Active Craniospinal Tensioning (ACT): Axial Spinal Traction for Glymphatic Modulation.

The glymphatic system is a clearance pathway that facilitates convective exchange between cerebrospinal fluid (CSF) and interstitial fluid, and is increasingly implicated in the pathophysiology of neurodegenerative and neuroinflammatory disorders. However, translation of glymphatic physiology into intentional, noninvasive biomechanical interventions remains limited. Building on a previously introduced biomechanical framework that proposed axial spinal traction as a method to modulate CSF and glymphatic circulation, practitioner-applied pelvis-stabilized axial spinal traction (PSAST) has been characterized as a controlled prototype, although its reliance on professional administration and structured setup may constrain deployment in population-level or preventive contexts. This report introduces active craniospinal tensioning (ACT) as a translational, participant-driven extension of the established axial traction-glymphatic modulation framework, specifically designed for ambulatory populations. ACT employs a voluntary squat maneuver combined with a standardized overhead anchor system to generate controlled axial tension along the craniospinal axis, while preserving the same dural tensioning and craniospinal coupling principles described in prior axial traction models. By shifting force generation from practitioner-applied loading to participant-regulated loading, ACT presents a scalable approach for exploratory preventive application under supervised conditions. ACT is theoretically framed for individuals exhibiting reduced perivascular water diffusivity, such as those with lower diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) indices. This report provides a practical implementation framework for ACT and supports future hypothesis-driven investigation of biomechanical modulation of CSF and glymphatic circulation using advanced neuroimaging biomarkers.