Sunday, December 21, 2014

The Benefits of Cranial Facial Release

I would like to recommend a safe chiropractic treatment that has the capacity to improve quality of life. While reading about orofacial pain disorders I encountered a description of a technique called Cranial Facial Release (CFR). After reading about it for a few months, I eventually decided to undergo the procedure myself. I knew that I held a lot of tension in my nose and behind my eyes and I was hoping that CFR could help to alleviate the pressure there. I figured that such a strong form of stimulation could increase the circulation to my nasal tissues, alleviate the trauma that they held, and help reduce the tone in my facial musculature. My nose was broken 15 years prior (at age 17) and was numb and painful at times. I really felt like my nasopharynx was a tense rock in the middle of my head, and I hoped the technique would help me better incorporate it into a calm, healthy facial posture.

I found that Dr. Adam Del Torto, the chiropractor that originated this form of the technique lived near me. Cranial facial release involves inserting a balloon into the nasal cavity, up through each nostril. The balloon travels through the nasal cavity, past one of the three nasal turbinates. The balloon is then inflated and as it fills with air it passes through the nasopharynx and out into the throat. This opens up the breathing passageways and mobilizes the bones of the face and cranium. I felt an expansion under my face and a tremendous amount of relief afterwards. Many patients choose to have the procedure done on a regular basis for years. Dr. Del Torto usually charges a fixed amount for 4 sessions – the minimum recommended treatment. He views it as a chiropractic adjustment for the cranium. Similar to any chiropractic adjustment, the cranial bones crack allowing the osseous release of cranial fixations at the sutures. During my visit Dr. Del Torto explained to me in depth how the treatment stimulates specific neurological structures to provide a form of relief that can't be found any other way. His technical explanations made a lot of sense to me, but I imagine that there are other benefits as well. 

I cranial facial release as a form of myofacial release for the nasal passages. I am convinced that the soft tissues in this area can become traumatized due to stress, cold, physical injury or undue tension and then remain excessively tense so that: 1) circulation decreases and inflammation increases, 2) the muscles atrophy and undergo “adaptive muscle shortening,” 3) the neurons in the area relay pain messages to the brain, and 4) this causes the facial muscles to become excessively tense further exacerbating the psychological stress. I am also convinced that reduced circulation diminishes the immunological response rendering these tissues more susceptible to upper respiratory tract infection. I think that CFR helps to correct each of these four problems. The balloon puts strong pressure on many muscles and soft tissues throughout the nasopharynx, and nasal cavity. It seems to me that this pressure (applied to soft tissues that are rarely, if ever, stimulated) that reverses these four degenerative processes.

The stimulation and physical compression of the tissues helps to reduce past trauma, and in my opinion is much like massaging a sprained ankle. Massage and isometric stretching is really the only way to return an ankle to its premorbid state. Of course it is painful to massage, but compressing the muscles is the best way to reduce their tone. The fact that the muscles and soft tissues deep in our nasal cavity are never stimulated forces them to “remember” past trauma. They become a “somatic anchor” deep within the face for pain. For me, as with most patients, each CFR treatment was less uncomfortable. My fifth treatment was not uncomfortable at all. This means that when stimulated the nociceptive neurons in these tissues are sending reduced pain signals. I believe that even when not stimulated these areas were sending pain signals to my brain and now are no longer doing so.

CFR has the potential to help anyone, but may produce the best results for people that focus concertedly on remaining calm afterwards. Influencing how your brain interprets intense forms of stimulation is incredibly important to how your body copes with them. The way that you breathe surrounding an injury before, during and after helps the body to appraise the injury and determine how best to deal with it. I recommend making calm a priority after the procedure and attempting to breathe diaphragmatically, employing deep breathing exercises, and perhaps the “ujjayi breath” technique. I would recommend going home, resting quietly, even napping. After each visit I went home, laid around, stretched, and spent the rest of the night breathing diaphragmatically. I think that it is also important to remain very calm before, and after the procedure. For this reason, I thought it was great that Dr. Del Torto was peaceful, reassuring and congenial during the visits.

After CFR you become aware of muscles and tissues behind your face that you never noticed before. I laid down for several hours with my eyes closed in order to focus on the accompanying sensations. You feel these muscles tighten and release for hours after the procedure. While this happened I tried my best to memorize what it felt like for these areas to release and I tried to keep them relaxed. Simply turning your attention to these sensations builds somatotopic and musculotopic maps in the cerebral cortex which help you sense and control these areas. I believe that after the procedure patients want to build these cortical maps so that they can notice and become conscious of tension in these areas later. As I did this I used other facial muscles, flaring and constricting my nostrils, in an attempt to link these new cortical maps to existing ones. I noticed that the less attention I paid to my nose, the tighter it would become. Conversely the more attention, the more it relaxed. It would be interesting to follow the efferent nerve pathways from these areas up into the brain. Pain signals originating in the nasal cavity are sent to subcortical threat/stress areas such as the amygdala, and end up in cortical ones such as the anterior cingulate cortex, and the insula.

After the procedure I went on a long walk and I noticed that my face felt surprisingly calm. As I passed people on the street I was worried that perhaps I would appear “too” calm. I realized that I should embrace the calmness and try to take full advantage of my current state and really focus on allowing my face to remain placid. I focused on breathing deeply and evenly, with eyes wide while looking upwards. I figured that if I practiced this over the course of a few days it would look natural. It really did. I no longer have a perpetual pained and fearful expression on my face and I no longer look like someone who had their nose broken violently. There are claims that CFR changes the look of people’s faces. It does have a cosmetic or aesthetic component and definitely helped me to develop a more relaxed countenance. I have realized that before the procedure I was perpetually wincing. I notice myself wincing from time to time but it is much easier now to stop it.

I had five CFR sessions over the course of a month. Before the month, during and after I probed my nose with q-tips. Again, at first this was very uncomfortable but became much less painful with time. I didn’t press very far but would make circles with the q-tips just past my nostrils while breathing deeply. Using the qtips beforehand probably complemented the CFR and also made the actual balloon inflation less uncomfortable for me.

I can breathe through my nose much better now. In fact Dr. Del Torto intentionally opened up two of my six turbinates that were completely closed down. I think that the most important thing about CFR is to appraise it positively. It is “invasive” in some ways and you want your body to embrace the sensations that you feel afterward rather than reject them. I want to encourage you to appraise the treatment as a deep tissue massage that is providing relief. The key is to self-soothe and to trigger the relaxation response. Afterwards you want to think about how to build this relaxed nasopharyngeal posture into your normal day-to-day facial posture.

See my blog entry about self massage for the nasopharynx here: