Comparison between CV4 and EV4 - Osteopathic Research

Comparison between 

CV4 and EV4 

via Biofeedback-measurement 

MASTER THESIS 

zur Erlangung des Grades 

Master of Science in Osteopathie 

an der Donau Universität Krems 

niedergelegt 

an der Wiener Schule für Osteopathie 

von Margit GRILL 

Matrikel Nummer 0564468 

Wien, Dezember 2006 

Betreut von Walter KRASSER 

Statistik von Dr. Michael Benesch 

Margit Grill / 2006

1 

INDEX 

1 INTRODUCTION....................................................................................... 3 

1.1 HYPOTHESIS / QUESTIONS....................................................................... 6 

2 ANATOMICAL AND PHYSIOLOGICAL FUNDAMENTALS........... 8 

2.1 OCCIPITAL BONE..................................................................................... 9 

2.2 INTRA-CRANIAL MEMBRANE SYSTEM ................................................... 11 

2.3 CEREBROSPINAL FLUID (CSF) .............................................................. 13 

2.3.1 Formation and circulation .............................................................. 13 

2.3.2 Function and tasks .......................................................................... 15 

2.3.3 External Liquor space ..................................................................... 15 

2.3.4 Internal Liquor space...................................................................... 15 

2.3.5 Projection / ventricle-system........................................................... 16 

2.4 AUTONOMIC NERVOUS SYSTEM (ANS)................................................. 17 

2.4.1 General: .......................................................................................... 17 

2.4.2 Cardio-vasculary and respiratory regulation................................. 19 

2.4.2.1 Cardiovasculatory centre:........................................................ 21 

2.4.2.2 Respiratory centre ................................................................... 21 

2.4.3 Cutaneous blood supply .................................................................. 22 

2.4.4 Skin moisture................................................................................... 23 

2.4.5 Summary table of sympathetic and parasympathetic activity 

Parameters measured by biofeedback ........................................................ 24 

3 FUNDAMENTALS OF THE CRANIOSACRAL TECHNIQUES ..... 25 

3.1 HISTORY............................................................................................... 25 

3.2 PRIMARY RESPIRATORY MECHANISM.................................................... 26 

3.3 THE FIVE FUNDAMENTALS OF THE CRI................................................. 26 

3.4 CV4 AND EV4 WORKING MECHANISM ................................................. 27 

3.5 INDICATIONS AND CONTRAINDICATIONS............................................... 28 

4 MATERIAL AND METHOD.................................................................. 29 

4.1 BIOFEEDBACK (BFB) ........................................................................... 29 

4.1.1 Biofeedback – technical conditions................................................. 29 

4.1.2 Comfort Program ............................................................................ 30 

4.1.3 Sensors ............................................................................................ 31 

4.1.3.1 Multi sensor............................................................................. 31 

4.1.3.1.1 EDG = electro dermography.............................................. 31 

4.1.3.1.2 PPG: Pulse plethysmography ............................................ 32 

4.1.3.1.3 TEM: Thermistor measurement......................................... 32 

4.1.3.2 Breathing sensor1 and 2.......................................................... 32 

4.1.3.3 Fastening of sensors ................................................................ 33 

4.1.3.3.1 Multisensor fastening......................................................... 33 

4.1.3.3.2 Breathing sensors positioning............................................ 33 

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4.2 DESCRIPTION OF THE TECHNIQUES: CV4, EV4 AND PLACEBO ............. 34 

4.2.1 CV4-technique = Compression of the fourth ventricle................... 35 

4.2.2 EV4 technique = Extension of the fourth ventricle (as per Jealous) 

36 

4.2.3 „Placebo“ technique....................................................................... 36 

4.3 METHOD............................................................................................... 37 

4.3.1 Points of criticism............................................................................ 38 

4.4 CONDITIONS NECESSARY FOR THE ROOM.............................................. 39 

4.5 INCLUSION AND EXCLUSION CRITERIA .................................................. 39 

5 PROCEDURE............................................................................................ 41 

6 RESULTS AND STATISTICAL EVALUATION................................. 42 

6.1 PROFILE OF A SINGLE SUBJECT (SUBJECT 3) .......................................... 43 

6.2 DESCRIPTIVE STATISTIC........................................................................ 48 

6.2.1 Course measurement per subject .................................................... 48 

6.2.1.1 Results ..................................................................................... 49 

6.2.2 Technique comparison: description of the mean courses 8 

intervals....................................................................................................... 49 

6.2.2.1 Result....................................................................................... 52 

6.3 INFERENCE STATISTICS ......................................................................... 54 

6.3.1 Result............................................................................................... 54 

6.4 DESCRIPTION: MEAN VALUES / 3 INTERVALS ........................................ 55 

6.4.1 Diagram of tendencies .................................................................... 57 

6.4.2 Result:.............................................................................................. 57 

7 DISCUSSION ............................................................................................ 58 

7.1 AD: “SINGLE-PROFILE”......................................................................... 58 

7.2 AD: PARAMETER................................................................................... 59 

7.3 AD: PARAMETERS COMBINED ACTION................................................... 61 

7.4 POINTS OF CRITICISM............................................................................ 63 

7.5 CONSEQUENCE ..................................................................................... 64 

8 SUMMARY: .............................................................................................. 66 

9 BIBLIOGRAPHY ..................................................................................... 67 

10 APPENDIX ................................................................................................ 70 

10.1 INDEX OF ILLUSTRATIONS..................................................................... 70 

10.2 INDEX OF TABLES ................................................................................. 71 

10.3 ABREVIATIONS ..................................................................................... 71 

10.4 DESCRIPTIV STATISTICS........................................................................ 72 

10.5 INFERENCE STATISTICS ......................................................................... 84 

10.6 MEASUREMENT RESULTS...................................................................... 89 

2 

Margit Grill / 2006

3 

1 Introduction 

During my study of osteopathy and further seminars given by Jealous two 

craniosacral techniques caught my attention. 

The compression of the fourth ventricle (CV4) and the expansion of the fourth 

ventricle (EV4) are fluctuation techniques (fluid techniques) and should have an 

effect on the longitudinal fluctuation of the cerebrospinal fluid. Both techniques 

focus on the area of the fourth ventricle on which floor the physiological centres 

especially those for respiration and cardiovascular circulation, are located. This 

area is connected via “regulation circuits” to other brain regions and their 

surrounding areas. I often thought about whether there could be a difference 

between both techniques, as patients treated with an EV4 often felt alert whereas 

those treated with CV4 felt rather tired; however, both techniques in general 

showed a relaxing effect in combination with a calm and harmonious breathing. 

As various indications subsisted I decided to study these techniques in more 

detail. 

I came in contact with the biofeedback-system (BFB) per chance as I was 

looking for an appropriate non-invasive measuring method. This tool allows the 

study and measure of psycho-physiological body functions, as heart-rate, 

breathing-frequency and breathing-amplitude, skin-conductivity and skintemperature 

through which remarks about a persons current vegetative tension 

level can be made. The advantages of this measuring method are that it can be 

reproduced, allows a course measurement and is valid. The smallest varying 

during the procedure can be simultaneously measured and noted as well as 

observed on the computer screen. This method is usually used therapeutically to 

make aware and to voluntarily influence, even control autonomous functions. 

In order to render craniosacral techniques objectively, it is important to 

understand which procedures and changes take place during a therapeutic 

intervention. The question also arose whether changes during a CV4 and EV4 

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4 

technique could be proven by measurable physiological parameters or whether 

one of the techniques could show typical characteristics. 

Therfore, it was logical to use this measuring method for documentation and 

controlling. 

CV4 is a generally well known and applied technique that is used in a broad 

spectrum of indication. This technique going back to Sutherland in 1939 1 and is 

often described in osteopathic literature. In “Contribution of Thought” 

Sutherland 2 mentions repeatedly CV4 in connection with the importance and 

meaning of the fourth ventricle, its neighbouring autonomous centres (especially 

breathing and cardiovascular circulation) and the value of cerebrospinal fluid 

fluctuation for the craniosacral activity. After CV4, he also described the 

relaxing effect on the spine, through which secondary osteopathic lesions were 

less felt. 

Magoun 3 and Wales 4 described CV4 in detail and documented that, as a 

response of this technique, breathing slowed down and became more regular, the 

pulse became normal and the surface of the skin less humid. 

I heard these statements several times during my osteopathic training (from 

Arlot, Jealous, Shaver …) but I could not find any studies or publications in my 

research that lent weight to them. Osteopathic treatment has an old empirical 

history but a lot of osteopathic statements are not scientifically proven and I had 

to notice a lack of relevant studies. 

1 UPLEDGER John: Lehrbuch der Kraniosakral-Therapie, 2. Auflage, Heidelberg, Karl f. Haug Verlag, 

1994, p.54 

2 SUTHERLAND William: Contributions of Thought, 2nd Edition, (edited by A. Strand Sutherland, 

A. Wales), Sutherland Cranial Teaching Foundation, Portland, Oregon: Rudra Press, 1998, e.g. p.219 

3 MAGOUN Harold: Osteopathy in the Cranial Field, Original Edition, 1951, 2nd Printing, Sutherland Cranial 

Teaching Foundation, Cincinnati, Ohio: The C. J. Krehbiel Company, 1997, p.81-85 

4 WALES Ann: “The management, reactions and systemic effects of fluctuation of the cerebrospinal fluid” 

in: Journal of the Osteopathic Cranial Association, p.35-47 

published by The Osteopathic Cranial Association, 1953 

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5 

Dovesmith 5 believes that the strengthening of the occiput’s extension such as 

that occurring in CV4 and the longitudinal fluctuation has a sympathetic effect; 

but that the flexion or lateral fluctuation has an opposite (parasympathetic) 

influence. 

The EV4 technique procedure and its application realm which is identical to that 

of the CV4 were only documented in written form by Liem. 6 Further 

information about the EV4 technique originates from my class notes. Jealous 

noted a harmonising regulating effect for the both techniques, but he also 

indicated that: “EV4 takes the potency from the midline, the CV4 brings it to the 

midline”. 7 

Based on these facts, I decided to explore in my thesis these craniosacral 

techniques in relation to the effect on autonomous body functions, as a 

technique’s effect also determines the realm of indications and the therapeutic 

procedure. Additionally, the cranial techniques were compared with a placebotechnique 

in order, to objectify them and to get more basic information, which 

could underline the effect of CV4 or EV4. 

