by Thomas Attlee.
Meningitis, meningism and sub - clinical
Treatment of the long term after effects with cranio-sacral
So many people feel that they have never fully recovered from
some infection be it a major illness or an apparently
insignificant viral infection and they are left with
a lingering sense of unwellness, or sometimes with severely debilitating
symptoms. Such symptoms are frequently dismissed as inexplicable or
insoluble, but they are often due to residual effects on the meninges,
and relief of symptoms can often be obtained through treatment of the
meninges with cranio-sacral therapy.
Meningitis is an inflammation of the meninges or membranes
surrounding the brain and spinal cord, usually due to a viral or
bacterial organism which invades the meninges leading to inflammation
and consequent scarring of these membranes.
In its most serious and clearly recognisable form it leads to
multiple symptoms most commonly affecting the head and neck (but
potentially anywhere in the body) most notably headache, neck pain,
nausea, vomiting and a characteristic retraction of the neck (as if
the head were being forcibly pulled back by contracted tissues). In
babies and children in particular meningitis can be fatal.
In the majority of cases the acute symptoms of meningitis pass
within days or weeks once the infection and inflammation have
subsided, or have been treated. But in many cases residual symptoms
persist - sometimes mildly, sometimes severely - sometimes
immediately, sometimes emerging months or even years later, and often
deteriorating steadily as time goes by.
Even when only mild symptoms persist patients with a history of
meningitis may say that they have never fully recovered, or never felt
quite the same, since the time of the original infection. The
persistent symptoms are often not regarded as being related to the
meningitis and are often dismissed as malingering or stress related,
perhaps primarily because no obvious explanation or solution is
Undiagnosed sub-clinical meningitis.
Most severe cases of meningitis are clearly recognisable. What is
not so readily recognised is that there is a far greater number of
cases in which meningitis is not identified or diagnosed and yet a
milder infection and inflammation of the meninges has occurred.
Sometimes this is identified subsequently as meningism or
sub-clinical meningitis, but more often it is not recognised at all.
Such cases may arise from a simple cause such as a common cold, flu,
an ear infection, a digestive upset, an unidentified virus, or indeed
from any infection.
The initial symptoms are blurred under the more blatant symptoms of
the primary infection and the persisting failure to recover is simply
unexplained or dismissed as psycho-somatic.
Once again, the most common symptom pattern is persistent headache,
neck pain, visual disturbances, photophobia, nausea, vagueness, poor
concentration, poor memory and a general sense of malaise and
unwellness. Again the symptoms may arise immediately following the
primary infection, or may arise at a later date for no identified
reason, or may deteriorate steadily as time goes by.
Dismissed as psycho-somatic.
The repeated dismissal of the persisting symptoms as psycho-somatic,
or stress related, is in itself stressful and distressing for the
patient, who initially feels certain that they are not due to stress,
but with the constant repetition of such a mis-diagnosis, perhaps from
many different sources, and with no identifiable physical diagnosis,
may begin to doubt their own perception and even their own sanity.
Like all disease conditions this syndrome is likely to be aggravated
by stress but in the majority of cases the condition can be clearly
distinguished from stress related tension by its specific location,
its pattern within the patients day to day lifestyle, its
history, and other individual factors readily elicited through taking
a proper ease history.
Undoubtedly a large number of people will be able to identify with
the picture described above, with the discomflting and debilitating
condition, the persistent and often unrelenting nature of the
symptoms, the lack of proper diagnosis, the lack of response to a
variety of different therapeutic approaches, the lack of an apparent
solution, the frequently patronising dismissal of the condition as
psychosomatic, and the generally debilitating effect on the quality of
their whole life.
Fortunately there is a solution - and generally a relatively
simple and quick solution, through treatment of the mininges with
The meninges are comprised of three layers of membrane surrounding
and enveloping the central nervous system. The innermost layer, the
pia mater, forms a soft, closely adherent skin around the brain and
The middle layer, the arachnoid mater, carries a network of blood
vessels to supply the brain and spinal cord. The outermost layer is
the dora mater, or dural membrane, a watertight sheath which contains
and encloses cerebro-spinal fluid, a fluid which surrounds and bathes
the central nervous system, providing nutrition and drainage for the
central nervous system and creating the medium within which the
central nervous system grows, develops, and functions.
This dural membrane attaches to all the bones of the cranium forming
an inner lining (or periosteum) for the cranial bones. It also
attaches to the sacrum and coccyx and to the 2nd and 3rd cervical
vertebrae, C2 and C3. Apart from these firm bony attachments the dural
membrane in its normal healthy state is freely mobile, able to float
in response to moveinents of the body (thus accommodating the normal
bending and twisting of the spinal column), and also in response to
fluctuations of cerebro-spinal fluid within the membrane.
Scarring of the meninges impinges upon nerves.
In meningitis, meningism or sub-clinical meningitis, inflammation of
the mininges leads to scarring and sclerosis (or hardening) of the
membranes, which in turn creates tightness and restricted mobility
within the membrane.
Due to its bony attachments, any tension or restriction to the dural
membrane is likely to exert pulls on the various bones to which it
attaches, leading to possible misalignments and compressions of the
bones which may in turn impinge upon nerves and restrict arterial
supply, venous drainage, lymphatic flow or cerebro-spinal fluid flow.
In view of its attachments these compressive effects will be most
significantly felt in the upper cervical regions where the dura
attaches to the occiput and to the 2nd and 3rd cervical vertebrae
(hence also the forceful retraction of the neck in acute meningitis).
Consequent impingement of nerves and blood vessels in this region
would particularly affect: the vagus nerve Cr X
- causing nausea, headache, sickness, and visceral
disturbances; the accessory nerve Cr XI - causing contraction of
the sterno-mastoid and trapezius muscles; the cervical nerves -
causing pain and tension from the occiput-atlas joint at the back of
the head to the cervical musculature; the jugular vein - causing
restricted venous drainage from the brain, with consequent congestive
headaches, vagueness and haziness; the vertebral artery - causing
reduced arterial supply to the brain, with consequent poor
concentration, vagueness, dizziness and headaches.
Also, nerves to all parts of the body must penetrate the dural
membrane as they enter or leave the spinal cord. Tensions or
contractions in the dural membrane can therefore constrict the nerves
as they penetrate the membrane bilaterally throughout its length.
This constriction is likely to have a particularly significant
effect in the localised area affected by inflammation, causing
localised symptoms and symptoms along the pathway of the affected
nerves. However, the effects will not be limited to local symptoms,
particularly if the inflammation is severe, for the following reasons:
Firstly, the membrane system is a reciprocal tension membrane
system, indicating that tension anywhere in the membrane will be
reflected reciprocally to all other parts of the membrane system. So
any contraction anywhere in the dural membrane will cause abnormal
pulls and tensions throughout the meninges, potentially impinging upon
nerve outlets anywhere in the system. with consequent effects both
locally and in the structures supplied by the affected nerves. This
will particularly activate any previous weaknesses or lesioned areas.
This may affect not only spinal nerves but also cranial nerves
emerging through the dura within the cranium. So for example, the
optic, ophthalmic, trochlear and abducent nerves which supply the eyes
(along with the sympathetic and parasympathetic nerves responsible for
dilation and constriction of the pupils and focusing of the eyes)
might all be affected with consequent disturbances of vision,
photophobia and poor focusing.
Or there might be impingement of the vagus nerve, which supplies
most of the viscera in the thorax and abdomen including the heart,
lungs and most of the digestive system, and which is commonly
associated with nausea, headache and sickness.
Generalised tightness in the head.
Secondly, contraction anywhere in the membrane causing decreased
flexibility, may lead to a generalised tightening of the membranous
sheath around the brain and spinal cord, thereby interfering with
central nervous system function (a feeling of tightness and
contraction within the head is often described by patients with this
Thirdly, hardening or sclerosis of the membrane may cause
disturbances of cerebro-spinal fluid flow, locally or generally, and
since cerebro-spinal fluid provides nutrition and drainage to sustain
the central nervous system, this may have deleterious effects on
central nervous system function.
