If you’ve lived in Missoula for more than one winter, you know the feeling. The valley fills with cold air that just sits there. Wood smoke from thousands of stoves, exhaust from I-90, particulate matter from the surrounding drainages, all of it gets trapped under a temperature inversion that can last days. The mountains are still there; you just can’t see them. And your nose, sinuses, and the back of your throat are fighting a daily battle.
Add summer wildfire season on top of that, and Missoula residents deal with some of the worst air quality conditions in Montana, a state that is otherwise famous for clean air. The Missoula City-County Health Department monitors particulate matter (PM2.5) precisely because our valley topography creates a bowl effect that concentrates airborne pollution in ways flat-terrain cities simply don’t experience.
Most people manage this with over-the-counter sprays, antihistamines, or simply suffering through it. Some see an ENT and leave with a diagnosis of “chronic sinusitis” and a prescription that helps temporarily but doesn’t actually change anything structural.
There’s something else worth knowing about. It’s called Cranial Facial Release, and it works in a fundamentally different way from anything most people have tried.
First: Your Skull Is Not One Solid Bone
This surprises almost everyone. Most of us learned in school that the skull is a fixed shell protecting the brain. The reality is more interesting and more relevant to your health than that.
Your skull is made up of 22 individual bones, connected by fibrous joints called sutures. These sutures allow for subtle, rhythmic movement, an expansion and relaxation that happens every time you breathe. This isn’t gross movement you can feel from the outside. It’s micro-movement, operating in coordination with the motion of your sacrum at the base of your spine, and it drives one of the most critical functions in your body: the circulation of cerebrospinal fluid.
Cerebrospinal fluid (CSF) is the clear fluid that surrounds and cushions the brain and spinal cord. It delivers nutrients, removes metabolic waste products from brain tissue, and maintains the pressure environment the nervous system needs to function. The production and circulation of CSF depends on this rhythmic cranial motion, the bones expanding and relaxing, acting like a slow pump.
When cranial bones become fixated, locked into a restricted position, that pump is compromised. CSF doesn’t circulate as efficiently. Pressure builds in places it shouldn’t. And the symptoms that result can be wide-ranging, because virtually everything in the body is downstream of normal brain and nervous system function.
The bone at the center of all of this is the sphenoid.
The Sphenoid: The Bone Nobody Talks About but Everyone Should Know
The sphenoid bone sits at the base of the skull, roughly behind the bridge of your nose. It’s a butterfly-shaped bone that connects to almost every other cranial bone, making it the keystone of the entire skull’s movement pattern. When the sphenoid moves correctly, the rest of the cranial bones can too. When the sphenoid is restricted, the whole system gets thrown off.
The sphenoid also houses the pituitary gland, the “master gland” of the endocrine system, which regulates hormones throughout the body. Mechanical tension or restriction around the sphenoid doesn’t just affect breathing and pressure. It creates a mechanical stress on the structure directly responsible for hormonal regulation.
This is why people who get CFR treatment sometimes report improvements in things that seem unrelated to their presenting complaint: better sleep, more energy, improved mood, clearer thinking. It sounds like a stretch until you understand the anatomy. When the sphenoid frees up and cranial motion normalizes, you’re not just opening a nasal passage. You’re restoring a foundational movement pattern that the entire head and brain depend on.
What Causes Cranial Fixations?
Any trauma to the head or face can cause cranial bones to become fixated. Some of the most common causes in Missoula patients include:
Head impacts from outdoor sports. Mountain biking crashes, ski and snowboard falls, rock climbing accidents. Even impacts with helmets, the helmet protects your skull from fracture, but the forces still travel through the cranial bones and sutures.
Whiplash from car accidents. The rapid acceleration-deceleration of whiplash creates compressive forces through the cervical spine that transmit into the base of the skull. The cranial bones can jam just as surely as cervical vertebrae.
Old broken noses. The nasal bones connect directly to the adjacent facial bones, which connect to the sphenoid. A nose broken years or decades ago and “healed” may have left fixations that affect breathing and cranial motion ever since.
Birth trauma. The forces involved in delivery, particularly with forceps, vacuum extraction, or a difficult labor, can affect the cranial bones of newborns. Some adults carry patterns from their birth that have never been addressed.
Chronic mouth breathing. Ironically, people who develop mouth breathing habits because of nasal congestion (often driven by Missoula’s air quality) alter the resting pressure dynamics in the oral and nasal cavity, which over time affects the position and mobility of the surrounding facial bones.
Repeated exposure to poor air quality. Chronic inflammation in the nasal passages and sinuses, sustained over years of inversion and smoke seasons, creates tissue changes that affect the structural environment the cranial bones move within.
Most cranial fixations develop gradually and are never linked to a single dramatic event. The person who has had “sinus problems for as long as I can remember” often has fixation patterns that preceded any specific diagnosis.
What CFR Actually Does: The Procedure Explained Honestly
Cranial Facial Release uses a small medical balloon, about the size of a finger cot, attached to a hand pump. The balloon is carefully lubricated and inserted into one of the nasal passages, positioned in a specific channel within the nasopharynx (the airway just behind the nose, above the soft palate). It is not inserted into the sinuses.
The patient takes a deep breath and holds it. The balloon is inflated for approximately one to three seconds. That’s it.
The sensation is significant pressure, brief but intense, and is often compared to the feeling of water getting pushed up your nose when you jump into a pool. It isn’t pleasant, but it’s fast. Most people feel an immediate shift: a sense of opening, a release of pressure, often a noticeable change in how clearly they can breathe.
The inflation presses outward against the bony structures of the nasal passage, transmitting force through the sutures of the skull and creating a mobilization of the sphenoid and surrounding cranial bones. Clicks and pops in the head are common and are the sound of sutures releasing, similar to what happens during a spinal adjustment.