For this study I chose exclusively healthy subjects in order to obtain comparison 

values for people with specific pathologies that could be later used as basis for 

further research. The following quote from Sutherland confirmed this decision: 

“Through knowledge of the normal you can diagnose the abnormal.” 8 

5 DOVESMITH Edith: “Fluid fluctuation and the autonomic system” 

in: Journal of the Osteopathic Cranial Association, p.55 


6 LIEM Thorsten: Kraniosakrale Osteopathie, Stuttgart: Hippokrates Verlag, 1998, p.334 

7 JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie , notes Pöttmes, 2000 

8 SUTHERLAND William Garner: Contributions of Thought, 2nd Edition, (edited by A. Strand Sutherland, 

A. Wales), Sutherland Cranial Teaching Foundation, Portland, Oregon: Rudra Press, 1998, p.346 

Margit Grill / 2006

6 

1.1 Hypothesis / questions 

Hypothesis I 

“different technique – same effect?” 

Hypothesis II 

“different technique – different effect?” 

The purpose of this study is the comparison between the CV4 and EV4 

craniosacral techniques in relation to measurable parameters of 

autonomous body functions such as skin-conductivity, skin-temperature, 

heart-rate, breathing-rate and breathing-amplitude. 

The comparison with the placebo technique serves as factor to objectify the 

cranial techniques and shall exclude influences due to expectation. Furthermore 

the placebo-technique could underline the existence of an effect by the cranial 

techniques. 

‣ In the case of hypothesis I, this would mean that the above mentioned 

parameters would change in the same way but possibly with different 

intensity. 

technique 

 

effect 

parameter 

‣ Ad hypothesis II: on the other hand the techniques could show 

characteristic signs whereas one or several parameters would change 

specifically via the procedure; they could also show a more 

sympatheticotone or parasympatheticotone effect that would lead to a 

different measuring data. 

technique 

effect 

parameter 

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7 

The BFB baseline is the base measurement and a reference value in order to 

recognize changes occurring through the technique used during the measuring 

process. 

 

EV4-technique 

baseline 

 

CV4-technique 

 

placebo-technique 

Which parameters change if CV4 is compared to EV4? 


 


Which parameters change in comparison with the placebo-technique? 

placebo-technique 

 

 



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8 

2 Anatomical and physiological fundamentals 

The following section describes the anatomical and physiological fundamentals 

pertaining to the CV4 and EV4 cranial techniques. 

The books listed below are used as basis. 

DUUS Peter: 9 Neurologisch-topische Diagnostik 

FALLER Adolf: 10 Der Körper des Menschen 

NETTER Frank: 11 Nervensystem I, Neuroanatomie und Physiologie 

SCHMIDT Robert et al: 12 Physiologie des Menschen 

SCHMIDT Robert: 13 Physiologie kompakt 

SOBOTTA Johannes: 14 Atlas der Anatomie des Menschen 

The occipital bone serves as interface and is the binding structural element to the 

membrane and liquor system. The fluctuation of the cerebrospinal fluid (CSF) 

should play an important role in the effect of these techniques. The 

physiological centres are located on the floor of the fourth ventricle; they 

significantly contribute to the regulation of breath- and heart frequency, skin 

moisture and vasodilatation. 

9 DUUS Peter: Neurologisch-topische Diagnostik, Anatomie, Physiologie, Klinik, Stuttgart, 

New York: Thieme Verlag, 2001 

10 FALLER Adolf: Der Körper des Menschen, 13. Auflage (neu bearbeitet von M. und G. Schünke), 

Stuttgart, New York: Thieme Verlag, 1999 

11 NETTER Frank: Nervensystem I, Neuroanatomie und Physiologie, Bd. 5, Farbatlanten der Medizin, 

(Hrsg. G. Krämer), Stuttgart, New York: Georg Thieme Verlag, 1987 

12 SCHMIDT Robert et al: Physiologie des Menschen, 28. Auflage, 

Berlin, Heidelberg, New York: Springer Verlag, 2000 

13 SCHMIDT Robert: Physiologie kompakt, 4. Auflage, Berlin, Heidelberg, New York: Springer Verlag, 2001 

14 SOBOTTA Johannes: Atlas der Anatomie des Menschen, 20. Auflage, Bd.1, (Hrsg. R. Putz, R. Papst) 

München, Wien, Baltimore: Urban & Schwarzenberg Verlag, 1993 

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9 

fig. 1 

occipital bone 

2.1 Occipital bone 

The interface used to conduct the CV4 and EV4 cranial techniques is the 

occipital bone, the posterior base of the cranium. It consists of the basilar part, 

the squamous portion and the two condylar parts. The occipital bone is a part of 

the posterior cranial fossa, and together with the sphenoid, constitutes the SBS 

(sphenobasilar-symphysis). It is in contact through sutures laterally with the 

temporal bone, on top with the parietal bone and at the bottom with the condylar 

parts. The IX., X., XI. cranial nerves, the jugular vein, the inferior petrosus sinus 

and sigmoid sinus and the posterior meningeal artery all go through the jugular 

foramen, the opening located between the temporal bone and the occipital bone. 

A large part of the venal blood, approximately 80%, is drained via the jugular 

vein. Dural tensions or restrictions in the region of the jugular foramen can 

influence the function of the structures passing through it. 

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On the inner surface of the squamous portion of the occipital bone one can 

clearly see the superior sagittal sinus to whose edges the falx cerebri and falx 

cerebelli are attached. Stretching outwards from the confluence of the sinuses, 

the transverse sulcus is the point of attachment for the tentorium. 

The medulla oblongata is located in the clivus region, passes through the 

foramen magnum and continues downwards as spinal cord. The field of the neck 

muscles insertion is located on the outer convex wall of the occipital bone. 

Through its anatomical characteristics, it is clear that the occipital bone is an 

important connecting link to the membrane system. It is also a point of 

connection to the cardiovascular and fascial systems as well as the nerval, 

skeletal and muscular system. 

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2.2 Intra-cranial membrane system 

fig. 2 meningen 

Arachnoid and Pia mater (Leptomeninx) 

The arachnoid, which has no vessels, is located immediately next to the dura 

mater and bridges over all the wrinkles and crevasses, in contrast to the pia 

mater, a layer highly supplied with blood, which closely follows all of the 

brain’s convolutions and also has a nutritional function. The subarachnoidal 

space which is filled with CSF is located between the arachnoid and the pia 

mater. 

Dura mater (Pachymeninx) 

The inelastic dura mater lines the inner surface of the cranium and the spinal 

channel. It consists of the outer periostal and inner meningeal layer. In specific 

areas, the meningeal layer of the dura separates itself from the periostal layer 

and forms a cavity for the venal sinus system. 

The meningeal layers branch out to reunite and form the septum (duplicates of 

the dura) which runs vertically (falx cerebri and falx cerebelli), and horizontally 

(tentorium). 

The falx cerebri acts as partition between the hemispheres of brain. It runs in the 

shape of a crescent from the crista galli along the sagittal sinus to the internal 

protuberance of the occipital bone. Its basis forms the straight sinus and 

becomes the tentorium. The falx cerebelli separates the two hemispheres of the 

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cerebellum below the sinus. It springs forth on the underside of the straight sinus 

from the lower layer of the tentorium and leads to the foramen magnum. 

12 

fig. 3 tentorium and falx 

The tentorium stretches in the form of a tent from the straight sinus between the 

cerebrum and cerebellum. The great circumference (outer border) attaches 

posteriorly to the internal protuberance. Following laterally the transverse and 

the sigmoid sinuses to the upper margin of the temporal bone’s petrous part, the 

great circumference finally attaches to the posterior clinoid processes. The 

brainstem goes through the opening of the inner tentorium border, a free edge. 

It is attached to the anterior clinoid processes. 

The diaphragm of the sella turcica has an opening called the diaphragmatic 

hiatus through which the pituitary stalk runs. 

This membrane system permits the transmission, balancing and distribution of 

tension. Sutherland described this system as “reciprocal tension membrane”. 

The dynamic stillpoint or point of equilibrium which is connected to all 

membranes is located in the region of the straight sinus and is called 

“Sutherland’s Fulcrum”. 15 

15 MAGOUN Harold: Osteopathy in the cranial field, Original Edition, 1951, 2nd Printing, Sutherland Cranial 

Teaching Foundation, Cincinnati, Ohio: The C. J. Krehbiel Company, 1997, p.39 

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2.3 Cerebrospinal fluid (CSF) 

2.3.1 Formation and circulation 

The CSF is a watery, clear and chemically stable liquid that constantly renews 

itself within a few hours and contains energy sources such as nutrients (glucose, 

amino-acids); micro-nutrients (Vit.C, Vit.B, Na+, K+, etc.); proteins 

(immunoglobine, viral antibodies, etc.); endorphins; hormones and 

neurotransmitters. 

The CSF is produced by the choroid plexus in the ventricular system but 

also around the vascular system and in the subarachnoidal space. 

Sympathetic and parasympathetic nerves can be seen in the choroid 

plexus. They innervate the blood vessels as well as the epithelium. The 

parasympathetic tissues originate almost in their entirety from the superior 

cervical ganglion. A rising sympathetic tone leads to a decrease of the 

liquor production of up to 30%, while the liquor production of the 

parasympathetic increases up to 100%. 16 

The CSF of the lateral ventricles circulates through the inter-ventricular 

foramina (Monroi) to the third ventricle, and from there through the aquaeduct 

cerebri (Sylvius) to the fourth ventricle. The liquor originating from all of these 

production areas flows through the median aperture (Magendii) and the lateral 

aperture (Luschkae) to the subarachnoidal space, where it circulates around the 

two hemispheres of the cerebrum and the spinal cord. 

16 LIEM Torsten: Kraniosacrale Osteopathie, Hippokrates Verlag, Stuttgart 1998, p.214 

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14 

fig. 4 CSF - circulation 

The liquor re-absorption occurs in the venal system via the arachnoid 

granulations (Paccioni) laying in the superior sagittal sinus as well as through 

the capillary vessel walls in the CNS (central nervous system) and in the pia 

mater. At this point the blood-brain barrier keeps the liquor stable. The 

subarachnoidal space extends to the change of the cerebral to the spinal nerves 

where the liquors flows through thick venal plexi and microtobuli of collagen 

fibers to the connective tissues and eventually reaches the lymphatic system. 

The liquor production depends on the arterial system while its re-absorption 

depends on the venal system; thus follows a functional connection between the 

liquor, the venal and arterial systems, as well as a connex liquor – lymphatic 

system. A better exchange between cells, liquor, venal-, arterial-, and lymphatic 

systems should result from the CV4 and EV4 technique. 

