Sunday, December 21, 2014

The Benefits of Craniofacial Release

While reading about orofacial pain disorders I encountered a description of a treatment called craniofacial release (CFR). I continued to read about the technique for a few months, and 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.

After doing the proper research I found Dr. Adam Del Torto, a chiropractor that originated this form of the technique. It is a specialized technique that is derived from an earlier form of cranial treatment called Bilateral Nasal Specific (BNS) pioneered by chiropractor Richard Stober in the 1970s. CFR involves inserting a balloon into the nasal cavity, up through each nostril, through the nasal cavity, past one of the three nasal turbinates, through the nasopharynx and out into the throat. Many patients describe it as very intense and similar to having water up the nose. 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. In this case the cranial bones crack allowing the osseous release of cranial fixations at the sutures. I see it 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 be 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 the 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 allows 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 painful. 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.

I believe that the procedure 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, quietly resting, even napping. I laid around, stretched, and spent the rest of the night breathing diaphragmatically. I even turned down an offer from my friends to see a violent, loud movie the next night. 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 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 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 when these areas become tight 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 probably 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 the four 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, but that is a relatively minor therapeutic outcome. I also feel and look better. 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. Like any deep tissue massage, it can be relieving or it can be traumatizing. I believe that 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 massaging the nasopharynx here: