BY Erica McKeen & Dr Priyanka Pradhan

The Fulcrum, Issue 98 Spring 2026

Established in 2025 by Dr Priyanka Pradhan and Erica McKeen, Cranial Connect was founded on a shared vision to enhance practitioner support for clients navigating minor traumatic brain injury (mTBI). Here, they discuss how cultivating presence within the relational field enables our ‘feeling, thinking, seeing fingers’ to access deeper layers of safety, healing and connection — restoring hope through the power of the therapeutic relationship.

Despite concussion often being described as a “mild” injury, the reality for many is anything but.

In the context of working with people suffering from mTBI, as craniosacral therapists we both bring distinct perspectives. Erica’s background is rooted in the body — physiotherapy, fascial release, anatomy and biomechanics — while Priyanka’s is grounded in the mind and nervous system, with a focus on clinical neuropsychology and neurodegenerative conditions.

This article follows on from Nora Brennan’s important article¹ in issue 81 of The Fulcrum, where she articulated the challenges clients face when navigating care after head injury — challenges that, sadly, remain largely unchanged.

Moving Beyond the “Mild” Label

Despite concussion often being described as a “mild” injury, the reality for many is anything but. Consultant neurologist Dr Steve Allder delivered sobering statistics at the most recent Re:Cognition Health conference: 40–50% of people have ‘unfavourable’ outcomes at 12 months and 43% are unable to work five years after their injury.

When care becomes fragmented — referrals to multiple specialists, repeated investigations and an emphasis on “fixing” isolated parts — people often find themselves spending vast amounts of time, energy and money chasing relief. For many, this process inadvertently increases stress and reinforces a sense of failure or disbelief, further sensitising the nervous system and placing it on high alert. In some cases, the journey is too overwhelming to handle; suicide risk following traumatic brain injury is two to three times higher, particularly for adolescents, with the most vulnerable period being two to eight months after injury.

In Priyanka’s neuropsychology practice, she still encounters scepticism among medical professionals regarding the legitimacy of persistent mTBI symptoms. Similarly, Erica frequently meets clients who have been encouraged to “rehab their way out of it” without adequate resourcing or a felt sense of safety. This approach often reinforces dissociative patterns rather than supporting recovery.

The circumstances around the injury may have been traumatic and, even if not consciously remembered, will have been registered and incorporated into the body on a cellular level. Peter Levine, in his book, An Unspoken Voice², candidly relates his response to being struck by a car and how he used his life’s work to bring himself out of a state of shock and shut down back into present awareness.

As CST practitioners, we understand that healing occurs through relationship. We orient toward the inherent treatment plan — the system’s own capacity for repair and reintegration. This places us in a distinct position within concussion recovery: not as technicians fixing a broken mechanism but as practitioners supporting the conditions for coherence, safety and wholeness to re-emerge.

Language and Biology: The “Neurometabolic Cascade”

One of the first challenges for both clinicians and clients is language. While mTBI is the preferred clinical diagnostic term, head injury, concussion, and post-concussion syndrome (PCS) are often used interchangeably in different fields, creating confusion³.

From a diagnostic perspective, mTBI refers to a biomechanical force transmitted to the brain. Criteria typically include a Glasgow Coma Scale of 13–15, loss of consciousness under 30 minutes, post-traumatic amnesia under 24 hours and normal CT or MRI findings — often one of the most demoralising aspects for patients. Symptoms may appear immediately or be delayed by up to 72 hours, a clinically significant window and it would not be appropriate to place hands on these clients until acute medical risk has passed.

In practice, Priyanka has observed that patients respond differently to these labels. Some find mTBI frightening and prefer post-concussion syndrome; others feel that only the term brain injury captures the depth of their experience. Rather than imposing language, she meets what the patient brings; she does not diagnose — she listens.

Many clients describe feeling “not quite here”, “cut off” or “no longer themselves”.

From a biological perspective, mTBI is a constellation of symptoms arising from complex, multifactorial injury. Following an impact, fascia absorbs the force and may remodel along the line of impact, impairing motility. Neurones, glia and vascular structures are deformed, especially if rotational forces are present. As white and grey matter have different densities, they move at different speeds, causing micro-tears in the axons of the white matter. These microscopic tears in the axonal membrane trigger the neurometabolic cascade.