According to Sutherland, it is important that the rhythmical fluctuations of the 

CSF extend themselves unobstructed in the head. Should the free flow of the 

CSF be restricted, the whole body could suffer from disorders and 

malfunctions. 17 

17 SUTHERLAND William Garner: Contributions of thought, 2nd Edition, (edited by A. Strand Sutherland, 

A. Wales), Sutherland Cranial Teaching Foundation, Portland, Oregon: Rudra Press, 1998, p.176, p.194 

Margit Grill / 2006

15 

2.3.2 Function and tasks 

The cerebrospinal fluid’s hydrodynamic cushioning buffer function gathers 

forces occuring both inside and out, distributes them and thus acts as protection 

for the brain and spinal cord. The liquor overwhelmingly takes over the 

lymphatic and immunological function in the CNS as it is responsible for the 

exchange of substances between blood and nervous tissues. The liquor also 

feeds nerve cells and disposes of cell waste (brain kidney). Capillary endothel 

cells and choroid plexus are a part of the blood-brain barrier that is responsible 

for the selective substance exchange for the proper maintenance of biochemical 

functions. The liquor also takes over the transportation of neurotransmitters as 

well as hypothalamic- and neuro-hypophyseal substances. 

2.3.3 External Liquor space 

The subrachnoidal space filled with cerebrospinal fluid and located between the 

arachnoid and the pia mater is a thin slit and extends only in certain areas to 

cisterns. The liquor surrounds the spinal cord up to the 2 nd sacral vertebra in the 

subarachnoidal space. 

2.3.4 Internal Liquor space 

The ventricular system consists of both semicircular lateral ventricles of the 

cerebrum; the small third ventricle; as well as the fourth ventricle which extends 

cone-pike between the pons, medulla and cerebellum. 

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16 

2.3.5 Projection / ventricle-system 

fig. 5 

projection / ventricle-system 

from the front: 

frontal tuber 

Glabella 

Nasion 

anterior part of the lateral ventricles 

3 rd ventricle 

4 th ventricle 

posterior: 

squamous portion of the occipital bone 4 th ventricle 

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2.4 Autonomic nervous system (ANS) 

2.4.1 General: 

The parameters measured in this study (skin-conductance, skin-temperature, 

pulse-rate, and respiratory frequency) are body functions that are controlled, 

regulated and fine-tuned through the autonomic nervous system. The ANS is to 

a large extent independent from our will; however, numerous combinations and 

interrelationships between the somatic and the autonomic nervous system exist. 

The central ANS consists of parts of the cortex, thalamus, hypothalamus, limbic 

system and reticular formation. 

In the inter brain, the third ventricle divides the thalamus into two halves; the 

hypothalamus lies at the base of the third ventricle. The thalamus acts as 

switchboard to the cortex. The thalamus is also known as the “door to 

consciousness” as all information from the environment and the senses flow 

through its core. These afferent senses (with the exception of odour) meet in the 

thalamus, are judged, weighted, filtered, associated with a feeling and finally 

further directed; but only a fraction of this process reaches the consciousness. 

The thalamus is an important integration and co-ordination organ. 

The hypothalamus is with its neural, neuro-secretal and hormonal function the 

single most important regulation centre of all the autonomic functions that 

guarantee the homeostasis necessary for life. It coordinates the endocrine and 

the ANS. 

The central ANS controls the peripheral ANS, consisting of the sympathetic and 

parasympathetic. The sympathetic nerve increases performance levels under 

stress and emergency situations, as it activates organ functions that are necessary 

for intellectual and physical work. The parasympathetic serves the metabolism, 

regeneration, and the gathering of physical reserves. Its activity is increased in 

rest and sleep; however, a functional synergy exists between both parts of the 

ANS which affects the whole organism. 

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18 

Afferents: 

All the information going to the central nervous system from the visceral and 

skin receptors travels with the sympathetic and parasympathetic nerves. 

Approximately 80% of the vagus are afferents. This afferent system serves 

autonomic regulation and allows specific closed-loop control systems through 

the fine-tuning of permanent information in order to keep specific values, such 

as blood pressure, constant. 

Efferents: 

Sympathetic: 

The original sympathetic cells are located in the thoracic as well as lumbar sidehorns, 

and leave the spinal cord through the front-horns. The changeover to the 

postganglionary II. neurone occurs in the sympathetic trunc or in the ganglions 

of the outer periphery (superior, middle and inferior cervical ganglion, etc.). The 

transmitting substance is acetylcholin. The postganglionary fibres then lean 

towards the effected organ where they use adrenaline and noradrenaline as 

transmitters (adrenerg system). 

Parasympathetic: 

The original cells lie in centres of the brain, like the medulla, but also in the 

sacral part of the spinal cord. The preganglionary nerve fibres run with the 

oculomotor nerve (III), trigeminal nerve (V), facial nerve (VII), 

glossopharyngeal nerve (IX) and especially with the vagus nerve (X) to the 

ganglions located near the organ, where they are switched to the postganglionary 

II neurone. The conduction in all peripheral synapses of the parasympathetic 

occurs via acetylcholin. 

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19 

fig. 6 

sympathetic / parasympathetic 

2.4.2 Cardio-vasculary and respiratory regulation 

As discussed above, the hypothalamus is the most important regulation 

centre. There are regions with parasympathetic and sympathetic functions. 

When the rostral part of the hypothalamus is stimulated, especially the 

praeoptic area, the result is an increased parasympathetic activity involving 

sweating, vasodilatation, increased salivation, decrease in blood pressure and 

pulse as well as bladder contractions and rising gastrointestinal activity. 18 

The centres for respiratory and cardiovasculary regulation with autonomous 

centres for blood pressure, heart activity, vasodilatation, inspiration and 

expiration, etc. are located on the floor of the fourth ventricle, in the medulla 

oblongata. This allows a common regulation of the cardiac and respiratory 

functions. Various pieces of information from the cortex, other autonomic 

centres and the periphery are processed in this area. 

18 DUUS Peter: Neurologisch-topische Diagnostik; Anatomie, Physiologie, Klinik, 

Stuttgart, New York: Thieme Verlag, 2001, p.278 

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20 

In the realm of long-term circulatory system regulation, the release of renin 

causes the creation of angiotensin II which has a strong vaso-constricting 

effect and therefore causes blood pressure to rise. 

ADH = anti-diuretic hormone (= vasopressin) causes a strong constriction in 

most peripheral vessels. 19 fig. 7 

cerebral nerves nucleii 


Berlin, Heidelberg, New York: Springer Verlag, 2000, p.544 

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21 

2.4.2.1 Cardiovasculatory centre: 

In the reticular formation, afferent impulses travel from presso and chemoreceptors 

in the carotid sinus and the aortic arch via the vagus nerve and the 

glossopharyngeal nerve to the solitary tract nuclei, where they are then further 

transmitted and processed. This network of neural transmission and switching 

controls the efferent activity of pre-ganglionary sympathetic and 

parasympathetic neurones; thus ensures the short-term regulation of blood 

pressure and its adaptation to various conditions. 

A resting pulse normally lies between 60 and 80 beats per minute, depending on 

one’s fitness level. 

Efferent impulses travelling through the vagus nerve diverge as rami cardiaci on 

both sides, and go to the right side of the heart and to the sinoatrial nodes. Their 

restricting effect on the sympathetic fibres causes a decrease in pulse. 

Other impulses cause a functional restriction of the sympathetic fibres 

controlling the width of blood vessels that leads to vasodilatation. 

2.4.2.2 Respiratory centre 

Because of its vital importance, respiratory rhythm can only be consciously 

influenced in the short term. Respiration rhythm at rest usually lies around 10- 

14/cpm for adults and 14-16/cpm for youths. 20 Chemical breath regulation 

ensures the body’s equilibrium and that respiration is adapted to its metabolic 

needs. 

The respiratory centre controls itself to a large extent. Changes in arterial blood 

gases (partial compression of CO2 and O2) and pH play the biggest role in 

respiratory regulation. 21 The tension level of the pulmonary alveoli provides 

feedback to the respiratory centre via the vagus nerve. Chemo-receptors in the 

20 SCHMIDT Robert: Physiologie kompakt, 4. Auflage, Berlin, Heidelberg, New York: Springer Verlag, 

2001, p 227 

21 FALLER Adolf: Der Körper des Menschen, 13. Auflage (neu bearbeitet von M. und G. Schünke), 

Stuttgart, New York: Thieme Verlag, 1999, p.363 

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22 

carotid sinus respond through sinus nerves and chemo-receptors in the aortic 

arch via depressor nerves. One discerns the expiration centre from the 

inspiration centre. Various respiratory neurones are synoptically connected to a 

neurone network in the medulla oblongata. The breathing rhythm occurs in the 

“Prae-Boetzinger complex “ (respiratory centre). Most afferent nerve fibres run 

along the vagus nerve or glossopharyngeal nerve to the switching cores in the 

solitary tract nuclei, where interneurones are located. These interneurones 

change the activity of the respiratory network through oligosynaptic connections 

and adapt respiration to the prevailing circumstances. 22 

fig. 8 

breath regulation 

2.4.3 Cutaneous blood supply 

Blood circulation is necessary to thermo-regulation, as well as nutrition and 

metabolism. The sympathetic nervous system gets information and impulses 

from the cortex, hypothalamus and the vasomotoric centres of the medulla. 

There are numerous (adrenerg) sympathetic fibres in the distal (acral) skin 

regions. They set free noradrenaline and cause a vasoconstriction. These fibres 

are useful to the (tonic base activity) of vessels. The postganglionary 

sympathetic fibres that innervate blood vessels proceed in the arterial vessels on 

the border between adventitious and middle tunica while in the veins; they carry 


Berlin, Heidelberg, New York: Springer Verlag, 2000, p.594, p.603 

Margit Grill / 2006

23 

through the middle tunica. Dilatory reactions therefore depend on a central 

inhibition of this activity. 

Sympathetic-cholinergic-vasodilatating fibres probably also exist in humans. 

From the cortex going around the medulla oblongata, a vasodilatation occurs in 

response to strong emotions such as anger or fear. 

Parasympathetic cholinergic vasodilating fibres come from the VII., IX., X. 

cerebral nerve and from the sacral marrow. Their switching occurs via the 

postganglionary neurone either in or in immediate proximity to the effected 

organ. They have no tonic base activity. A functional vessel innervating of 

significance could only until now be demonstrated in the small pia arteries of the 

brain, the coronary arteries and the genital organs. 23 

A vasodilatation can also occur through stimulation of nociceptive afferent 

neurones via mechanical or chemical stimulation of the skin. 

