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craniosacral therapy

"...craniosacral therapy bears approximately the same relationship to real medicine that astrology bears to astronomy.... [it] is medical fiction...." -- Steve E Hartman and James M Norton*

window in Murren, SwitzerlandCraniosacral therapy (a.k.a. craniopathy and cranial osteopathy) is a holistic therapy that involves the manipulation of the skull bones (the cranium) and the sacrum to relieve pain and a variety of other ailments, including cancer. (The sacrum is a bone between the lumbar vertebrae and tail vertebrae, composed of five fused vertebrae that form the posterior pelvic wall.) The therapy was invented by osteopath William G. Sutherland in the 1930s. Another osteopath, John Upledger, is the leading proponent of craniosacral therapy today. Like other holistic therapies, this one emphasizes subjective concepts such as energy, harmony, balance, rhythm, and flow.

Craniosacral therapists claim to be able to detect a craniosacral "rhythm" in the cranium, sacrum, cerebrospinal fluid and the membranes which envelop the craniosacral system. The balance and flow of this rhythm is considered essential to good health. The rhythm is measured by the therapist's hands. Any needed or effected changes in rhythm are also detected only by the therapist's hands. No instrument is used to measure the rhythm or its changes, hence no systematic objective measurement of healthy versus unhealthy rhythms exists. The measurement, the therapy, and the declared cure are all subjectively based. As one therapist put it:

During the treatment, the client is usually supine on a table. The therapist assesses the patterns of energy in the body through touch at several "listening stations" and then decides where to start that day and how to focus the treatment. [Woodruff]

The same therapist maintains that the therapy is "a waste of time and money" for people who do not have faith in the therapy. Successful treatments, however, may well be due to the placebo effect and subjective validation. Since there is no plausible biological basis for the claims made by therapists for craniosacral rhythms, it is likely that the therapists are deluded, i.e., imagining they are detecting and manipulating a subtle energy.

Skeptics note that the skull does not consist of moveable parts (unlike the jaw) and brain cells lack actin and myosin (the things in muscle cells that make them move). The only rhythm detectable in the cranium and cerebrospinal fluid is related to the cardiovascular system, but craniosacral therapists deny craniosacral rhythms are due to blood pressure. When tested, therapists have been unable to consistently come up with the same measurements of the alleged craniosacral rhythm. (Dr. Ben Goldacre says there have been five such published studies and "in none of them did the osteopaths give similar answers.") In a systematic review of the scientific evidence for craniosacral therapy, the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that

The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found. CONCLUSIONS: 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. (1999)

The fact that there is no objective measurement of craniosacral rhythms and that the subjective measurements of practitioners show much disharmony, imbalance, and lack of unity far outweighs the anecdotes of people who give credit to the therapy for relieving them of some malady. If the anecdotes were backed by scientific studies, using proper controls and randomization techniques, the weight of the evidence would swing in favor of the therapy. Such studies are lacking. Six studies have been done, but only one was done with proper controls and that study was negative. There is simply no good evidence for the claims made by practitioners of craniosacral therapy about cranial rhythms being either measurable or an important factor in anyone's health and well-being.

As one research professor at a college of osteopathy put it:

since interexaminer reliability is zero, and since no properly randomized, blinded, and placebo-controlled outcome studies demonstrating clinical efficacy have been published, cranial osteopathy should be removed from the required curricula of colleges of osteopathic medicine and from osteopathic licensing examinations.

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See also "alternative" health practice, chiropractic, and therapeutic touch.


further reading

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

Cranial Manipulation and Tooth Fairy Science by Dr. Harriet Hall "...cranial therapy is silly. Its underlying theory is false, it has no therapeutic value, and its safety is questionable."

Craniosacral Therapy and Dubious Aspects of Osteopathy by Stephen Barrett, M.D.

Bizarre Therapy Leads to Patient's Death by Stephen Barrett, M.D.

Craniosacral Therapy: Pure, Unadulterated Quackery from SkepticalHealth

Some Notes on Cranial Manipulative Therapy by William T. Jarvis, Ph.D.

The Upledger Institute

Craniosacral Therapy - Demonstrable Nonsense by Dr. Steven Novella

Alas poor Craniosacral. A SCAM of infinite jest, of most excellent fancy by Mark Crislip

Infant Dies After Craniosacral Therapy There is no way to prove that the certified craniosacral therapist killed the infant with this preposterous manipulation. But we must ask why would any parent subject their infant to this kind of treatment? Apparently, many parents with colicky babies are willing to try anything, no matter how inane, to get their babies to stop crying all the time.

Up the garden path: craniosacral therapy by Edzard Ernst "In a nutshell: 1) ineffective therapies, such as CST, may seem harmless but, through their ineffectiveness, they constitute a serious threat to our health; 2) bogus treatments become bogus through the false claims which are being made for them; 3) seriously flawed studies can be worse than none at all: they generate false positive results and send us straight up the garden path." Last updated 21-Jan-2014

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