Cranial Adjusting in San Antonio: What It Is and Who Needs It

When most people think about chiropractic, they picture the spine. Neck, mid-back, lower back — that's where the action is. What very few people know is that the skull itself can also be adjusted, and that doing so can resolve conditions that spinal care alone can't touch.

Cranial adjusting is one of the most precise, gentle, and underutilized techniques available in chiropractic. It's also one of my personal areas of focus here at Pura Vida Chiropractic — and once patients understand what it is and what it can do, they often wish they'd found out about it sooner.

Dispelling the Fused-Skull Myth

The first thing I have to address is the assumption that the skull is one solid, fused bone. Most of us learned in school that the cranial sutures — the joints between the 22 bones of the skull — fuse in early childhood and stay fused for life.

That's not accurate.

Research using cadavers and advanced imaging has shown that cranial sutures retain a small but measurable degree of mobility throughout adult life. These joints have ligamentous connections, a synovial-like tissue layer, and — critically — they are part of the rhythm of the cerebrospinal fluid (CSF) system.

The cranial rhythmic impulse (CRI) is a subtle, palpable motion of the cranial bones that reflects the production and circulation of cerebrospinal fluid. CSF bathes the brain and spinal cord, provides nutrients, removes waste products, and maintains the pressure environment that the nervous system requires to function properly. The CRI cycles approximately 6–12 times per minute in a healthy adult.

When cranial bones are restricted — whether from birth trauma, head injury, dental work, TMJ dysfunction, or chronic muscular tension — this rhythm is disrupted. And when CSF flow is impaired, the effects can be surprisingly far-reaching.

What Happens When Cranial Bones Are Restricted

The skull houses the brain. It also forms the attachment points for key structures of the dura mater — the tough membrane that lines the inside of the skull and the spinal canal. When cranial bones are misaligned or restricted in their motion, they create tension in the dura, which can transmit mechanical stress all the way down to the sacrum.

This is why cranial work and SOT (Sacro Occipital Technique) are so closely related. DeJarnette recognized that the cranium and the sacrum form the two ends of a unified meningeal system, and that a problem at one end often creates problems at the other.

Beyond the dural tension, cranial restrictions can directly affect:

• Blood flow through the cranial sinuses
• Drainage of the lymphatic system of the head and neck
• The function of cranial nerves that exit through small foramina in the skull base
• The pressure and flow of cerebrospinal fluid through the ventricular system

Conditions That Respond to Cranial Adjusting

In my experience, the following conditions often have a cranial component that, when addressed, produces significant improvement:

Headaches and migraines — Particularly chronic tension headaches and those that originate at the base of the skull or behind the eyes. Cranial restrictions alter CSF pressure and can compress cranial nerves involved in pain processing.

Vertigo and dizziness — The temporal bones house the vestibular apparatus. Temporal bone restrictions are among the most common cranial findings and are often directly related to balance disturbances and positional vertigo.

Tinnitus — Ringing or buzzing in the ears that hasn't responded to standard treatment may have a temporal bone component. The same structures that affect hearing are housed in the temporal bone.

TMJ/TMD dysfunction — The temporomandibular joint is formed by the temporal bone and the mandible. Cranial adjusting that addresses temporal bone misalignment often produces dramatic improvement in TMJ pain, clicking, and restricted jaw opening.

Trigeminal neuralgia — The trigeminal nerve exits through a foramen in the skull base. Cranial restrictions that impinge on this pathway can contribute to facial nerve pain.

Post-concussion symptoms — This is an area where cranial work can be genuinely transformative. Patients who continue to experience headaches, brain fog, light sensitivity, and cognitive difficulties months after a concussion often find significant relief when cranial motion is restored. The concussion disrupts the normal cranial rhythm; restoring it supports recovery.

Ear infections and fluid in children — The eustachian tube, which drains the middle ear, runs adjacent to structures influenced by temporal bone position. Children who experience recurrent ear infections often have temporal bone restrictions — and cranial adjusting can improve drainage significantly.

Learning and attention difficulties — CSF flow and intracranial pressure affect brain function. Children with chronic cranial restrictions often show improvements in focus and learning capacity when cranial motion is restored.

Adjustments that won't hold — This is a clinical clue I watch for carefully. If spinal adjustments aren't holding — particularly in the upper cervical spine — there's often a cranial driver. The atlas (C1) and the occiput (the base of the skull) are mechanically interdependent. A restricted occiput will keep pulling C1 back out of alignment.

What Qualifies Me to Offer This

Cranial adjusting within the SOT system — sometimes called SOT Craniopathy — is part of the Advanced SOT certification curriculum through SORSI (Sacro Occipital Research Society International). This is the same post-graduate certification program that includes CMRT and reflects a significantly higher level of training than standard chiropractic licensure.

I've been applying cranial techniques since shortly after completing my doctorate at Western States Chiropractic College in 2003 and have refined this work over more than two decades of practice. In San Antonio, this level of cranial expertise within a chiropractic context is genuinely rare — and it's one of the reasons patients come to us from across the city and beyond.

What a Cranial Session Feels Like

Patients are almost universally surprised by how gentle cranial adjusting is. There are no high-velocity thrusts, no dramatic movements. The contacts are light — sometimes just a few grams of pressure — and they're held while the practitioner monitors the cranial rhythm and waits for the tissue to release.

Most patients find it deeply relaxing. Some describe feeling a warmth or subtle movement in the skull. Some notice an immediate change in head pressure, eye clarity, or ear ringing during the session. Others notice the difference in the days following treatment as the nervous system integrates the change.

A full cranial evaluation takes about 20–30 minutes and is often combined with spinal and sacral work as part of a comprehensive SOT treatment.

Key Takeaways

• The skull has 22 bones with sutures that retain measurable mobility in adults
• The cranial rhythmic impulse (CRI) reflects CSF circulation and is disrupted when cranial bones are restricted
• Cranial restrictions create dural tension that can affect the entire spine, cranial nerve function, and CSF flow
• Conditions that respond include headaches, vertigo, tinnitus, TMJ, post-concussion symptoms, trigeminal neuralgia, ear infections in children, and learning difficulties
• Cranial adjusting is extremely gentle — light contacts, no forceful manipulation
• Dr. Dan Foss holds Advanced SOT certification through SORSI and has 20+ years of cranial adjusting experience
• San Antonio patients with chronic conditions unresponsive to standard care should know this option exists

If you've been dealing with persistent headaches, dizziness, TMJ pain, or symptoms after a head injury that haven't resolved with standard treatment, cranial adjusting may be the missing piece. Give us a call at Pura Vida Chiropractic: (210) 685-1994. We'd love to take a look at the whole picture.