Circulating hormones also influence the tone of peripheral vessels; however, this 

mechanism only plays a secondary role. 

2.4.4 Skin moisture 

Skin moisture serves first and foremost the purpose of thermoregulation; it is 

also an expression of man’s vegetative state of reaction. The sweat glands are 

only regulated by sympathetic synapses in which acetylcholin is used as 

transmitter. The sympathetic tone increases sweat glands secretion, thus skin 

moisture. 


Berlin, Heidelberg, New York: Springer Verlag, 2000, p.525 

Margit Grill / 2006

2.4.5 Summary table of sympathetic and parasympathetic activity 

Parameters measured by biofeedback 

24 

parasympathetic sympathetic parameter 

pulse-rate slowing down increase pulse-rate 

breathing rate slowing down increase breath frequence 

-amplitude 

vasodilatation (adrenerg) vasoconstriction temperature 

decrease increase (cholinerg) skin-conduction 

tab. 1 sympathicus / parasympathicus / parameter 

Margit Grill / 2006

25 

3 Fundamentals of the craniosacral techniques 

The following section deals with the fundamentals pertaining to the CV4 and 

EV4 cranial techniques. The following books are used as basis. 

BECKER Rollin: 24 The Stillness of Life 

JEALOUS James: 25 script „Emergence of Originality” 

LIEM Thorsten: 26 Kraniosakrale Osteopathie 

MAGOUN Harold: 27 Osteopathy in the Cranial Field 

SUTHERLAND William Garner: 28 Contributions of Thought 

3.1 History 

The craniosacral concept was developed by Sutherland between 1898-1954. 

He expanded Still´s ground principles of osteopathy to the cranium. Through 

thoughts, experiments and clinical observations, he researched and identified 

relationships between the mobility of sutures, fluids, membranes and certain 

dysfunctions respectively diseases. Sutherland discovered a slowly pulsating 

movement that was independent from the heart and breathing rhythms and that 

could be influenced by subtile manual methods of treatment. The similarity 

between the dynamic of the embryological development and the pulmonary 

breathing lead to the phrase: “primary respiratory mechanism” 29 (=PRM). 

24 BECKER Rollin: The Stillness of Life, (edited by R. Brooks), Portland: Stillness Press, 2000 

25 JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, script „Emergence of Originality”, 

Vienna, 1998 

26 LIEM Thorsten: Kraniosakrale Osteopathie, Stuttgart: Hippokrates Verlag, 1998 


Teaching Foundation, Cincinnati, Ohio: The C. J. Krehbiel Company, 1997 

28 SUTHERLAND William: Contributions of Thought, 2nd Edition, (edited by A. Strand Sutherland, 

A. Wales), Sutherland Cranial Teaching Foundation, Portland, Oregon: Rudra Press, 1998 



Margit Grill / 2006

26 

3.2 Primary respiratory mechanism 

The craniosacral rhythm or cranial rhythmic impulse (=CRI) has a frequency of 

6 – 14 cycles per minute. There is also a somewhat slower rhythm of 2 ½ cycles 

and with 6-10 cycles in 10 minutes. 30 In the flexion-phase = cranial inspiration, 

the head and the body become wider and somewhat shorter, in the extensionphase 

= cranial expiration phase, smaller and longer. To bring the subject to a 

neutral stage and “synchronizing” with the practitioner at the beginning of the 

treatment is a precondition. 

3.3 The five fundamentals of the CRI 

‣ inherent mobility of CNS, based on neuroglia mobility 

‣ CSF fluctuation 

‣ membrane system mobility 

‣ movement of the cranial bones 

‣ movement of the sacrum (the cranial rhythm is transmittered to the 

sacrum via the dura mater) 

The goal of the craniosacral techniques is the decrease of tension in the 

membrane system, the improvement in mobility of articulary restrictions, 

especially in the head area, as well as the improvement in the CSF fluctuation. 

The resulting optimization of arterial, venal and lymphatic circulation leads to 

an improved function of the physiological system on the biodynamic, 

bioelectrical and biochemical level. All of the body’s exchanges (functions) are 

stimulated and thus support the body in its quest for homöostasis. The resulting 

systemic effect grabs the individual as a whole and reflects osteopathic basic 

thought. 

30 JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, script “Emergence of Originality”,Vienna, 

1998 

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27 

‣ Life is movement 

‣ The body is a unit 

‣ Structure and function reciprocally affect each other 

‣ Rule of the arteries 

‣ The body has the power to heal itself 

3.4 CV4 and EV4 working mechanism 

The CSF longitudinal fluctuation is brought to a stillpoint via the occipital bone. 

CV4 prevents the flexion phase and EV4 prevents the extension phase of the 

CRI. The anatomical connection between the occipital bone and the tentorium 

causes a change in the membrane system’s tension, which should lead to 

changes in pressure and hydrodynamic behavior in intracranial fluids. These 

pressure, tension and flow changes influence, even stimulate the neighbouring 

physiological centres. 

A parasympathetic effect raises liquor production and a stagnating fluctuation 

could be once again accelerated by the stimulation of the exchange process 

(production and resorption). 

A further thought model for those workings of this effect is the one offered by 

Jealous. The “biodynamic cranial osteopathy” communicates with the natural 

laws of primary respiration and their healing power. ”CV4 is a technique that 

takes us back to the first function of life which is the movement of the midline in 

the embryonic plate. It reorganizes all electrical processes in the body around 

their origin” and ”EV4 takes the potency from the midline, the CV4 brings it to 

the midline“. 31 Sutherland and Becker 32 also repeatedly mentioned on the 

ground laying meaning of this potency for the craniosacral work. For Still 33 , the 

CSF was: „one of the highest known elements“ and an important element for 

31 JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, notes, Pöttmes, 2000 

32 BECKER Rollin: The Stillness of Life, (edited by R.Brooks), Portland: Stillness Press, 2000 

33 STILL Andrew Taylor: The Philosophy and Mechanical Principles of Osteopathy, 1902, 

Kirksville: Osteopathic Enterprise, 1986, p.44-45 

Margit Grill / 2006

28 

man’s health. He said: „the great river of life must be tapped and the withering 

field irrigated at once, or the harvest of health be forever lost”. 

Gould and Gross 34 (1999) study offers an interesting aspect to this theme. 

Experiments showed that apes possessed (developed) new brain cells in the 

fourth ventricle region that moved to other brain regions, mature and are then 

included in the brain’s working mechanism. It is possible that people also have 

this potential for regeneration and this process could possibly be supported or 

stimulated by a CV4 or EV4 technique. 

3.5 Indications and contraindications 

Indications: 

Harmonisation and regulation of the ANS’ physiological centres and 

harmonisation at a hormonal, vegetative, muscular and chemical level… 

Improvement in metabolism: improvement of the arterial, venal and 

lymphatic circulation, increase in immunity, decrease in fever during 

infections and inflammations. 

Decrease of tension: muscular hypertension, high blood-pressure, 

tachycardia… 

Contraindications: 

Danger of encephalorrhagy, aneurysm, acute head injury, acute stroke. 

Relative contraindications: carcinoma and Aids 

34 GOULD Elizabeth, GROSS Charles: “New Brain Cells in Highest Brain Areas”, published by Steven Schultz, 

Princeton University, 1999, http://www.newswise.com/articles/1999/10/NEURO/PTU.html [4.5.2002] 

Margit Grill / 2006

29 

4 Material and method 

4.1 Biofeedback (BFB) 

BFB is learning through the response of physiological functions that normally 

occur unconsciously (e.g. increased muscle tension during mental stress) and 

their influence in the realm of a therapeutic goal (relaxation under stress). 

With the BFB training, the test subject can develop a growing consciousness 

about specific internal physiological functions; attain control over them; and 

apply them to every day life. 

The goal of this method is to offer the client an economical, rapidly effective 

assistance, e.g. sicknesses involving either pain, psychosomatic symptoms, 

psychological and psychiatric disorders, neuromuscular and neurological 

disorders, as well as urological diseases. 

BFB is also an important part of muscular diagnostics, in particular (psycho-) 

vegetative states of tension. 

4.1.1 Biofeedback – technical conditions 

The biofeedback unit’s instruction manual served as information source for the 

technical data and for the correct manipulation of sensor application. 

The study uses the computer supported biofeedback system called SOFT from 

Insight Instruments, SOFTdat model 8020-B, with the “Comfort program”. 

Using sensors connected on one side to specific body parts of the test subject 

and to the SOFT-dat on the other side, the person’s physiological parameters are 

taken. 

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30 

4.1.2 Comfort Program 

The chosen measuring parameters are saved in the menu under „last 

setting“ and are available for further similar sessions. 

Mark: this indicates that markers can be placed and shown on the screen. 

They are numbered and can be viewed under review. 

Stop: this indicates the end of the session 

End with save: the captured data can be designated by a name with a 

maximum of 8 spaces and saved on the PC. 

Export data: the software offers the possibility to deliver the indicated 

data in various formats for further processing. 

Arrangement of the instruments 

blue: 

red: 

multi sensor and cable 

breathing sensor 1 and 2, cable, stand 

computer supported biofeedback system 

practitioner 

 

 

supporting person 

fig. 9 

arrangement of the instruments 

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31 

4.1.3 Sensors 

4.1.3.1 Multi sensor 

This multisensor simultaneously captures three physiological measurements: 

electrical skin conductivity 

pulse rate 

skin temperature 

fig. 10 

multi sensor 

4.1.3.1.1 EDG = electro dermography 

This measures the electric conductivity of the skin, which is a relative 

measurement tool for sweat gland activity and thus for the activity of the 

sympathetic as well. Every mental stimulation has a direct effect on the skin 

resistance. 

Technical facts: 

• Unit of electrical skin conductance: Siemens (S) 

• Electrical conductivity is the reciprocal value of the skin’s electrical 

resistance 

• Unit of the skin’s electrical resistance: Ohm ( Ω) 

• The report is done digitally in micro-Siemens (µS) 

• The surface area of both sensors is 50.3 mm 2 

• The skin conductance value is marked four times per second 

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32 

4.1.3.1.2 PPG: Pulse plethysmography 

• Registration of blood volume pulse via photoplethysmography 

• Changes in the blood volume’s relative size are measured 

• Pulse rate unit (fp): bpm (beats per minute) 

• Pulse parameters are marked nine times per second 

4.1.3.1.3 TEM: Thermistor measurement 

Registration of the skin’s temperature trends via a thermistor. It can capture 

measures between 21 to 38 degrees. The dissolution is extremely high (0.02 

degree) in order to exactly capture trends. The measurement is not meant for the 

measurement or observation of exact body temperature but rather only for an 

interpretation of the behaviour of temperature which is represented relatively. 