Fourthly, restriction of the membrane may lead to impingement on
blood vessels - either directly on the vessels themselves, or
indirectly through its effect on nerves which supply blood vessels - thereby
restricting arterial supply, venous drainage and lymphatic flow to
affected parts of the body with consequent deterioration in function.
This sclerosis or hardening of the membrane if untreated is likely
to increase with time, since the reduced mobility and reduced local
fluid flow - arterial, venous, lymphatic and cerebrospinal -
will prevent proper nutrition to the area and lead to continuing
expansion of the fibrosed area around a local fibrosed focus. It is
for this reason that the patients symptoms deteriorate as time
goes by, or perhaps only appear some time after the initial episode.
The cranio-sacral system.
The dural membrane forms a vital integral part of the cranio-sacral
system. The cranio-sacral system consists of the dural membrane, with
its associated structures - the bones of the cranium and sacrum,
the cerebro-spinal fluid and the fascia which emanates to all parts of
the body from its connections to the dora at the spinal cord.
All these structures pulsate together in a symmetrical rhythmic
motion known as the cranial rhythm. Any disturbance of function within
any of these structures can be palpated by the experienced
cranio-sacral therapist as a disturbance to this symmetrical rhythmic
motion, and the exact location of the restriction can be identified.
For example, inflammation of the meninges in the upper cervical region
on the right would create a focal point of restriction towards which
the cranio-sacral motion would pull. Distarbance of function can be
diagnosed and treated through the cranio-sacral system
Disturbances of function anywhere in the body (not just within the
cranio-sacral system) are reflected through the fascial and dural
pathways into the cranio-sacral system. Similarly, distortions within
the cranio-sacral system reflect out through the dora and fascia to
influence and affect all parts of the body.
Consequently, the cranio-sacral practitioner can, by tuning into the
asymmetries and distortions of the cranio-sacral system, make a
detailed diagnosis of the whole body, and by correcting imbalances can
restore proper functioning to all parts of the body thereby treating a
very wide variety of conditions.
The cranio-sacral system is extremely subtle. Its movements can only
be palpated with a correspondingly subtle touch. When more forceful or
heavy handed therapies are applied the cranio-sacral system simply
puts up its defences and shuts them out.
Having tuned in to the subtle movements of the cranio-sacral system
through this exceptionally gentle contact, the cranio-sacral
practitioner can then influence and release the affected restrictions
by gently rebalancing the subtle twists, pulls and asymmetries
reflected through the system.
Exceptionally gentle and subtle.
In the case of the meningeal effects with which we are concerned
here, treatment would involve firstly, in accordance with the
principles of cranio-sacral therapy, following the pulls exhibited by
the membranes, to a point of slacking off when the restricted tissues
would be able to unhook and release themselves; and secondly, applying
the gentlest of traction to the affected area of membrane in order to
stimulate a process of release and opening out.
One very valuable technique which might be used in these
circumstances is the technique for the release of tension within the
falx cerebri (and consequently tensions throughout the reciprocal
tension membrane system).
With the patient lying on his or her back, the practitioner places
one hand under the occiput with the fingers extending caudally under
the neck; the other hand is placed over the frontal bone, the fingers
extending towards the face (taking care not to cover or discomfort the
As the practitioner tunes in, various subtle pulls and twists will
manifest, some of which may be superficial and transient, others more
profound and persistent. If the practitioner allows his hands to be
very gently drawn into these subtle patterns, he will eventually find
himself drawn to a barrier or point of resistance.
If he waits patiently at that barrier, the resistance will
eventually unlock, dissolve, and slacken off, allowing the cranium to
return to a more easeful, freely mobile, fluent, and symmetrical
Another technique that would be particularly suitable in the
treatment of these meningeal effects is dural tube traction from the
Having first ensured that the cranial base is released by various
means, the practitioner places his or her hands so that the occiput is
resting lightly onto the fingers, with the tips of the fingers
projecting slightly beyond the base of the occiput.
