BY Vicki Sampieri

The Fulcrum, Issue 97 Winter 2025

As I lie in my bed, post op, an overwhelming sense of excitement rushes through me. It’s a real buzz, a sense of discovery and recognition of my own physiological response, mapped  against my knowledge, as a craniosacral therapist, of trauma and stress.

In October 2024, I underwent repair surgery for a femoral hernia. Sadly, it was unsuccessful and I returned for further surgery. It was within my two contrasting peri-operative experiences that I discovered a much wider context to surgical trauma and a deeper layer of understanding about the pre-operative stress response and its real, tangible impact not only  on surgical outcomes but on recovery and emotional well-being.

The hospital environment that day felt like a storm brewing

One key aspect of my reflection has been revisiting my palpable fear of needles. For years, I  had vainly attempted to overcome it. Only recently, as my second surgery loomed, did I meet  this phobia from an alternative angle, viewing it as a form of embodied intelligence, my body’s natural protective instinct to an unnatural invasion. Meeting this aspect of myself unconditionally shifted my physiology but equally important was recognising fear’s effect on  my nervous system.

The Physiology Behind the Stress Response

The term peri-operative refers to the entire surgical journey – before (pre-operative), during (intra-operative) and after surgery (post-operative). While medical care often focuses on the surgical act itself, the nervous system is responding across all these phases.

We know that surgery activates both the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, leading to a flood of catecholamines and cortisol.  This is a lifesaving response but detrimental when prolonged or not fully processed. The acute stress response – including tachycardia, hypertension, hyperglycaemia and  immunosuppression – can be maladaptive in a surgical context, contributing to post-operative complications, delayed healing and chronic pain.

There is considerable research in this field but much of the focus is weighted heavily towards pharmacology, controlling and managing anaesthesia pain and haemodynamics. It rarely integrates the psychological, environmental and relational factors that contribute to a  patient’s stress response, most of which are predominant at the pre-operative phase.  Understanding and supporting the whole peri-operative period allows for a more holistic and  trauma-informed approach to healing.

The Chaotic First Surgery: Fight, Flight, Freeze

Although this was not my first encounter with general anaesthetic, it was my first significant  surgery in adulthood and I could feel the apprehension in my body as I shuttled to and fro  from resourcing. Despite knowledge, there is only so much you can rationalise when the  body’s survival system is triggered.

The hospital environment that day felt like a storm brewing: the nerves of a new secretary,  the long line of fearful patients, the time-pressed anaesthetist rushing onto the ward to  cannulise me without acknowledging my fear of needles. My surgeon, due to staff shortages,  collected me himself, his own anxiety about completing his surgeries adding to the mounting  tension. My sense of safety collided with the tension and urgency in this environment and the day’s mounting pressures began to take their toll on my well-being.

I named the fast pace to the medical team, hoping to slow things down. Unacknowledged, I  was driven further into a feeling of unsafety and powerlessness. My last words, “my legs are  going”, were met with silence as the mask was placed over my face. My legs had wanted to  run but I was stuck and I went into controlled unconsciousness in a state of flight.

My first days post-surgery were marked by an irresistible urge to flick my legs out as they  trembled and shook. This constant need to stretch my lower limbs persisted for several  weeks, gradually easing with CST. I had expected signs of trauma from the surgery itself but,  despite my best efforts, my body felt confused, disjointed and disconnected.

I was surprised at how challenging it was to resource myself – many of my usual strategies  felt inadequate in restoring any sense of feeling OK. This sense of physiological chaos  lingered much longer than I had anticipated. An unfamiliar anxiety began to creep in, one that felt disproportionate to the surgical outcome itself. I was feeling despondent and my body  carried a heavy, weighted fog.

It took persistent resourcing, self-care and the invaluable support of family and friends to crawl slowly out the other side.

A New Experience: Feeling Safe, Healing Differently

The second time round, my mind and body weren’t carrying the same anticipations and the  surgical methodology was different. These factors alone influenced how I felt that day and my surgery and healing outcomes. However, it was my interactions with the anaesthetist that had a lasting impact.

