Craniosacral Therapy

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Craniosacral Therapy

Postby patoco » Tue Jul 18, 2006 2:03 pm

Craniosacral Therapy

Lymphedema People

http://www.lymphdemapeople.com

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Yet another "treatment" method that has emerged in the lymphedema groups discussions is something called craniosacral manipulation therapy.

Another wonderful cure-all or is it just more unsubstantiated and unscientific bunk??

Read the below article and judge for yourself.

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Craniosacral Therapy

Stephen Barrett, M.D.

Craniosacral therapy is one of many terms used to describe a various methods based on fanciful claims that:

The human brain makes rhythmic movements at a rate of 10 to 14 cycles per minute, a periodicity unrelated to breathing or heart rate.
Small cranial pulsations can be felt with the fingertips.

Restriction of movement of the cranial sutures (where the skull bones meet) interfere with the normal flow of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) and cause disease.
Diseases can be diagnosed by detecting aberrations in this rhythm.
Pain (especially of the jaw joint) and many other ailments can be remedied by pressing on the skull bones.

Most practitioners are osteopaths, massage therapists, chiropractors, dentists, or physical therapists. The other terms used to describe what they do include cranial osteopathy, cranial therapy, bio cranial therapy, and two chiropractic variants called craniopathy and sacro occipital technique (SOT).

Dubious Claims

Craniosacral therapy was originated by osteopath William G. Sutherland, who published his first article on this subject in the early 1930s. Today's leading proponent is John Upledger, DO, who operates the Upledger Institute of Palm Beach Gardens, Florida. Various Institute publications have claimed:

CranioSacral Therapy is a gentle, noninvasive manipulative technique. Seldom does the therapist apply pressure that exceeds five grams or the equivalent weight of a nickel. Examination is done by testing for movement in various parts of the system. Often, when movement testing is completed, the restriction has been removed and the system is able to self-correct [1].

The rhythm of the craniosacral system can be detected in much the same way as the rhythms of the cardiovascular and respiratory systems. But unlike those body systems, both evaluation and correction of the craniosacral system can be accomplished through palpation. CranioSacral Therapy is used for a myriad of health problems, including headaches, neck and back pain, TMJ dysfunction, chronic fatigue, motor-coordination difficulties, eye problems, endogenous depression, hyperactivity, attention deficit disorder, central nervous system disorders, and many other conditions [2].

Practitioners today rely on CranioSacral Therapy to improve the functioning of the central nervous system, eliminate the negative effects of stress, strengthen resistance to disease, and enhance overall health [3].

Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system. By complementing the body's natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, including: migraine headaches; chronic neck and back pain; motor-coordination impairments; colic; autism; central nervous system disorders; orthopedic problems; traumatic brain and spinal cord injuries; scoliosis; infantile disorders; learning disabilities; chronic fatigue; emotional difficulties; stress and tension-related problems; fibromyalgia and other connective-tissue disorders; temporomandibular joint syndrome (TMJ); neurovascular or immune disorders; post-traumatic stress disorder; post-surgical dysfunction [4].

The Upledger Institute also advocates and teaches "visceral manipulation," a bizarre treatment system whose practitioners are claimed to detect "rhythmic motions" of the intestines and other internal organs and to manipulate them to "improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body." [5]

Weird Beliefs

Some of Upledger's beliefs are among the strangest I have ever encountered. Chapter 2 of his book, CranoSacral Therapy: Touchstone of Natural Healing, he describes, how he discovered and communicates with what he calls the patient's "Inner Physician":

By connecting deeply with a patient while doing CranioSacral Therapy, it was possible in most cases to solicit contact with the patient's Inner Physician. It also became clear that the Inner Physician could take any for m the patient could imagine -- an image, a voice or a feeling. Usually once the image of the Inner Physician appeared, it was ready to dialog with me and answer questions about the underlying causes of the patient's health problems and what can be done to resolve them. It also became clear that when the conversation with the Inner Physician was authentic, the craniosacral system went into a holding pattern [6].