The temperature is marked five times per second. 

4.1.3.2 Breathing sensor1 and 2 

Two small instruments affixed to a pedestal and attached via cable to SOFT-dat 

are used to register breathing activity without physical contact using infrared 

light. This is done to measure the relative size of breath movements in the chest 

and abdominal areas. 

• Breath frequency unit: breath/minute (cycles per 

minute) 

• Input of breath amplitude: % 

• Breath is measured five times per second 

fig. 11 breathing sensor 

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33 

4.1.3.3 Fastening of sensors 

4.1.3.3.1 Multisensor fastening 

The test subject’s hands are to be cleaned with soap prior to the test and the ring 

finger of the non-dominating hand wiped with alcohol. The multisensor is 

attached to the inner side of the non-dominating hand’s 4 th finger, as fingers with 

strongly calloused skin are not adequate for this purpose. 

The inner side of the finger is placed on the multisensor and pushed forward to 

the guiding border. The guiding border is used to guarantee a definite 

positioning of the finger on the sensor. 

The fastening belt is placed around the finger, slightly placed over the finger and 

zipped shut so that the finger’s surface fully lies on the sensor. 

The finger may at no time be tied too tightly as this will cause wrong 

measurement values to be taken – pressure that is too strong will cut off blood 

circulation. 

The test subject’s hand should be positioned as to have finger and sensor up in 

the air (they shall not rest against something). Hand or finger movements are to 

be avoided as they could compromise results. 

4.1.3.3.2 Breathing sensors positioning 

The distance between the active surface of the breathing surface and any area 

from which breathing movements are to be taken should be approximately 15- 

20cm and positioned parallel to the thorax or abdomen. In order to obtain 

measurement results that can be reproduced, one must always use the same 

distance. 

A distance of 17cm is used for this experiment. Breathing sensor 1 is located at 

navel level, breathing sensor 2, the width of a hand lower than the sternoclavicular 

joint. The same clothing should always be worn for different 

measurements as varying fabrics reflect light differently. Strong prints or black 

Margit Grill / 2006

34 

clothing should be covered by a white cloth. The clothing should be even and 

form-fitting so that body and cloth move together. 

A precondition to an accurate breathing activity registration is that the subject be 

in a position that is as relaxed, comfortable and stable as possible. 

4.2 Description of the techniques: CV4, EV4 and Placebo 

Test subject positioning: 

the subject is lying on a bed in a relaxed supine position 

Practitioner 

the practitioner sits in a relaxed position at the head of the bed. 

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35 

4.2.1 CV4-technique = Compression of the fourth ventricle 

Position of the hands: 

• the underarms are lying on the bed 

• hands are resting in each other 

• the thenar eminences and thumbs parallel 

and pointing in caudal direction. 

• the thenar eminences are located on the 

lateral angle of the occipital bone. 

fig. 12 

CV4 

Performance: 

In the cranial extension phase, the intent is to follow the shrinking of the occiput 

and to somewhat press together its anguli laterales. In the cranial flexion phase, 

the intent is to hinder the anguli’s branching out laterally by using minimal 

compression whereby care must be taken not to block the cranial rhythm. 

Movement amplitude gets smaller whereby the flexion and extension movement 

comes to a stop after several cycles. This is called the “stillpoint” and can last 

from a few seconds to several minutes while hands remain on the occiput. 

At the end of the stillpoint, the practitioner feels a strong expansion force in the 

form of pressure on the balls of the thumbs which he passively observes. These 

cranial expiration and inspiration movements are observed for a few cycles to 

once again judge the quality of the cranial rhythm. 

Margit Grill / 2006

36 

4.2.2 EV4 technique = Extension of the fourth ventricle (as per 

Jealous) 

Hand positioning: 

• Underarms rest on the bed 

• The occiput rests in the hands 

• Finger tips meet in the middle and are placed somewhat forward 

fig. 13 

EV4 

Performance: 

In the cranial inspiration phase, the external rotation is observed with the intent 

to retard the expiration phase in its movement. The movements amplitude gets 

smaller and after a few cycles, the flexion and extension movement comes to a 

stop. This can last several seconds or minutes. Hands remain in this position 

until a warming and softening of the tissues located underneath them is felt. The 

renewed expiration and inspiration movements are further observed for a few 

cycles in order to evaluate their qualitative changes. 

4.2.3 „Placebo“ technique 

In this placebo technique, the positioning of the hands is almost identical to EV4 

whereby here, the hands are located a bit more caudally so that only the little 

finger is in contact with the occiput. The intent is not to perceive any rhythm; 

the goal is to emotionally limit the subject by placing a fictivious separation 

layer between. There is no intention to perform a CV4 or EV4 technique. 

Margit Grill / 2006

37 

4.3 Method 

For this research, 12 subjects were used (N = 12, n = 7m, n = 4f) aged 21 to 43. 

The measurement occurred between 18.4.2001 and 22.6.2001. 

Each was subjected to a CV4, EV4 and placebo technique at one week interval. 

The measurements were done via the Biofeedback-system before and during the 

techniques, to record the course. 

The following parameters were captured: 

‣ skin-conductivity 

‣ skin-temperature 

‣ pulse-rate 

‣ breathing-rate 

‣ breath-amplitude 

The measurement on a subject occured on the same week day, at the same time 

(+/- ½ hour) in order to limit variations due to the time of day. 

In order to minimize subject influence on the measurements, the techniques 

were made anonymous by initializing each technique. Test subjects were not 

informed of this process so that they did not know which technique was being 

performed. 

The techniques’ sequence order was determined prior to the beginning of the 

study. Each test subject picked a closed envelope in which his/her sequence was 

enclosed. 

Margit Grill / 2006

38 

subject technique / sequence week 1 week 2 week 3 

1 CBA C B A 

2 BCA B C A 

3 BAC B C A 

4 ACB A C B 

5 ABC A B C 

6 CAB C A B 

7 BCA B C A 

8 BAC B A C 

9 CBA C B A 

10 ABC A B C 

11 CAB C A B 

12 ACB A C B 

tab. 2 sequence / technique 

A = CV4-technique 

B = EV4-technique 

C = placebo-technique 

4.3.1 Points of criticism 

As a consequence of the low number of subjects the statistical evidence must not 

be overestimated. Therefore, this study can only represent a “pilot project” 

suggesting tendencies. 

Furthermore, the placebo-technique has to be seen from a critical point of view, 

because the border between a subtile craniosacral technique with minimal and 

focused pressure or movement and the placebo technique is very small. 

Unconscious and involuntary minimal pressure or movement of the hands 

cannot be totally excluded. Hence the practitioners experience and skill could 

influence the applied technique. 

Margit Grill / 2006

39 

4.4 Conditions necessary for the room 

Room temperature should be between 22° and 24°C in order to keep conditions 

constant for the test subject 

Intensive sunlight falling on the test subject can render results inaccurate and 

needs to be filtered by drawn blinds 

The test room’s door should be shut in order to avoid disturbing noises that can 

have an influence on the measuring results. No telephones or mobiles are 

allowed in the room and a „do not disturb“ sign is hung on the outside of the 

door. 

These precautionary measures should ensure a homogeneous environment for all 

test subjects, without any acoustic or thermal disturbances. 

4.5 Inclusion and exclusion criteria 

The following pre-conditions were observed in order to ensure the most stable 

starting situation as possible. 

Only people who had never undergone a cranio-sacral-osteopathetic treatment 

were used. This ensured an objective reaction on the part of the test subject that 

excluded any form of behavioral influence due to expectation. 

At the time of the study, test subjects should feel healthy, meaning that they are 

in generally good health, suffer from no acute or chronic disease necessitating 

regular medication such as febral infections, pneumonia, bladder infection, 

diabetes, asthma, known case of high blood pressure, thyroid disorder and so 

forth. People with recent post-traumatic wounds were also disqualified. 

As the study explored the differences between the CV4 and EV4 techniques, 

special dysfunctions in the test subjects were not searched for. This is the goal of 

a further study. Test subjects could, however, feel slight aches, which they do 

not feel on a regular day, such as a temporary feeling of tenseness in the neck or 

in the lower spine. 

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40 

The test subjects were not allowed to engage in any physical activity one hour 

prior to the measuring, such as sports, heavy physical work, etc., nor were they 

allowed to take any substances such as alcohol, nicotine, medicine, coffee, tea, 

etc., as this could have an effect on the thermo-regulation, the cardio- and 

metabolic systems as well as respiration. 

Test subjects should try to relax and get rid of everyday stress in the waiting 

room for the 20 minutes preceding phase. 

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41 

5 Procedure 

waiting room 

20 minutes 

testing room 

relaxed supine position 

5 minutes 

fastening of sensors 

5 minutes 

measurement starting 

duration 15 minutes 

The program “Comfort” does not record the 1 st minute 

basic measurement 

= baseline 

5 minutes 

1 st mark = starting 

the technique 

technique 

10 minutes 

further marks, 

when a stillpoint 

is noticed 

Non involved persons set the marks 

last mark 

end after 

15 minutes 

data: printing, storing 

and exporting 

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42 

6 Results and statistical evaluation 

The statistical evaluation was made by Benesch. 

The measurements occured between: 18.4.2001 – 22.6.2001 

For this study, 12 subjects (8 men and 4 women) aged 21 to 43 were used. 

At the time of the measurement, they felt healthy and fulfilled the necessary 

inclusion and exclusion criteria. 

The goal of this study was to determine whether there exists a measurable 

difference between the CV4 and EV4 techniques. The measurements were done 

via the Biofeedback-system. 

The following parameters were captured: 

‣ skin-conductivity 

‣ skin-temperature 

‣ pulse-rate 

‣ breathing-rate 1 

‣ breathing-amplitude 1 

From these measurements, there were 57 measurements per test-subject over 

time, each showed mean-values, because the individual measurement-values 

were taken in very short intervals. These data were printed out with a graphical 

representation. (see appendix) 

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43 

6.1 Profile of a single subject (subject 3) 

To avoid confusion of the data, only one profile that seems interesting to me 

should be isolated and described in detail, because this study explores both 

cranial techniques and not single profiles. 