Taking time, she sat with me on the ward, made eye-contact, paused, acknowledged my fear  of needles non-judgementally and compassionately provided solutions to make the experience as comfortable as possible. She continued to hold a safe, respectful and empowering space while administering the anaesthetic. Her skillset extended far beyond the  life-saving administration of drugs; I was held holistically as I gently slipped into controlled  unconsciousness.

The result? My immediate post-operative recovery was smoother, lighter and quicker. I experienced significantly less physical agitation and a more regulated emotional state in the  days that followed. Longer term, my healing trajectory felt more integrated. Scar tissue softened faster, my sleep returned more quickly and the return to full energy came without  the emotional heaviness that had shadowed the first experience.

When psychological, environmental and relational factors are integrated into care, our nervous system calms. 

I still experienced trembling in the fascia located at the surgical site but this felt localised and  manageable. There was no charge or jarring from my legs and my whole body felt integrated and calm. I hadn’t previously connected the link between my felt sense to the pre-operative  and anaesthetic experience. Only now did the pieces fall into place. The excitement I felt was the recognition of this missing link.

Moving Beyond Anaesthesia: Holistic Opportunities

Reflecting on my two surgeries, it’s clear that the body’s stress response isn’t just related to a patient’s ability to heal from surgery itself. There’s immense potential to transform surgical care if viewed holistically, taking pre-operative circumstances into consideration.¹

It’s the simple things – being met with presence, recognising individual needs, fostering trust – that have the most profound impact on our nervous system. When psychological, environmental and relational factors are integrated into care, our nervous system calms.  Soothing language, mindful handling and even taking time to acknowledge a patient’s fears  can influence the trajectory of both surgery and the healing that follows.

Non-pharmacological interventions such as music therapy, cognitive behavioural therapy, acupuncture and CST are certainly gaining traction in their ability to mitigate stress without  unwanted side effects. As craniosacral therapists, we know how much of a difference CST could make here but we lack the research and evidence that science and medicine demand.  Perhaps we can follow the example of a trial exploring the use of acupuncture to reduce peri-operative anxiety,² which showed measurable improvements in levels of anxiety and post-operative outcomes.

Moving Forward

The surgical experience, I’ve come to realise, doesn’t begin in theatre. It begins in the nervous system during the pre-operative phase – long before the scalpel touches the skin –  and continues throughout the peri-operative journey.

Drawing on my personal journey and the missing link it revealed, I now support the client’s  surgical processes in a much wider, more integrated way. When craniosacral therapists work  with birth processes, we don’t just look at the birth itself; our enquiry is much broader. Similarly, in my clinic, when taking a medical history, I now actively include a client’s state of  mind and body immediately before entering the theatre. I also offer pre-operative support as  well as post operative treatment.

By tending to the nervous system at these key points, we may lessen the overall trauma to  the body, ease the peri-operative stress response and enhance the body’s innate capacity to  heal.

Vicki Sampieri is a biodynamic craniosacral therapist and artist based in East Sussex, with a background in education. In addition to supporting clients through pre- and post-operative care, she has a keen interest in how CST can support post-concussion recovery and is exploring collaborations with sports researchers and scientists investigating the  consequences of concussion, sub-concussion and their links to dementia.

References and further reading

1. The Impact of Psychological Pre-habilitation on Surgical Outcomes. University of California –  Los Angeles Health Sciences. “Psychological prehabilitation improves surgical recovery.”
   ScienceDaily. ScienceDaily, 17 March 2025. www.sciencedaily.com/releases/2025/03/250317160503.htm.
2. Wiles MD, Mamdani J, Pullman M, Andrzejowski JC. A randomised controlled trial examining  the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in  neurosurgical patients. Anaesthesia. 2017 Mar;72(3):335-342. doi: 10.1111/anae.13785.
   Epub 2017 Jan 16. PMID: 28092106.

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