Then simply thinking the occiput away from the vertebral column will
provide sufficient stimulus to initiate a very slight subtle traction
which will very gently stretch the dural membrane as it passes from
its attachments around the foramen magnum at the base of the skull,
through the vertebral canal clown to the sacrum and coccyx.
The experienced cranio-sacral therapist can direct the therapeutic
effect as required, focusing the attention on appropriate areas of
resistance and monitoring the response and release of the cranio-sacral
This traction is so gentle and subtle that by the standards of any
other therapy it would not be considered as traction at all. Anything
more forceful will again only lead to resistance from the body. Only
by approaching the membranes in this exceptionally gentle way, with a
subtlety and sensitivity that must be developed by the practitioner
through regular and consistent practice, will the cranio-sacral system
Using this approach is very effective, often rapid and dramatic.
Countless examples would be possible but a few brief case histories
will demonstrate the point.
A young man aged 26 suffered from constant persistent
headache emanating from the base of the skull on the right hand
side, radiating up over the head to the right eye, also spreading
down into the neck, sometimes accompanies by nausea and migraine
attacks. The headache had been with him every day for over a year.
He awoke with it every morning and it tended to become more severe
as the day progressed.
He was leading a pressurised life (which he enjoyed) but the
symptoms showed no relationship to the fluctuations of pressure or
relaxation in his life.
He had contracted viral meningitis 15 years previously at the
age of 11 since when he had suffered migraine attacks and blurred
Cranio-sacral diagnosis immediately identified the affected area
of the meninges. After one treatment he reported virtually
complete relief from symptoms with just slight headache
Two further treatments removed the residual symptoms and he was
able to continue his pressuriscd but enjoyable lifestyle to its
A girl of 13 suffered from persistent headache, nausea, neck
pain, dizzy spells, intense pain behind the right eye and in the
right temple, tiredness, poor concentration, poor memory, reduced
mental function, fatigue and a general feeling of being constantly
unwell and unable to carry on a normal life. Her condition had
arisen from a viral infection nine months previously.
She had been off school for a term and a half. When she did try
to go to school she invariably returned halfway through the day
unable to carry on.
She had previously been a bright and intelligent girl; it was
now being suggested that she would have to stay clown a year at
school because she was so far behind.
Numerous medical tests over several months had revealed nothing.
Acupuncture treatment had not helped. Some suggestion of
psychosomatic causes and malingering had been suggested but
nothing about her personality was consistent with such a
suggestion and it was not seriously considered.
ME or post-viral syndrome was considered to be the most probable
diagnosis (another common dumping ground for undiagnosed
conditions) but again, a detailed analysis showed that the
symptoms were not consistent with this theory. There had been no
suggestion or indication of meningitis at any tune.
Cranio-sacral diagnosis immediately revealed a marked and severe
restriction of the meninges. with severe distortion of the
symmetry of the membranes through the head, focusing around the
upper cervical and occipital regions on the right hand side,
radiating down into the neck and projecting down through the dural
membranes to the sacrurn.
After one treatment she went back to school, and instead of
returning halfway through the day as usual, she phoned her
mother at the end of the day to say she was going round to a
friend for tea - the first time she had done this for months.
Her life returned to normal immediately and her symptoms were
completely eliminated after five further treatments.
She did not have to stay down a year and excelled in her class
at the end of year exams. She subsequently passed all her 0 levels
with flying colours whilst simultaneously pursuing a highly active
and demanding plethora of other pursuits. in all of which she
excelled. A complete recovery was clearly evident.
Cases of unresolved after-effects of meningitis, meningism, and
undiagnosed sub-clinical meningitis are common. The failure to
identify, diagnose, and treat them leads to a great deal of
unnecessary suffering which can readily be alleviated by effective
It is to be hoped that with the increasing awareness of
craniu-sacral therapy most of these cases can be identified for what
they really are, and treated appropriately with cranio-sacral therapy.
Last, but in no way least, the results of the technique speak for
themselves - as they always have.
Reproduced from The International Journal of Alternative &
Complementary Medicine, September 1992.