The first markery, was set after the five minute base-measurement (baseline) at 

the beginning of the technique. It showed the point at which the practitioner set 

his hands on the subject’s head, and the technique began. Further markings were 

set at noticed stillpoints and at the end of the measurement process after 15 

minutes. 

At the beginning, CV4 presented a clear rise of the pulse-rate and breathamplitude 

with a simultaneous decrease of the breathing frequency. 

On the other hand, the subject only reacted with a rise in temperature after the 

introduction of a stillpoint via CV4 or EV4, also skin-conductivity increased 

slightly after the stillpoint at EV4. 

No change in the measuring data was noticed with the placebo-technique. 

This example indicated that as of the beginning of the technique, all the 

parameters were more or less influenced, but also that the stillpoint phase 

presented further changes, such as by CV4 in this case (= 2. stillpoint / 

marking 3). 

This subject showed almost no deviation in the measurement-data with the 

placebo-technique, but stronger changes during the CV4-technique and smaller 

reactions on the EV4-technique. During the complex evaluations of all the 

parameters, no parasympathetic or sympathetic effect could be firmly assessed 

for one of the two cranial techniques. 

Margit Grill / 2006

sequence subject 3 1.week / B 2.week/A 3.week/ C 

EV4 CV4 placebo 

skin-conductivity 

minimal 

 

after the stillpoint 

skin-temperature = 

after the stillpoint 

after the stillpoint 

pulse-rate 

minimal after the 

stillpoint 

after the stillpoint = 

mean value 89,9 mean value 84,59 mean value 73,54 

breathing-amplitude 1 = = 

breathing-rate 1 minimal minimal in the last 1/3 

mean value 24,42 mean value 18,6 mean value 17,3 

tab. 3 individual parameter / subject 3 

red = parasympathetic 

44 

It was interesting that the pulse and breathing mean value decreased from the 

first to the third week especially after the CV4 technique. Conversely the pulsemean-value 

was raised one week later during the next intervention for people 

who were trained (subject 12, 6 and 8). 

Review - print-out / subject 3 following now 

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45 

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46 

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PLACEBO 

47 

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48 

6.2 Descriptive statistic 

see page 72-83 / appendix 10.4 

To facilitate comparison, the raised data of the time-course were statistically 

processed. 

6.2.1 Course measurement per subject 

Following description: individual courses 

‣ Comparison of the techniques for skin-conductivity 

‣ Comparison of the techniques for skin-temperature 

‣ Comparison of the techniques for pulse-rate 

‣ Comparison of the techniques for breathing-frequency 1 

‣ Comparison of the techniques for breathing-amplitude 1 

CV4 = A = technique 1 = black 

EV4 = B = technique 2 = red 

Placebo = C = technique 3 = green 

Margit Grill / 2006

49 

6.2.1.1 Results 

From the description of the single courses one notices that the parameters 

changed at the beginning of the technique but every subject showed his own 

induvidual form of “profile”. 

The result of the changes is to be seen as “person-specific”. 

6.2.2 Technique comparison: description of the mean courses 

8 intervals 

The parameter measurements were taken and compared at eight identical 

intervals. 

‣ Technique comparison for skin-conductivity - mean course 

‣ Technique comparison for skin-temperature - mean course 

‣ Technique comparison for pulse-rate - mean course 

‣ Technique comparison for breathing-frequency 1 - mean course 

‣ Technique comparison for breathing-amplitude 1 - mean course 

technique 1 = CV4 = black 

technique 2 = EV4 = red 

technique 3 = placebo = green 

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50 

mean course 

EDG 

mean course 

temperature 

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51 

mean course pulse-rate 

mean course breathing-amplitude 1 

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52 

mean course breathing-frequency 1 

6.2.2.1 Result 

Skin-conductivity : 

CV4 and EV4: both techniques indicated a decreasing tendency. CV4 had a 

low and placebo a high deviation. 

Placebo-technique: interestingly, the skin-conductivity rose somewhat prior to 

the technique and decreased only minimally at the begin of the intervention. 

Skin-temperature: 

CV4 and EV4: in the first half, there was a rise in the temperature of 

approximately 0,5°C. 

Placebo: the temperature rose similarly, but approximately by 1°C. 

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53 

Pulse-rate: 

The pulse-rate showed a very large deviation for all techniques. 

CV4: The puls-rate sank more clearly at the beginning of the technique than 

with EV4 and placebo. 

Breathing-amplitude 1: 

CV4: again presented the smallest deviation and the decrease in breathingamplitude 

was more clearly recognized as in EV4 and placebo. 

Breathing-frequence 1: 

CV4: After the beginning of the technique, the breathing-frequence droped 

noticeably. After the “drop” it rose again up to the start-level. 

EV4 and placebo: there was also a continued decrease, but it had started 

already before the technique and did not rise afterwards. 

Summary: 

CV4 showed a noticeably small deviation in the skin-conductivity and 

breathing-amplitude 1. 

All of the CV4 parameters in the middle of the procedure lay among the lowest 

values (black linie), placebo in the middle (green line) and EV4 (red line) 

slightly higher. 

The observation of the parameters and their interrelationship showed that all of 

the techniques had more or less a parasympathetic tendency. The breathingfrequency 

presented a clear marker for the CV4 technique by going back to the 

starting level after the “drop”. 

Margit Grill / 2006

54 

6.3 Inference statistics 

see page 84-88 / appendix 10.5. 

As several of the measuring variables are “leftrise” (=linkssteil) and have 

extreme values, the data were transformed with logarithms. The measurements 

were split in 3 equal intervals ( 1. interval: values 1-17, 2. interval: values 18-38, 

3. interval: values 39-57). For each measuring-value-variable the inference 

statistical analysis was made via the “General linear model with repeatmeasurement” 

GLM-model – repeated; statistical program: SAS Realease 8.01), 

with sequence, technique and time as grouping-variables. 

6.3.1 Result 

Based on the inference statistics there was no significant difference between the 

CV4, EV4 and placebo-techniques. Over the course of the three intervals, 

there were however significant, even highly-significant changes in all 

parameters, meaning that the values over the course of the three intervals were 

more than by chance different. 

p = probability 

time-course 

technique 

skin-conductivity p = 0,0006 sign. p = 0,21 

skin-temperature p < .0001 h. sign. p = 0,8 

pulse-rate p = 0,0014 sign. p = 0,21 

breath-amplitude 1 p = 0,0119 sign. p = 0,51 

breath-frequency 1 p = 0,0278 sign. p = 0,58 

tab. 4 result / inference statistics 

Margit Grill / 2006

55 

6.4 Description: mean values / 3 intervals 

The charts below show the trends of the individual parameters. 

1. interval: measurement-value 1 - 17 Baseline 

2. interval: measurement-value 18 - 38 0 - 5 minutes technique 

3. interval: measurement-value 39 - 57 5 - 10 minutes technique 

EDG 

0,60 

0,50 

0,40 

0,30 

0,20 

0,10 

0,00 

µS 



Placebo 

1 2 3 



Placebo 

skin-temperature 

Placebo 



1 2 3 

29,80 

29,60 

29,40 

29,20 

29,00 

28,80 

28,60 

28,40 

28,20 

°C 



Placebo 

Margit Grill / 2006

56 

pulse-rate 

75,00 

70,00 

bpm 

65,00 

60,00 

55,00 

50,00 


Ev4 

Placebo 

1 2 3 


Ev4 

Placebo 

breath-amplitude1 

50 

% 

40 

30 

20 

10 



Placebo 

0 

Placebo 



1 2 3 

breath-rate 1 

20 

19 

18 

17 

16 

15 

14 

13 

12 

11 

10 

cpm 



Placebo 

1 2 3 



Placebo 

Margit Grill / 2006

57 

6.4.1 Diagram of tendencies 

skin-conductivity falling tendency CV4 > EV4 > placebo 

skin-temperature rising tendency placebo > CV4 > EV4 

pulse-rate falling tendency CV4 / EV4 / placebo 

breathing-amplitude 1 falling tendency CV4 / EV4 > placebo 

breathing-frequency 1 falling tendency 

rising 

CV4 / EV4 / placebo 

CV4 after the “drop” 

tab. 5 result / tendencies 

6.4.2 Result: 

The breathing-frequency showed a clear sign for the CV4 technique by going 

back to the starting level after the “drop”. 

All interventions had a more or less parasympathetic tendency. 

Margit Grill / 2006

58 

7 Discussion 

Concerning the question whether there is an identical or different effect using 

CV4, or EV4, the determining factor is the viewing angle and the observation 

method, because the changes in the parameters can be set in relation to the 

individual single-course of the subject, but also to the technique. The values of 

the parameters, as expression of the effect, can be interpreted individually or as 

a group. 

7.1 Ad: “single-profile” 

The course measurement of the subjects with their individual reaction sample 

shows that the techniques react more “person-specifically” as clearly 

“technique-specifically”. As the individual-profile shows, the pulse and breathrate-mean-values 

sink from one intervention to the next, especially with CV4, if 

the subject has a higher pulse level. This effect cannot be verified for all subjects 

as this study does not explore any pathologies but the tendential characteristics 

of the techniques. The pulse-mean-rate of other subjects, who have through their 

fitness level a low pulse rate, rose. Immediate effects shall therefore be 

differentiated from mid-term effects. The course-measurement result and the 

mid-term changes are however an indication of the harmonizing respectively 

homöostatic influence of the techniques as reported by Jealous 35 , and they have 

a say in the matter of indications as well as for the therapeutic process. 

7.2 Ad: Technique 

Because of the inclusion and exclusion criteria and the environment conditions 

the subjects are already prior to the techniques in a relaxed atmosphere. An 

important result of the study is that despite these preconditions there are 

significant changes in the parameters via the CV4 , EV4 and placebotechniques 

over the time (inference statistics). 

35 JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, notes, Pöttmes 2000 

Margit Grill / 2006

59 

It seems that, globally seen there is no difference between all techniques. 

However, if one takes the statistically prepared parameters with their highly 

significant to significant reliabilities into account, then there are indeed subtile 

differences to be seen between all techniques in the course of the measurement. 

In the descriptive statistics, the techniques show “stimulus-specific” responses 

in skin-conductivity, skin-temperature, breath-rate and breathing-amplitude. 

