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Craniosacral therapy

No one can deny that craniosacral therapy is relaxing. But, then again, so is a nap, and a nap is cheaper.

Does Craniosacral Therapy Work?

Craniosacral therapists make big promises, but can’t agree on diagnoses and have failed to pass fair scientific tests of efficacy

1,400 words, published 2008, updated 2011
by Paul Ingraham, Vancouver, Canadabio
I am a science writer, the Assistant Editor of ScienceBasedMedicine.org, and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I’ve written hundreds of articles and several books, and I’m known for sassy, skeptical, referenced analysis and a huge bibliography. I am a runner and ultimate player, and live in beautiful downtown Vancouver, Canada. • full bioabout SaveYourself.ca

Craniosacral therapy (CST) involves light holding of the skull and sacrum and barely detectable movements. Indeed, the action of craniosacral therapy is so gentle and slight that it is the best example of the so-called “subtle” therapies, which claim to achieve profound health benefits with minor and safe interventions. Practitioners believe that the tiny manipulations of CST influence the pressure and circulatory rhythm of cerebrospinal fluid, the fluid that surrounds and cushions the brain and spinal cord.

CST founder John Upledger, an osteopath1 is one of the most famous personalities in complementary and alternative medicine. Mr. Upledger says that CST “works with natural and unique rhythms of our different body systems to pinpoint and correct source problems.”

Does craniosacral therapy work as advertised? I have some concerns about it:

  1. There is good, recent scientific evidence that the most important and basic assumption about how CST works is not true — research has (once again) shown that craniosacral therapists cannot actually move the bones of the skull enough to affect the pressure or circulation of the fluid surrounding the brain and spinal column.2
  2. There is also a logical problem: the cranial bones do not move to relieve the pressure of dangerous swelling in the cranium, so they are probably not going to move for therapist’s fingers either.3
  3. There is recent scientific evidence that CST therapists produce conflicting diagnoses of the same patients.4 That is, when asked to asses a patient, CST therapists came to mutually exclusive conclusions.
  4. Any effect that CST has must be a complex and subtle one, since it cannot be measured. Subtle effects of therapy certainly exist — just because it can’t be measured doesn’t mean it isn’t there. However, it seems unlikely that any therapist is wise and knowing enough to reliably produce a therapeutic effect by leveraging a phenomenon so subtle that it can’t be measured.

At least it’s relaxing!

I have experienced CST, and I can attest that it is truly, deeply relaxing and comforting to have your head held for a long time by a craniosacral therapist with the best intentions to provide a soothing experience. Receiving craniosacral therapy is one of the most relaxing experiences I have ever had on any massage table. That said, those experiences were not much different from any other soothing massage or even just a good nap. I have been just as relaxed on my couch with my cat in my lap.

Also on the bright side, I have no doubt at all that there are many great emotional and psychological benefits to the touch therapy involved. And I am even happy to admit that there may be some “interesting” neurological effects, some of which may even be therapeutic — and which are probably not medically harmful. It is, after all, a gentle therapy.

Despite my own professional expertise, I do not begin to have the power to micro-manage such subtle and “interesting” neurological effects … assuming they exist at all. This is a simple matter of humility. Anyone who has studied physiology and neurology honestly must admit to profound ignorance. No one knows how that system really works. There are just too many blank areas on the map.

Yet, craniosacral therapists claim to “know” what is going on well enough to reliably produce a therapeutic effect. They believe that they have that power … and they believe it enough to charge patients for the service.

What do other osteopaths think?

Even Complementary Therapies in Medicine — a journal that is much friendlier to alternative therapies than mainstream scientific journals — published a review of the available research in 1999 and “found insufficient evidence to support craniosacral therapy.”5 Wouldn’t you expect such a journal to say just the opposite?

There hasn’t been any research supporting CST since then.