The chapter goes on to describe Upledger's care of a four-month-old French baby who was "as floppy as a rag doll." Although the baby had never been exposed to English, Upledger decided to see whether the baby's "Inner Physician" would communicate with him via the craniosacral system:

I requested aloud in English that the craniosacral rhythm stop if the answer to a question was "yes" and not stop if the answer was "no." The rhythm stopped for about ten seconds. I took this as an indication that I was being understood. I then asked if it was possible during this session for the rhythm to stop only in response to my question and not for other reasons, such as body position, etc., The rhythm stopped again. I was feeling more confident. I proceeded [6].

Using "yes-no answers," Upledger says, he pinpointed the problem as "a toxin that was inhaled by the mother . . . over a period of about two-and-a-half hours while cleaning the grease off an antique automobile engine" during the fourth month of pregnancy. After "asking many particulars" about what he should do, Upledger was told to "pump the parietal bones that form a large part of the roof of the skull, and to pass a lot of my energy through the brain from the back of the skull to the front." As he did this, Upledger frequently checked with the baby's "Inner Physician." After about an hour, Upledger says, the baby began to move normally [6].

In July 2003, a Pennsylvania chiropractor was convicted of insurance fraud in connection with the death of a 30-year-old epileptic woman whom she treated with cranial therapy. Court documents indicated that the patient died of severe seizures after following the chiropractor's advice to stop taking her anticonvulsive medication. The fraud involved submitting insurance claims falsely describing Upledger's "meningeal balancing" as spinal manipulation [7].

Related Systems

British osteopath Robert Boyd, who developed a variant he calls Bio Cranial Therapy, which -- according to the International Bio Cranial Web site -- is "extremely helpful" for "chronic fatigue syndrome (CFS); varicosity and varicose ulcers; tinnitus; bladder prolapse; prostate disorders; Meniere's syndrome; cardiovascular disturbances including hypertension, angina; skin disorders (psoriasis, eczema, acne etc); female disorders (dysmenorrhoea, PMS (PMT), menorrhagia etc); arthritis and rheumatic disorders; fibromyalgia and heel spurs; gastric disorders (hiatus hernia, ulceration, colitis); asthma and a range of bronchial disorders including bronchiectasis and emphysema." [8]

Sacro-occiptal technique (SOT) combines theories about spinal fluid pressure with chiropractic theories about spinal "nerve pressure" as a cause of ill health. Chiropractors who advocate SOT claim to detect "blockages" by feeling the skull and spine and measuring leg lengths [9].

The Scientific Viewpoint

I do not believe that craniosacral therapy has any therapeutic value. Its underlying theory is false because the bones of the skull fuse by the end of adolescence and no research has ever demonstrated that manual manipulation can move the individual cranial bones [10]. Nor do I believe that "the rhythms of the craniosacral system can be felt as clearly as the rhythms of the cardiovascular and respiratory systems," as is claimed by another Upledger Institute brochure [11]. The brain does pulsate, but this is exclusively related to the cardiovascular system [12], and no relationship between brain pulsation and general health has been demonstrated.

A few years ago, three physical therapists who examined the same 12 patients diagnosed significantly different "craniosacral rates," which is the expected outcome of measuring a nonexistent phenomenon [13]. Another study compared the "craniosacral rate" measured at the head and feet of 28 adults by two examiners and found that the results were highly inconsistent [14].

In 1999, after doing a comprehensive review of published studies, the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that the theory is invalid and that practitioners cannot reliably measure what they claim to be modifying. The 68-page report concludes that "there is insufficient evidence to recommend craniosacral therapy to patients, practitioners, or third party payers." [15]

In 2002, two basic science professors at the University of New England College of Osteopathic Medicine concluded:

Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. Since no properly randomized, blinded, and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations [10].

I certainly agree! In fact, I believe that most practitioners of craniosacral therapy have such poor judgment that they should be delicensed.