The full treatment protocol involves four sessions, ideally spaced over one to two weeks, with each session including multiple passes through different nasal channels. Before each session, we address the rest of the spine, particularly the cervical spine and thoracic region. This matters: the CFR literature is clear that rushing to the cranium without first clearing the structures below it limits outcomes. The dura (the membrane surrounding the brain and spinal cord) attaches to the cervical spine, and tension at those attachment points pulls directly on the cranial system. We clear that tension first, then work the cranium.
Who in Missoula Actually Gets Good Results from CFR?
This is the question that matters most, and the honest answer is: CFR works best for people with structural contributors to their problem, not purely inflammatory ones. Here’s how that distinction plays out in practice.
Chronic sinusitis that doesn’t fully respond to treatment. If your ENT has done a scope, told you your anatomy looks fine, and you still can’t breathe clearly or feel constant pressure behind your eyes, there may be a structural fixation component that medications can’t address. CFR changes the geometry of the nasal airway, not just the tissue response.
Headaches with an unclear pattern. Migraines and tension headaches that cluster around the temples, forehead, or base of the skull often have a cranial component. When intracranial pressure is elevated due to restricted CSF circulation, headaches become more frequent and more severe. CFR addressing the cranial restriction can change the baseline.
Persistent post-concussion symptoms. This is where CFR has some of its most compelling results. People who took a hit, whether from a ski crash at Snowbowl, a mountain bike wreck in the Rattlesnake, a football or wrestling injury at UM, and have never quite felt right since: ongoing brain fog, sensitivity to light, low-grade headaches, difficulty concentrating. These symptoms often persist because the cranial bones were knocked into a fixation pattern that has never been corrected. The concussion “healed” but the structural restriction didn’t.
TMJ disorder that isn’t responding to dental interventions. The sphenoid bone has anatomical relationships with the temporomandibular joint. Night guards address the symptoms of grinding; they don’t address the underlying cranial tension that often contributes to it. Many TMJ patients see meaningful improvement with CFR when the sphenoid releases.
Sleep apnea and chronic snoring. CFR opens the nasal airway structurally, not chemically. For people with obstructive sleep apnea driven by nasal airway restriction, this can meaningfully reduce the effort required to breathe during sleep. It doesn’t replace CPAP for severe cases, but for mild to moderate cases or as a complement to other treatment, improved nasal airflow changes the equation.
Vertigo and tinnitus with no diagnosed cause. The inner ear environment is sensitive to pressure changes in the surrounding structures. Some cases of vertigo and ringing in the ears are connected to cranial fixation patterns affecting the temporal bones (which house the inner ear). When other causes have been ruled out, CFR is worth exploring.
People who just can’t breathe through their nose. Sometimes the problem is exactly that simple. Missoula winters are hard on nasal passages. If you’ve been a chronic mouth breather, slept poorly because your nose is always partially blocked, or feel like your sinuses never fully clear, even when you’re not sick, CFR can produce a quality-of-life change that nothing else has achieved.
What CFR Is Not Right For
Honesty matters here. CFR is not appropriate for everyone and isn’t a treatment for every condition.
It is contraindicated in people with active nasal infections, nasal polyps (until evaluated), recent facial fractures, or certain blood clotting conditions. Anyone who has had sinus surgery should discuss their history with us in detail before considering CFR.
It is also not a substitute for proper diagnosis. If you have chronic sinusitis, an ENT evaluation to rule out structural issues like polyps, deviated septum requiring surgical correction, or fungal infections is appropriate before or alongside CFR. We work with your other providers, not instead of them.
And while the conditions CFR can help with is a long list, it’s important to understand that CFR targets cranial restriction specifically. If your headaches are hormonal, your sinus issues are purely allergic, or your sleep apnea is driven by obesity rather than airway structure, CFR will have limited impact. Proper intake and evaluation helps us identify who will actually benefit before starting treatment.
Why So Few Practitioners Offer CFR, And What That Means for You
CFR requires specific certification and significant hands-on training. There are only a few hundred certified CFR practitioners in the United States. This isn’t a technique you improvise; the positioning within the nasopharynx, the sequencing of nasal channels, and the integration with full-spine assessment before each session are all learned through structured training.
Dr. Glen’s CFR certification makes Clearwater Chiropractic one of the very few places in Montana where this treatment is available. Patients travel from the Bitterroot Valley, from Butte, from Kalispell, and from smaller communities throughout western Montana to access it.
If you’ve been searching for this and haven’t been able to find it locally, or if you’ve never heard of it but recognize yourself in the descriptions above, we’d like to talk.
The Conversation Worth Having
The people who benefit most from CFR are usually the ones who’ve tried other things. They’ve been to their primary care doctor, perhaps an ENT, maybe tried acupuncture or massage. Some of what they tried helped partially. None of it solved the problem.
The reason is usually that the structural, cranial component of what they’re dealing with hasn’t been addressed, because most practitioners aren’t trained to recognize it or treat it.
If that’s you, if you have chronic sinus pressure, headaches that recur without a clear explanation, a concussion history with lingering symptoms, or just a nose that hasn’t worked right in years, come in for a consultation. We’ll do a thorough intake, talk through your history, and give you an honest assessment of whether CFR is likely to help.
Missoula is a hard place to breathe some of the time. You shouldn’t have to accept that as a permanent condition.
Clearwater Chiropractic Missoula, MT 📞 (406) 534-0678
Learn more about our Cranial Facial Release (CFR) service.
Dr. Glen Maricelli, DC practices at Clearwater Chiropractic in Missoula, Montana. He holds certification in Cranial Facial Release and offers CFR as part of a comprehensive chiropractic care approach that includes spinal assessment, manual therapies, and individualized treatment planning.