In 2006, craniosacral therapy was strongly questioned in yet another journal that you might expect to be friendlier to an alternative therapy, Chiroprotic & Osteopathy.6 Dr. Steve Hartman, a professor of anatomy at a college of osteopathic medicine, writes with much greater authority on this subject than I have:

Craniosacral therapy lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, “cranial” methods remain popular with many practitioners and patients.

Until outcome studies show that these techniques produce a direct and positive clinical effect, they should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health elsewhere.

As a scientist in this age of evidence-based practice, I have grown frustrated in my dealings with the “cranial” faithful. As a group, evidence carries little weight with them.

Hartman, “Cranial osteopathy: its fate seems clear,” Chiroprotic & Osteopathy, 2006

Should patients buy craniosacral therapy?

Unproven therapies should never be sold to patients without acknowledging the uncertainties — it’s just not ethical.7

I can imagine a health care professional who sells CST but strictly limits her therapeutic predictions and is conspicuously humble. Such a therapist might integrate CST as one component of treatment, a relaxing touch therapy, hoping but not really believing or trusting that it might also have some other subtle benefits. This would have to be clear to the patient.

That would be a responsible use of CST — presented with a grain of salt, and offered as just one component of therapy, not the centerpiece.

How many CST therapists actually practice in this way? In my experience, CST practitioners like this are quite rare. It’s more likely that anyone who practices craniosacral therapy is a “true believer” — ideologically committed to the modality, unaware of the substantial scientific evidence that CST is ineffective … and not interested in it either. If a therapist offers you CST but fails to acknowledge the uncertainties, you may wish to consider taking your business elsewhere.

About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.

Further Reading

Notes

  1. Osteopaths are a strange hybrid profession, sort of like a cross between a doctor and a chiropractor and a physiotherapist. Generally speaking, osteopathy has modernized and become a part of scientific medicine. However, there are prominent exceptions, like Dr. Upledger, who defend beliefs that are questioned by other osteopaths. BACK TO TEXT
  2. Downey et al. Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement. Journal of Orthopaedic & Sports Physical Therapy. 2006.

    This study tried to show the effects on the skulls and cerebrospinal fluid circulation of rabbits. The researchers found that “low loads of force, similar to those used clinically when performing a craniosacral frontal lift technique, resulted in no significant changes in coronal suture movement or intracranial pressure in rabbits.” In short, if you can’t move rabbit skull bones or change their intracranial pressure, it’s safe to assume that you probably can’t do it to humans either — and without that mechanism in good working order, craniosacral therapy has no basis at all. The researchers concluded: “These results suggest that a different biological basis for craniosacral therapy should be explored.” But, of course, a “different biological basis” for craniosacral therapy has never even been suggested, let alone tested.

    BACK TO TEXT
  3. Increased intracranial pressure becomes is serious with small increases in the fluid volume — only about a 100mL. There are well-described mechanisms that the body uses to try to compensate for increasing intracranial pressure: see the Monro-Kellie hypothesis. Expansion of the cranium is not one of the mechanisms that relieves pressure. BACK TO TEXT
  4. Moran et al. Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. Journal of Manipulative & Physiological Therapeutics. 2001.

    “Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment” in craniosacral therapy. So, researchers compared the diagnostics methods of “two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.” The researchers concluded that “interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent.” Emphasis mine.

    BACK TO TEXT
  5. Green et al. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complementary Therapies in Medicine. 1999.

    From the abstract: “This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.”

    BACK TO TEXT
  6. Hartman. Cranial osteopathy: its fate seems clear. Chiroprotic & Osteopathy. 2006.

    Anyone curious about craniosacral therapy should read this clear, compelling and harsh critique of it. As an osteopath himself, Dr. Hartman’s opinion carries considerable weight, and he writes well.

    BACK TO TEXT
  7. Ethics 101: making risks and limitations of therapy clear to the patient before they agree to it or pay for it is called “informed consent,” a well-defined necessity for the ethical delivery of any health care product or service. BACK TO TEXT