published 8/15/08

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

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Craniosacral therapy (CST) involves light holding of the skull and sacrum and almost imperceptible movements. Indeed, the action of craniosacral therapy is so subtle that it is the poster child for the so-called “subtle” therapies. Such manipulations allegedly affect the pressure and circulatory rhythm of cerebrospinal fluid (the fluid that cushions the brain and spinal cord).

According to CST founder John Upledger, an osteopath1 and one of the most famous personalities in alternative medicine, craniosacral therapy “works with natural and unique rhythms of our different body systems to pinpoint and correct source problems.” Thus craniosacral therapy fits well into that large category of therapies that claim to have profound health benefits achieved with minor interventions.

There are three particularly obvious and serious concerns about craniosacral therapy:

There is good, recent scientific evidence that the most important and basic assumption about how CST works is just 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
There is also good, recent scientific evidence that CST therapists cannot agree with each other! That is, when tested separately, they come to different conclusions about the same clients. It’s a simple fact that craniosacral therapists rarely agree on the results of their assessment methods3 — and they can’t all be right. This is called “inter-rater reliability” testing, and it’s a fair way of separating sense from nonsense.
Even if we ignore the previous two problems and allow, for the sake of argument, that CST does affect the nervous system in the way that Upledger claims, the effect would obviously still be extremely complex and subtle. It is unlikely that any therapist is wise and knowing enough to predictably produce a therapeutic effect in this way.

At least it’s relaxing!

On the bright side, it truly is deeply relaxing and comforting to have your head held for a long time by a compassionate craniosacral therapist, and of course most therapists (of any kind) are compassionate people with the best intentions. Receiving craniosacral therapy is one of the most relaxing experiences I have ever had.

Also on the bright side, I have no doubt at all that there are many emotional and psychological effects 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.

But I also know that I do not personally understand, and could not possibly reliably control, 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.

Yet, craniosacral therapists claim to “know” what is going on — and how to leverage it for a reliable therapeutic effect. They believe that they have that power, and they believe it enough to charge you for the service.

CST might, possibly, have some “interesting” neurological effects — but can anyone know whether or not they are therapeutic? And produce them reliably?

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.”4 Wouldn’t you expect such a journal to say just the opposite?

And, no, there hasn’t been any research supporting CST since then.

In 2006, craniosacral therapy was even more harshly criticized in yet another journal that you might expect to be friendly to an alternative therapy, Chiroprotic & Osteopathy.5 Dr. Steve Hartman, as an osteopathic physician himself (like the founder of craniosacral therapy), writes with much greater force on this subject than I can muster:

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, Chiroprotic & Osteopathy, 2006

Could it ever be ethical to sell craniosacral therapy to patients?

I can imagine a health care professional who studies CST but strictly limits their therapeutic expectations of it, and stays conspicuously humble. Such a therapist might be able to ethically integrate CST into treatment as a relaxing touch therapy, hoping but not really believing or trusting that it might also have some other subtle therapeutic side-benefits. This would have to be clear to the patient.6

This would be the only responsible way to use CST — with a gigantic grain of salt, in other words.

I suspect that CST practitioners like this are in the minority. It’s more likely that anyone who practices craniosacral therapy is a “true believer” — someone who is neither aware of the substantial scientific evidence that CST is ineffective … and not interested in it either.

Notes

Osteopaths are a strange hybrid profession, sort of like a cross between a doctor and a chiropractor and a physiotherapist. Generally speaking, osteopathy has worked hard to modernize and join the mainstream. Dr. Upledger is certainly an exception to this trend, an “old school” practitioner with many beliefs that have been challenged by his more science-friendly colleages. Return to text.
Downey et al. 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. Return to text.
Moran et al. 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. Return to text.
Green et al. 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.” Return to text.
Hartman. 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. Return to text.
Making risks and limitations of therapy clear to the patient is called “informed consent,” a well-defined necessity for the ethical delivery of any health care product or service — yet something that’s lacking from virtually all of alternative health care (and to some extent from mainstream health care as well). To be ethical, a CST therapist would have to say to a patient, “This therapy may not do anything, and in fact there is ample scientific evidence that it does not. However, with your approval, we will do it anyway, because it is pleasant and physically safe, and there are numerous benefits to a deeply relaxing experience.” However, as you can see, when stated like this, CST seems a bit pointless — why not just advertise and provide a relaxing touch therapy experience instead? Return to text.