This cascade includes altered electrical activity and a temporary loss of the brain’s capacity for self-regulation. Glial cells respond through gliosis. Normally, microglia act as housekeepers but when chronically primed through prior concussions, physical trauma, infection, autoimmune conditions or prolonged stress, they can become destructive — aggressively pruning even healthy synapses.

Immune Health and the Lived Experience of Fragmentation

This excessive synaptic pruning contributes directly to reduced neural connectivity and to the lived experience of fragmentation and disconnection. From this perspective, disorders of mood, cognition and emotional regulation can be understood not simply as psychological” symptoms but as reflections of the brain’s immune health — a body–brain connection that has historically been under-recognised within conventional medicine.

Over time, these inflammatory and metabolic changes can reduce connectivity within the brain’s functional networks. Regions such as the thalamus, hypothalamus, corpus callosum and limbic system — areas essential for integration, regulation and communication — are particularly vulnerable. Furthermore, through the gut–brain axis, neuroinflammatory and autonomic disturbances can also activate enteric glial cells. This contributes to gastrointestinal dysfunction, systemic inflammation and further disruption of the gut–brain communication loop.

This highlights the deep interconnectedness of the brain, gut and nervous system. It reinforces the importance of therapeutic approaches that support regulation, reconnection and integration rather than focusing solely on the site of injury. At all stages of recovery, when these systems are under strain, changes in cognition, mood, sleep and sensory processing are to be expected. In this context, the “invisible” symptom of fatigue — which can be incredibly debilitating — is inevitable; it is one of the most common symptoms and causes a vicious cycle of reduced function and suffering in this client group.

Predictable and Unpredictable Outcomes

What we both notice again and again in our clinical work is how central the theme of disconnection is to this journey. There can be disconnection within neural pathways, within fluid and tissue dynamics and within a person’s felt sense of self. Many clients describe feeling “not quite here”, “cut off” or “no longer themselves”. These experiences often reflect elements of dissociation — an intelligent, protective response of the nervous system when capacity is exceeded.

Importantly, disconnection does not always begin at the moment of impact. Pre-injury trauma plays a significant role for many. From a physiological perspective, the brain may have already adapted to earlier trauma by wiring itself to prioritise survival over integration. This can manifest as reduced interoceptive awareness, difficulty responding to one’s own needs or a habitual orientation away from the body. When a mTBI occurs on top of this pre-existing patterning, the system has fewer resources available to adapt and recover.

From a vagal perspective, these patterns often show up as a chronic shift away from social engagement toward states of shutdown or collapse. At the same time, shock may be held within the dural, bony and fluid systems, limiting the brain’s natural motility and restricting the free movement and drainage of cerebrospinal fluid and blood. When physiological restriction, immune activation and nervous system defence overlap, the body’s capacity to reintegrate is further challenged. In this context, dissociation is not pathology; the system is simply doing its best to survive overwhelming circumstances. However, it loses access to stillness and the inherent treatment plan. Potency cannot fully express and the “spark” dims.

One of the most consistent and disruptive symptoms after concussion is disturbed sleep.

Emotional resilience and a felt sense of safety are increasingly recognised as influential in recovery. The nervous system a person brings to an injury — shaped by history, environment and current levels of support — plays a powerful role in how healing is accessed. One story shared at a recent conference stays with us. It compared the outcomes of an elderly woman and a young, athletic male university student from a family of high-achievers. The elderly woman, with good social support and limited stressors, recovered relatively smoothly. The young athlete, however, experienced a devastating loss of identity. Unable to return to sport, study or his social world — and lacking understanding from those around him — his injury became life-altering. This reminds us that recovery is never purely biological; it is relational, contextual and deeply human.

Sleep, Clearance and the Conditions for Repair

One of the most consistent and disruptive symptoms after concussion is disturbed sleep. Increasingly, research suggests that sleep is central to recovery. The glymphatic system — the brain-wide clearance pathway — removes metabolic waste and neurotoxins. It is most active during non-REM sleep, when cerebrospinal fluid circulates more freely. Deep rest is when the brain quite literally cleans itself.

After mTBI, neurometabolic disruption, autonomic dysregulation and persistent sympathetic activation makes it difficult to access the parasympathetic states required for restorative sleep. When disturbed sleep, restricted fluid motion, dural shock patterns and chronic stress compromise clearance, waste products such as tau and beta-amyloid can accumulate, increasing long-term neurodegenerative risk. This underscores the importance of early, whole-system support that restores the conditions required for repair, rather than merely suppressing symptoms.