Reader Comment

As a physical therapist and exercise physiologist, I'd like to thank you for your article on "craniosacral therapy". Too many patients and therapists have been duped by this so-called therapy. If these therapist were ever to suggest to any self-respecting neurosurgeon, that they could move the sutures of the skull with ounces of force, they would get laughed right out of the room. I have personally witnessed how saws and drills are needed (with more than a few ounces of force) to alter the structure of the adult skull. To tell patients that you have the ability to analyze the cerebral spinal fluid flow with your fingertips and then "normalize" it by mobilizing the cranial sutures is not just quackery but malpractice. They should lose their license.

References

Discover CranioSacral Therapy. Undated flyer distributed in 1997 by the Upledger Institute.
Upledger CranioSacral Therapy I. Brochure for course, November 1997.
For serious education in complementary care . . . come to the source. Brochure for course, Upledger Institute, Aug 2001.
CranioSacral Therapy. Upledger Institute Web site, accessed Aug 15, 2001.
Visceral manipulation. Upledger Institute Web site, accessed Aug 15, 2001.
Upledger JE. CranoSacral Therapy: Touchstone of Natural Healing. Berkeley, Caliifornia: North Atlantic Books, 1999, p 51-58.
Barrett S. Bizarre therapy leads to patient's death. Chirobase, July 7, 2003.
Bio Cranial Therapy in action. International Bio Cranial Web site, accessed Aug 21, 2001.
Homola S. Bonesetting, Chiropractic, and Cultism, 1963.
Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine 6(1):23-34, 2002.
Workshop catalog, Upledger Institute, 1995.
Ferre JC and others. Cranial osteopathy, delusion or reality? Actualites Odonto-Stomatologiques 44:481-494, 1990.
Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Physical Therapy 74:908-16, 1994.
Rogers JS and others. Simultaneous palpation of the craniosacral rate at the head and feet: Intrarater and interrater reliability and rate comparisons. Physical Therapy 78:1175-1185, 1998.
Kazanjian A and others. A systematic review and appraisal of the scientific evidence on craniosacral therapy. BCOHTA, May 1999]

http://www.quackwatch.org/01QuackeryRel ... anial.html

Quackwatch Home Page

This article was revised on September 21, 2004.
Last edited by patoco on Tue Jul 18, 2006 2:18 pm, edited 1 time in total.
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Craniosacral Therapy Is Not Medicine

Postby patoco » Tue Jul 18, 2006 2:17 pm

Craniosacral Therapy Is Not Medicine

To the Editor:

Although the prescientific thinking emblematic of most "alternative" health care may lead infrequently to fortuitous insights, many of these techniques have been tested, have failed, and should be abandoned.

For example, we have observed in our laboratory and described in Scientific Review of Alternative Medicine1 one of the manipulation procedures (craniosacral therapy/cranial osteopathy) used by many physical therapists, occupational therapists, osteopathic physicians, and others. Based on our observations, we have drawn several conclusions.

We believe that Sutherland's Primary Respiratory Mechanism is invalid. "Cranial" rhythms cannot be generated through organic motility of brains because neurons and glial cells lack the dense arrays of actin and myosin filaments required to produce such movement. Other hypotheses regarding genesis of this rhythm (eg, Upledger's "pressurestat" model2) remain purely speculative. Movement between the sphenoid and occipital bones at their bases is impossible past late adolescence because, by then, they have become one very robust bone.3-6 Movement among components of the cranial vault also is impossible in most adults because coronal and sagittal sutures usually have begun to ossify by age 25 to 30 years and the lambdoidal suture only slightly later.7-9 Interexaminer reliability is approximately zero, many published coefficients have been negative, and the most parsimonious explanation for data collected thus far is that practitioners are imagining the cranial rhythm.1 Finally, even if purported cranial and intracranial movements are real, are being propagated to the scalp, and are being assessed accurately by practitioners, there is no reason to believe that parameters of such movements should be related to health and no scientific evidence that they can be manipulated to a patient's health advantage.

