretical principles?
Osteopathy upholds the unity and oneness of the body. The assumption of the homeostatic capabilities of the organism as a whole is fundamental to Osteopathy. We believe that the body has the capacity for self-healing. Osteopathy emphasizes the principle of adequate blood supply and proper 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 failure?
Osteopaths are legally authorized to treat musculoskeletal disorders of the body; however, if you have viral, bacterial, or fungal infections, you should consult a physician. You should also consult a medical specialist if you have organ dysfunction or neoplasms (cancer).
An osteopath seeks to eliminate a symptom by addressing its underlying cause; for example, lower back pain may be caused by nerve compression. Osteopaths can play a complementary role in treating health conditions involving dysfunction.
10. Osteopaths are generally recognized as professionals who treat or improve musculoskeletal conditions—so how can it be claimed that they improve vascular, visceral, or neurological dysfunctions?
Through touch and with the appropriate palpation training acquired over several years of practice, the osteopath will be able to perceive, through Cranial Osteopathy with Physiological Focus Imaging, the dysfunctional anatomical structures in the patient’s body.
We believe that this cognitive and tactile communication can be facilitated by the extracellular matrix of both the patient and the osteopath: both can communicate through palpation 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, which may be dynamic—allostatic.
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—at both the microscopic and macroscopic levels—simultaneously. For example, the heart functions in harmony simultaneously with the liver, kidneys, spleen, and the digestive, hormonal, molecular, and cellular systems.
This simultaneous balance of the various structures that make up the entire body 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 contains specific representations of the peripheral body; the brain is somatotopic, meaning that the left hand or the right foot corresponds to specific sensory areas of the brain. Each anatomical structure is perceived distinctly by the osteopath.
The enteric, endocrine, and vascular nervous systems depend on the coordination of the autonomic and central nervous systems.
By focusing visually and through palpation on each structure indicated by the nervous system, the osteopath can bring about a rebalancing of that structure. We believe that the nervous system knows how to rebalance specific structures through its relationship with the whole, tracing back to the root cause.
We consider that the nervous system possesses the principle of potential homeostasis 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 from changes in cell membranes—processes that constantly remodel the extracellular matrix and trigger epigenetic and genetic responses which, when considered as a whole and in sync, we believe are coordinated by the nervous system.
We believe that the reticular formation nuclei (the phylogenetic age of the reticular formation is estimated at over 500 million years) 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.
Our intervention as osteopaths can be particularly important in maintaining posture and alleviating musculoskeletal symptoms—the most common reasons for which we are consulted.
We can also help reduce or eliminate the symptoms of vestibular dysfunction, commonly referred to as vertigo and dizziness. For more information, please see Tonturas e Vertigens ( Dizziness and Vertigo).
By focusing on and applying palpation to a specific anatomical structure, osteopaths can trigger a response from the nervous system and potentially alter 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.