The Dural Layers of the Central Nervous System

When we think about the structures that protect our brain and spinal cord, most people picture the skull and vertebrae. But there’s another crucial protective system that often goes unrecognized: the meninges. These three layers of tissue wrap around your entire central nervous system and can play a significant role in many conditions we treat as physiotherapists.

The Three Meningeal Layers

The meninges consist of three distinct layers, each with its own structure and function:

Dura Mater (The “Tough Mother”)

The outermost layer, the dura mater, is a thick, fibrous membrane that lines the inside of the skull and the spinal canal. It’s remarkably strong and provides mechanical protection for the delicate neural tissue beneath. The dura:

• Attaches firmly to the skull bones
• Forms protective partitions within the skull (falx cerebri, tentorium cerebelli)
• Creates a continuous tube around the spinal cord down to the sacrum
• Contains the venous sinuses that drain blood from the brain

Arachnoid Mater (The “Spider-like” Layer)

The middle layer gets its name from its web-like appearance. The arachnoid mater:

• Sits beneath the dura but doesn’t attach to the brain surface
• Creates the subarachnoid space below it
• Contains cerebrospinal fluid (CSF) that cushions the brain and spinal cord
• Features delicate projections called arachnoid granulations that help recycle CSF

Pia Mater (The “Tender Mother”)

The innermost layer, the pia mater, is a thin, delicate membrane that intimately follows every contour of the brain and spinal cord:

• Adheres directly to the neural tissue
• Follows every fold and groove of the brain
• Contains blood vessels that supply the nervous system
• Provides a protective barrier for the underlying tissue

Why the Dura Matters in Musculoskeletal Care

You might wonder why a physiotherapy clinic would be interested in these deep structures. The answer lies in the dura’s extensive connections throughout the body and its role in many common conditions.

Dural Attachments and Tension

The dura isn’t just floating freely inside your spine. It has specific attachment points that create mechanical connections throughout your body:

• Cranial attachments: The dura attaches to the base of the skull, particularly around the foramen magnum (the opening where the spinal cord exits the skull)
• Upper cervical connections: Strong attachments to the first two cervical vertebrae (C1-C2)
• Lumbar and sacral attachments: The dural tube ends at approximately the S2 level, with connections to the coccyx via the filum terminale

These attachments mean that tension in one area can transmit forces to another. A fall on the tailbone, for instance, can create tension that affects structures all the way up to the base of the skull.

Conditions Related to Dural Dysfunction

Headaches and Migraines

The dura itself contains sensory nerve fibers and is sensitive to mechanical tension and irritation. When the dura becomes restricted or inflamed, it can contribute to headaches:

• Cervicogenic headaches
• Post-traumatic headaches
• Certain types of migraines
• Headaches that worsen with specific positions or movements

Whiplash and Concussion

After trauma to the head or neck, the dural system can develop restrictions that persist long after the initial injury appears to have healed. This may explain why some patients continue to experience symptoms months or years after a whiplash injury or concussion:

• Persistent neck pain and stiffness
• Ongoing headaches
• Balance problems
• Difficulty concentrating
• Light and sound sensitivity

Vertigo and Dizziness

The dura’s close relationship with the upper cervical spine and its connections to the vestibular system mean that dural tension can contribute to vertigo:

• Cervicogenic dizziness
• Balance disturbances
• Spatial disorientation
• Motion sensitivity

Chronic Back Pain and Sciatica

In the lumbar spine and sacral region, dural tension can affect:

• Nerve root mobility
• Back pain patterns
• Sciatica-type symptoms
• Recovery from disc injuries

Recurrent Strains and Unexplained Pain

Sometimes patients present with patterns of injury that seem disproportionate to the mechanism, or pain that moves around the body. These can sometimes be related to underlying dural tension that creates areas of vulnerability or altered movement patterns.

What Can Affect Dural Mobility?

Several factors can influence dural mobility and health:

Physical Trauma

• Falls (especially onto the tailbone or head)
• Motor vehicle accidents
• Sports injuries
• Birth trauma (both for mother and baby)

Surgical History

• Spinal surgeries
• Epidural injections
• Lumbar punctures
• Neurosurgical procedures

Inflammatory and Infectious Conditions

• Meningitis (even years after recovery)
• Chronic inflammatory conditions
• Autoimmune disorders

Postural and Mechanical Factors

• Prolonged poor posture
• Repetitive strain
• Scar tissue from previous injuries

Assessment and Treatment Approaches

At At Ease Physio, we consider the dural system as part of our comprehensive assessment, particularly when:

• Symptoms don’t follow typical patterns
• Standard treatments haven’t been fully effective
• There’s a history of trauma, surgery, or infection
• Symptoms seem to move or change location
• Certain positions or movements consistently provoke symptoms

What Treatment Might Include

Treatment addressing dural restrictions typically involves gentle, specific techniques including:

• Dural mobilization: Gentle movements that encourage normal gliding of the dural tube within the spinal canal
• Neural tension techniques: Exercises that help restore normal mobility of the nervous system
• Craniosacral therapy approaches: Gentle techniques addressing restrictions in the cranial and sacral regions
• Manual therapy techniques: Hands-on approaches to release dural restrictions and restore mobility
• Postural education: Helping you understand positions and movements that support dural health
• Home exercises: Specific stretches and movements you can do to maintain improvements

When to Consider Dural Involvement

If you’re experiencing any of the following, the dural system might be worth investigating:

• Symptoms that haven’t responded to conventional treatment
• A history of head or tailbone trauma
• Post-concussion symptoms that persist beyond expected recovery time
• Headaches associated with neck pain or specific positions
• Unexplained vertigo or balance problems
• Symptoms that seem to travel or change location
• Pain or restrictions that seem out of proportion to apparent injury

The nervous system is complex, and sometimes the answer lies in structures we don’t commonly consider. If you’re curious about whether dural involvement might be contributing to your symptoms, contact us to discuss your situation with one of our physiotherapists.