Similarly, in 1997, the authors of a report prepared for The Insurance Corporation of British Columbia concluded that "no plausible functional background and no empirical evidence of effectiveness of craniosacral therapy could be discerned from the materials reviewed."10 In 1998, the National Council Against Health Fraud concluded that "cranial osteopathy is more a belief system than a science."11 In 1999, independent reviewers "found insufficient evidence to support"12 or "recommend craniosacral therapy to patients, practitioners or third-party payers for any clinical condition."13

We are aware of no scientific research supporting the clinical value of these techniques. We should not teach our students that health-related restrictions and imbalances in cranial and intracranial movements can be manipulated to a patient's health advantage, because there is no evidence supporting such claims. We are still deliberating these issues only because craniosacral therapy/ cranial osteopathy is a belief system—not medicine—and as such has been impervious to disconfirmation for most of a century.

We are not characterizing craniosacral therapy as just another approach to health care about which knowledge is incomplete. To the contrary, we believe that craniosacral therapy bears approximately the same relationship to real medicine that astrology bears to astronomy. That is, this approach to "health care" is medical fiction, and it is not appropriate to teach fiction as part of medical or allied health curricula.

We intend no disrespect for practitioners who may feel that their professional identities are challenged by our views. However, until researchers have replicated demonstrations of efficacy—using properly controlled scientific trials—we believe that craniosacral therapy/cranial osteopathy should be removed from all medical and allied health curricula.

Steve E Hartman, PhD
Professor
Department of Anatomy
College of Osteopathic Medicine
University of New England
Biddeford, ME 04005
(shartman@une.edu)

James M Norton, PhD
Professor
Department of Physiology
College of Osteopathic Medicine
University of New England

References

1 Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine. 2002;6:23–40.

2 Upledger JE, Vredevoogd JD. Craniosacral Therapy. Chicago, Ill: Eastland Press; 1983:11–12.

3 Melsen B. Time and mode of closure of the spheno-occipital synchondrosis determined on human autopsy material. Acta Anat. 1972;83:112–118.

4 Madeline LA, Elster AD. Suture closure in the human chondrocranium: CT assessment. Radiology. 1995;196:747–756. Medline

5 Okamoto K, Ito J, Tokiguchi S, Furusawa T. High-resolution CT findings in the development of spheno-occipital synchondrosis. Am J Neuroradiol. 1996;17:117–120. Medline

6 Sahni D, Jit I, Neelam, Suri S. Time of fusion of the basisphenoid with the basilar part of the occipital bone in northwest Indian subjects. Forensic Sci Int. 1998;98:41–45. Medline

7 Cohen MM Jr. Sutural biology and the correlates of craniosynostosis. Am J Med Genet. 1993;47:581–616. Medline

8 Perizonius WRK. Closing and non-closing sutures in 256 crania of known age and not allowed from Amsterdam (A.D. 1883-1908). J Hum Evol. 1984;13:201–216.

9 Verhulst J, Onghena P. Cranial suture closing in Homo sapiens: evidence for circaseptennian periodicity. Ann Hum Biol. 1997;24:141–156. Medline

10 Oppel L, Beyerstein BL, Mathias R, et al. Craniosacral Therapy: A Review of the Scientific Evidence. Report prepared by the Alternative Therapy Evaluation Committee for The Insurance Corporation of British Columbia; 1997.

11 Cranial Manipulative Therapy: Information for Prudent Consumers From the National Council Against Health Fraud Inc. Loma Linda, Calif: National Council Against Health Fraud Inc; 1998.

12 Green C, Martin CW, Bassett K, Kazanjian A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med. 1999;7:201–207. Medline

13 Green C, Martin CW, Bassett K, Kazanjian A. A Systematic Review and Critical Appraisal of the Scientific Evidence on Craniosacral Therapy. Vancouver, British Columbia, Canada: British Columbia Office of Health Technology Assessment; 1999.

Journal of the American Physical Therapy Association

http://www.ptjournal.org/Nov2002/Nov02_Letters.cfm
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