7.3 Ad: parameter 

The subject’s psycho-physiological state is best reflected by skin-conductivity 

and delivers relevant information about the level of vegetative (sympathetic / 

parasympathetic) and psychic excitement and/or relaxation. As skinconductivity 

reacts to outer and inner stimuli, it was tried to secure similar 

preconditions for the measurement, but environmental influences active on the 

subjects such as conflicts, resolutions, worries, mood, etc. cannot be completely 

eliminated. The beginning level shows for several subjects that there are 

important differences that can have been brought on by either positive or 

negative emotionally loaded thoughts. Several subjects show a small rise at the 

beginning of the technique as well as with two subjects (subject 8/placebo, 

subject 9/CV4) who fell asleep and dreamed towards the end of the intervention. 

It is interesting to note that the skin-conductivity level is higher in the 

placebo-technique than in the CV4- and EV4-technique. The CV4 deviation is 

very small compared to the placebo’s und EV4’s. These facts can either be seen 

as indication of a deep relaxation or a decrease of sympathetic activity due to 

CV4. This trend can also be an indication that the placebo-technique does not 

influence the psycho-vegetative area as much as CV4 and EV4. Skinconductivity 

as a factor of expectation that an intervention will be done, stays on 

the higher level of expectation, because no cranial technique is used. 

The craniosacral concept works with very subtile, minimal but very precise 

techniques. It is therefore possible that this small difference is due to the 

technique’s focus on the fourth ventricle. 

Margit Grill / 2006

60 

A decrease in the sympathetic tone causes warming of the skin via a stronger 

blood-flow. Aside from thermoregulation, psycho-vegetative processes also play 

a role, especially in the hand area. In the placebo-technique, temperature rose 

higher as in CV4 or EV4. Temperature and skin-conductivity thus differ in their 

course and intensity in all three techniques. In the placebo-technique, the rise in 

temperature is possibly due to the breathing- or cardio-vascular-system. 

Breathing sensor 1 and 2 show almost identical results, therefore only breathing 

sensor 1 was evaluated, to decrease the spread in measuring data of the 

respiratory-system. 

The obvious breathing form (belly or breast-breathing) is a product of the usual 

breathing pattern and the current situation or level of activity. Calm breathing 

causes a CO 2 blood concentration rise which leads to venal stretching and a 

better blood supply as mentioned above. 

Generally, the breathing became more harmonious or more regular and its 

rate decreased, like Magoun 36 and Wales 37 described. The CV4 breath-rate is to 

be handled differently. Of visible significance is the “drop” occuring in CV4 in 

the middle and the subsequent rise as well as by far smaller deviation. The 

“drop” is comparable to the procedure of the technique, the breath-rate falls and 

rises simultaneously to the slowing down or acceleration of the longitudinal 

fluctuation. What is also noticeable is the approximately constant level of the 

breathing-amplitude in the placebo-technique. 

This result is possibly an indication that CV4 has another influence on the 

respiratory system and to the autonomic centres than the EV4 or placebotechnique. 



37 WALES Ann: “The management, reactions and systemic effects of fluctuation of the cerebrospinal fluid” 

in: Journal of the Osteopathic Cranial Association, p.46 


Margit Grill / 2006

61 

A clear relationship exists between breathing and heart-rate. Deep calm 

breathing normally modulates the heart’s rhythm (respiratory sinus arrhythmy = 

RSA: heart frequence rises through breathing in and falls when breathing out) 

and slows down the pulse-rate in her tendency. 

As each person has a characteristic pulse-rate at rest that depends among others 

on his fitness level, a large value deviation is called forth. Active, vegetative and 

central nervous parts, physical performance, cognitive behavior as well as 

breathing activity all influence the heart-rate. Pulse- and breath-rate should 

occur in a synchronized manner due to their preconditions at rest, as calm 

relaxed breathing leads to a decrease in the pulse-rate. The descriptive statistics 

also shows here a minimally different picture for CV4 where the pulse-rate does 

not increase with the breath-rate in the last third. 

The rise in breath-rate is noticeable from outside and could be the basis for 

Dovesmith’s 38 observations that CV4 (extension of the occiput) has a 

sympathetic effect. For the other parameters a sympathetic effect is not to 

confirm. As each profile shows an individual reaction pattern, as described 

above, this fact can also be the basis for Dovesmith’s thought model. 

7.4 Ad: parameters combined action 

The parameters taken are to be seen in their combined action as indicators of a 

person’s relaxation level. 

Relaxation is a process that comprises the simultaneous activation-changes of 

several systems. These include the muscular, cardiovascular, autonomic, 

endocrine and cognitive systems. Relaxation cannot be forced but is much more 

like a vegetative reaction that occurs by itself when the external and internal 

conditions allow it. A parameter alone therefore cannot prove a person’s general 

relaxation level and it could cause wrong interpretation. 

38 DOVESMITH E.Edith: “Fluid fluctuation and the autonomic system”, in: Journal of the Osteopathic Cranial 

Association, p.54-61, published by The Osteopathic Cranial Association, 1953, p.55 

Margit Grill / 2006

62 

If one takes the measuring data of the individual parameters into account, a 

general parasympathicotone tendency can be seen for CV4, EV4 and 

placebo. 

The changes are different for the individual parameters as well as for their 

combined effect. The immediate technique-specific parasympathetic tendencies 

are an expression of rest and regeneration through which the self-healing forces 

can be stimulated. As the placebo-technique moves in this direction as well, one 

has to wonder what causes could be responsible for this. Under certain 

circumstances the position of the hands in the occipital area may have an 

influence. A therapeutic process probably takes place, that one does not 

ackowledge on purpose as it is extreme difficult, almost impossible “not to feel 

anything and to do nothing”. 

Perhaps the reason for this effect is the touching of the head. “Knowing by 

applied, respectful touching, that is targeted to the patient as a whole, always 

has an effect on the oldest parts of our sensory system. The person treated 

increasingly feels his decreasing muscle-tone, the deepening breathing and its 

regularity, his comfort. He feels his most primitive behavioral scheme, that is 

the one originating from man´s early developmental history” writes 

Feldenkrais 39 . 

Another aspect is the placebo effect such as it is known in other medical fields 

(e.g. medication). 

Interestingly, if one compares techniques, the beginning values of the individual 

parameters are on very different levels. Unfortunately I could not find any 

suitable model for this phenomenon, even after consulting colleagues. It is 

probably due to the insufficient members of subjects. It is also possible that 

already in the beginning phase or when attaching the sensors in nonverbal areas, 

a communicative exchange of information and therefore an influence on the part 

39 LIEM Thorsten: Kraniosakrale Osteopathie, Stuttgart: Hippokrates Verlag, 1998, p.269 

Margit Grill / 2006

63 

of the subjects could occur. Watzlawick 40 /quotation: “One cannot not 

communicate”. 

7.5 Points of criticism 

Unfortunately the marker could not be statistically valued at the time of the 

stillpoint as the changing staff of the marking often had insufficient PC 

experience and did not pay attention to the position of the cursor when clicking 

the mouse. 

After the study was completed, it turned out in conversations with some 

subjects, that they could feel whether a cranial- or placebo-technique was being 

applied. An additional questionnaire would enrich this study but I thought it to 

far reaching at the point in time (planing stage) for this project. The level of 

agreement would be interesting to see. 

40 WATZLAWICK et al: Menschliche Kommunikation, Formen Störungen Paradoxien, 10. Auflage, 

Bern: Hans Huber Verlag, 2000 

Margit Grill / 2006

64 

7.6 Consequence 

The selection of time-intervals is decisive for the interpretation to show the 

techniques’ immediate reactions on physiological functions and parameters. The 

inference statistics with mean values of three time-intervals show significant 

changes, but cannot show the techniques’ characteristic signs. The descriptive 

statistics with mean values of eight time- and three time-intervals present a 

different way of responding and document the difference between placebo- 

EV4- and CV4- technique. 

The inference statistics confirm hypothesis 1, whereas the 

descriptive statistics confirm hypothesis 2. 

The results of this study seems to favour the classic CV4 

technique, because EV4 reveals no technique-specific response. 

• Regardless of the applied technique or placebo, the practitioners touch 

“affects” the person and thus has an effect on his physiological functions. 

• The comparison with the placebo-technique underlines the existence of an 

effect by the cranial techniques. 

• The comparison showes “technique-specific” signs such as the “drop” 

(breathing frequence) and a small deviation in skin-conductivity by CV4 

and the high deviation of skin-conductivity by placebo. 

• The results of this study strengthen the assumption of the harmonizing 

influence on the autonomic centres, especially through CV4. 

• CV4, EV4 and placebo present parasympathetic tendencies with 

different characteristics. 

• When CV4 was applied, healthy subjects generally showed more reactive 

responses during the course-measurement and after one week. This has to 

be seen as a “person-specific” response. 

Margit Grill / 2006

65 

This study is a contribution to render craniosacral techniques objective and 

offers basic information on the changes in autonomous body functions during a 

CV4, EV4 and placebo-technique application, that could be used as comparison 

values for further studies with specific pathologies. 

The unaspected rise of the pulse-rate’s mean value in trained individuals one 

week after a CV4 could probably be of interest. The implications of this rise 

could be of significance in the treatment of athletics for their training in 

preparation of a competition. 

Margit Grill / 2006

66 

8 Summary: 

This study investigated whether there is a measurable difference between the 

two cranial techniques CV4 and EV4. Additionally a placebo-technique serves 

the purpose of comparision and objectivity. The cranial techniques focus on the 

fourth ventricle with the neighbouring autonomic centres. The measuring was 

taken via a Biofeedback-system and the following parameters of physiological 

bodyfunctions were registered: skin-conductivity, skin-temperature, pulse-rate, 

breath-rate and breathing-amplitude. After a one week interval and a preceding 

rest phase 12 healthy subjects got one of the two cranial techniques or placebotechnique. 

Inclusion and exclusion criteria concerning the subjects, but also 

conditions necessary for the room had to be met in advance. 

The individual courses showed that the parameters changed at the beginning of 

the technique and each subject presented an individual profile of “personspecific” 

effects. 

The inference statistic demonstrated over the period of time that all parameters 

showed significant even highly significant changes, but no significant 

differences between the techniques. 

The descriptive statistics presented for the breath-rate subtile differences in form 

of a “technique-specific” “drop” when CV4 was used. Skin-conductivity showed 

a very small deviation in CV4 versus EV4 and especially placebo-technique. 

Skin-conductivity was generally at a markedly higher level with the placebotechnique. 

The cranial techniques showed also a parasympathetic tendency for CV4, EV4 

and placebo, with varying intensity. 