CST should not be a last resort.

As CST practitioners, we know that deep rest cannot be forced — it must be invited. Through co-regulation, we offer an experience of being met and held. This relational safety allows the autonomic nervous system to shift toward parasympathetic dominance, supporting digestion, immune function, repair, and — critically — sleep. By bringing awareness to the brain centres involved in sleep–wake regulation, including the thalamus, hypothalamus, and brainstem networks, we support the system’s capacity for deep rest. By allowing patterns to settle and orienting toward inherent motility, the system regains access to stillness. The inherent treatment plan comes; potency returns; the spark re-ignites and repair begins.

Case Material: Recovery in Context

The following cases illustrate not only the diversity of concussion presentations but the importance of meeting each system where it is at.

Acute Presentation: A teenage boy sustained a rugby impact. Despite mental fog, he sat a GCSE exam 48 hours later. Ordinarily a confident speaker, he struggled with word-finding and concentration. CST commenced on day five post-injury, once acute medical risk had passed. Sessions focused on settling shock, resourcing and supporting safety. After two sessions, his symptoms had fully resolved. He went on to perform well in the remainder of his exams and his mother described feeling that she “had her boy back”.

What is striking here is not just the speed of recovery, but what was potentially at stake. Had he failed to achieve the required grades, he would not have been able to return to the same school for A-levels, would have lost his place on the school rugby team and likely lost his established peer group. A “mild” injury could easily have become a major, life-altering event.
This case illustrates a common pattern. In the acute phase of mTBI, many young people continue with daily demands, not realising that their brain is in a state of metabolic crisis. The neurometabolic cascade means that even simple cognitive tasks can be exhausting and yet this is often invisible.

Chronic Presentation: A woman in her mid-twenties fell from her horse and sustained an impact to the right temporo-occipital region. She presented for treatment one year later, defeated and exhausted. Her history included ADHD and multiple prior riding injuries, likely contributing to microglial priming and nervous system vulnerability. She had been given outdated advice to “rest in a dark room”. Subsequent medical advice was not helpful and an equestrian colleague commented that most people with head injuries end up “topping themselves”; while deeply inappropriate, the comment reflects the stark reality of elevated suicide risk in this population. CST focused on resourcing, supporting pattern resolution, fluid and bony motility and restoring a sense of safety and stillness within her body. After four sessions, she was able to reduce her medication. After five sessions, she reported that she was beginning to “feel normal again”.

What CST Offers

These case studies demonstrate that mTBI recovery is not linear; it is relational, systemic and deeply human. As craniosacral therapists, by working beneath adaptive patterns and orienting toward inherent health, we support the systems necessary for recovery — rest, igestion, immune function and glymphatic clearance. By resourcing these and allowing shock patterns to unwind, we invite the restoration of connection within systems that have become fragmented. And our fundamental position of meeting people as whole, sentient beings — not symptom clusters — restores dignity. The effects are measurable in function, quality of life and capacity.

Capturing measurable outcomes that are understood outside of CST is vital for our work. We endorse the use of the WHHQ and the widely-used and freely available Rivermead Post Concussion Symptom Questionnaire for this purpose. This matters now more than ever. Medical systems are overstretched and people continue to receive mixed messages about how best to support their health.

CST should not be a last resort. We are uniquely positioned to support recovery because we facilitate healing — not just treating the symptoms that arise when health is compromised. Our work is subtle, profound and desperately needed.

Erica McKeen is a biodynamic craniosacral therapist with a background of 24 years as a physiotherapist, based in Co. Antrim, Northern Ireland.

Dr Priyanka Pradhan Priyanka is a consultant clinical neuropsychologist and has worked in the NHS for 25 years alongside an independent practice. She trained as a biodynamic craniosacral therapist more recently with the aim to support her clients living with neurological conditions.

References

1. Brennan, N. (2020). Ripples on a Pond: Working with the Far-Reaching Impact of Mild Traumatic Brain Injury. The Fulcrum, Issue 81, September 2020.
2. Levine, P. A. (2010). An Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.
3. Sharp, D. J., & Jenkins, P. O. (2015). Concussion is confusing us all. Practical Neurology, 15(3), 172-186

The opinions expressed in this article are those of the authors and do not necessarily reflect the viewpoints of the CSTA.