The results of this study strengthen the assumption of the harmonizing influence 

on the autonomic centres, especially through CV4. The comparison with the 

placebo-technique underlined the existence of an effect by the cranial 

techniques. The conclusion of this research tend to support the application of 

CV4 as EV4 does not show any technique-specific signs. 

Margit Grill / 2006

67 

9 Bibliography 

BECKER Rollin: The Stillness of Life, (edited by R. Brooks), 

Portland: Stillness Press, 2000 

DOVESMITH Edith: “Fluid fluctuation and the autonomic system”, 

in: Journal of the Osteopathic Cranial Association, p.54-61, 


DUUS Peter: Neurologisch-topische Diagnostik, 

Stuttgart, New York: Thieme Verlag, 2001 

FALLER Adolf: Der Körper des Menschen, 13. Auflage, (neu bearbeitet von 

M. und G. Schünke), Stuttgart, New York: Thieme Verlag, 1999 

GOULD Elizabeth, GROSS Charles: “New Brain Cells in Highest Brain Areas”, 

published by Steven Schultz, Princeton University, 1999 

http://www.newswise.com/articles/1999/10/NEURO/PTU.html 

[download at: 4.5.2002] 

JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, script 

„Emergence of Originality”, Vienna, 1998 

JEALOUS James: WSO Seminar: Biodynamische Kranialosteopathie, 

notes, Pöttmes, 2000 

LIEM Thorsten: Kraniosakrale Osteopathie, 

Stuttgart: Hippokrates Verlag, 1998 

Margit Grill / 2006

68 

MAGOUN Harold: Osteopathy in the Cranial Field, Original Edition, 1951, 

2nd Printing, Sutherland Cranial Teaching Foundation, 

Cincinnati, Ohio: The C. J. Krehbiel Company, 1997 

NETTER Frank: Nervensystem I, Neuroanatomie und Physiologie, 

Bd. 5, Farbatlanten der Medizin, (Hrsg. G. Krämer), 

Stuttgart, New York: Georg Thieme Verlag, 1987 

SCHMIDT Robert et al: Physiologie des Menschen, 28. Auflage, 


SCHMIDT Robert: Physiologie kompakt, 4. Auflage, 


SOBOTTA Johannes: Atlas der Anatomie des Menschen, 20. Auflage, 

Bd.1, (Hrsg. R. Putz, R. Papst) 

München, Wien, Baltimore: Urban & Schwarzenberg Verlag, 1993 

STILL Andrew Taylor: The Philosophy and Mechanical Principles of 

Osteopathy, 1902, 

Kirksville: Osteopathic Enterprise, 1986 

SUTHERLAND William Garner: Contributions of Thought, 2nd Edition, 

(edited by A. Strand Sutherland, A. Wales), Sutherland Cranial 

Teaching Foundation 

Portland, Oregon: Rudra Press, 1998 

UPLEDGER John: Lehrbuch der Kraniosakral-Therapie, 2. Auflage, 

Heidelberg, Karl F. Haug Verlag, 1994 

Margit Grill / 2006

69 

WALES Ann: “The management, reactions and systemic effects of fluctuation 

of the cerebrospinal fluid”, 

in: Journal of the Osteopathic Cranial Association, p.35-47, 


WATZLAWICK et al: Menschliche Kommunikation, Formen Störungen 

Paradoxien, 10. Auflage, 

Bern: Hans Huber Verlag, 2000 

Margit Grill / 2006

70 

10 Appendix 

10.1 Index of illustrations 

fig. 1 occipital bone _____________________________________________________________ 9 

from SOBOTTA Johannes: Atlas der Anatomie des Menschen, 20. Auflage, Bd.1, 

(Hrsg. R. Putz, R. Papst), München, Wien, Baltimore: Urban & Schwarzenberg Verlag, 

1993, p.63 

fig. 2 meningen ________________________________________________________________ 11 

from NETTER Frank: Nervensystem I, Neuroanatomie und Physiologie, Bd. 5, Farbatlanten 

der Medizin, (Hrsg. G. Krämer), Stuttgart, New York: Georg Thieme Verlag, 1987, p.54 

fig. 3 tentorium and falx _________________________________________________________ 12 



1993, p.251 

fig. 4 CSF - circulation__________________________________________________________ 14 



1993, p.296 

fig. 5 projection / ventricle-system _________________________________________________ 16 



1993, p.298 

fig. 6 sympathetic / parasympathetic _______________________________________________ 19 

from FALLER Adolf: Der Körper des Menschen, 13. Auflage (neu bearbeitet von M. und 

G. Schünke), Stuttgart, New York: Thieme Verlag, 1999, p.610 

fig. 7 cerebral nerves nucleii _____________________________________________________ 20 



1993, p.290 

fig. 8 breath regulation__________________________________________________________ 22 

from SCHMIDT Robert: Physiologie kompakt, 4. Auflage, Berlin, Heidelberg, New York: 

Springer Verlag, 2001, p.237 

fig. 9 arrangement of the instruments ______________________________________________30 

Margit GRILL 

fig. 10 

fig. 11 

fig. 12 

multi sensor_______________________________________________________________31 

from therapie manual - Insight Instruments 

breathing sensor ___________________________________________________________32 

from therapie manual - Insight Instruments 

CV4 _____________________________________________________________________35 

from LIEM Thorsten: Kraniosakrale Osteopathie, Stuttgart: Hippokrates Verlag, 1998, p.334 

fig. 13 EV4 ____________________________________________________________________ 36 

from LIEM Thorsten: Kraniosakrale Osteopathie, Stuttgart: Hippokrates Verlag, 1998, p.336 

Margit Grill / 2006

71 

10.2 Index of tables 

tab. 1 sympathicus / parasympathicus /parameter........................................... 24 

tab. 2 sequence / technique .............................................................................. 38 

tab. 3 individual parameter / subject 3 ............................................................ 44 

tab. 4 result / inference statistics...................................................................... 54 

tab. 5 result / tendencies................................................................................... 57 

10.3 Abreviations 

ANS 

BFB 

bpm 

CI 

CNS 

cpm 

CRI 

CSF 


EDG 


μS 

p 

Pbd 

PPG 

SBS 

sign. 

TEM 

Autonomic Nervous System 

Biofeedback 

beats per minute 

contraindication 

Central Nervous System 

cycles per minute 

Cranial Rhythmic Impulse 

Cerebro-Spinal-Fluid 

Compression of the Fourth Ventricle 

Electrodermography 

Expansion of the Fourth Ventricle 

micro-Siemens 

probability 

Proband (engl.: subject) 

Pulsplethysmography 

Spheno-Basilar-Symphysis 

significant 

Thermistor-measurement 

Margit Grill / 2006

72 

10.4 Descriptiv statistics 

Made by Michael Benesch, Wien, 2001 

Margit Grill / 2006

Margit Grill / 2006 

73


74


75


76


77


78


79


80


81


82


83

84 

10.5 Inference statistics 

Made by Michael Benesch, Wien, 2001 

Skin-conductivity 

Source DF Type III SS Mean Square F Value Pr > F 

sequenz 5 5.23609332 1.04721866 1.01 0.4842 

Error 6 6.20919129 1.03486522 


Adj Pr > F 

G - G 

H - F 

technik 2 0.45357904 0.22678952 1.76 0.2144 0.2317 0.2144 

technik*sequenz 10 2.05080222 0.20508022 1.59 0.2217 0.2808 0.2217 

Error(technik) 12 1.55021844 0.12918487 


Adj Pr > F 

G - G 

H - F 

zeiten 2 0.38326947 0.19163473 14.58 0.0006 0.0075 0.0006 

zeiten*sequenz 10 0.05506752 0.00550675 0.42 0.9111 0.8287 0.9111 

Error(zeiten) 12 0.15767255 0.01313938 


Adj Pr > F 

G - G 

H - F 

technik*zeiten 4 0.01659641 0.00414910 1.66 0.1920 0.2379 0.1924 

technik*zeiten*sequenz 20 0.07610961 0.00380548 1.52 0.1619 0.2644 0.1626 

Error(technik*zeiten) 24 0.05997969 0.00249915 

Margit Grill / 2006

85 

Temperature 


sequenz 5 0.15284728 0.03056946 1.88 0.2313 

Error 6 0.09733275 0.01622212 


Adj Pr > F 

G - G 

H - F 

technik 2 0.00241255 0.00120628 0.22 0.8058 0.7564 0.8058 


Error(technik) 12 0.06583586 0.00548632 


Adj Pr > F 

G - G 

H - F 

zeiten 2 0.00406957 0.00203478 23.08 F 

G - G 

H - F 




Margit Grill / 2006

86 

Pulse-rate 


sequenz 5 1.40255755 0.28051151 0.79 0.5924 

Error 6 2.12706888 0.35451148 


Adj Pr > F 

G - G 

H - F 

technik 2 0.09074375 0.04537187 1.79 0.2095 0.2192 0.2095 


Error(technik) 12 0.30496727 0.02541394 


Adj Pr > F 

G - G 

H - F 

zeiten 2 0.03270476 0.01635238 12.00 0.0014 0.0090 0.0014 


Error(zeiten) 12 0.01635834 0.00136320 


Adj Pr > F 

G - G 

H - F 




Margit Grill / 2006

87 

Breath-rate 1 


sequenz 5 2.03332059 0.40666412 0.43 0.8111 

Error 6 5.62283264 0.93713877 


Adj Pr > F 

G - G 

H - F 

technik 2 0.05172495 0.02586247 0.56 0.5859 0.5290 0.5859 


Error(technik) 12 0.55497800 0.04624817 


Adj Pr > F 

G - G 

H - F 

zeiten 2 0.25377634 0.12688817 4.90 0.0278 0.0625 0.0278 


Error(zeiten) 12 0.31064808 0.02588734 


Adj Pr > F 

G - G 

H - F 




Margit Grill / 2006

88 

Breath-amplitude 


sequenz 5 10.12585608 2.02517122 0.96 0.5058 

Error 6 12.60506442 2.10084407 


Adj Pr > F 

G - G 

H - F 

technik 2 1.05479597 0.52739798 0.71 0.5127 0.4923 0.5127 


Error(technik) 12 8.95584342 0.74632028 


Adj Pr > F 

G - G 

H - F 

zeiten 2 0.36390318 0.18195159 6.57 0.0119 0.0242 0.0119 


Error(zeiten) 12 0.33254751 0.02771229 


Adj Pr > F 

G - G 

H - F 




Margit Grill / 2006

89 

10.6 Measurement results 

CD – ROM 

Margit Grill / 2006

Comparison between CV4 and EV4 - Osteopathic Research

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