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Craniosacral therapy

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See also: Cranial osteopathy

Craniosacral therapy (also called cranial osteopathy, osteopathy in the cranial field or cranial therapy) is a method of alternative medicine used by craniosacral therapists or osteopaths to assess and enhance the functioning of the patient by accessing their craniosacral system, which consists of the membranes and cerebrospinal fluid of the central nervous system. Proponents claim that measurements of craniosacral motion are a function of the cardiovascular system, and that by working with the body, including the skull they can remove restrictions in the flow of cerebrospinal fluid, relieving stress, decreasing pain, and enhancing overall health. [1] [2] [3] Opponents claim that the therapy has been shown to be without scientific basis, [4] [5] [6] [7] and some studies that support the therapy have been criticized for poor methodology. [8]

History

Cranial therapy was originated by osteopathic doctor William Sutherland DO (1873-1954), who studied under the founder of osteopathy, Andrew Taylor Still, at the first American School of Osteopathy in 1898-1900. While looking at a disarticulated skull, Sutherland was struck by the idea that the cranial sutures of the temporal bones where they meet the sphenoid bones were "beveled, like the gills of a fish, indicating articular mobility for a respiratory mechanism." [9] The idea that the bones of the skull could move was contrary to contemporary anatomical belief. Sutherland spent many years attempting to disprove his theory, but research on himself and on his patients led him to conclude that the bones of the skull do move along their sutures, and any hindrance in movement may be associated with a dysfunction.

After confirming the presence of movement between the bones of the skull, Sutherland evolved the idea that the dural membranes act as 'guy-wires' for the movement of the cranial bones, holding tension for the opposite motion. He used the term reciprocal tension membrane system (RTM) to describe the three Cartesian axes held in reciprocal tension, or tensegrity, creating the cyclic movement of inhalation and exhalation of the cranium. He called this breathing movement the primary respiratory mechanism, and later described its origin as the Breath of Life, [10] from the Book of Genesis (2:7). This was an acknowledgement of the vital force as a fundamental aspect of osteopathic philosophy.

The RTM as described by Sutherland includes the spinal dura, with an attachment to to the sacrum. In his observation of the cranial mechanism, Sutherland found that the sacrum moves synchronously with the cranial bones. The mechanical relationship between motion in the sacrum and the parietal bones has since been confirmed in experiments using electrodes measuring capacitance across parietal sutures of the squirrel monkey. [11]

Sutherland began to teach this work to other osteopaths from about the 1930s, and tirelessly continued to do so until his death. His work was at first largely rejected by the mainstream osteopathic profession as it challenged some of the closely held beliefs among practitioners of the time. However, his clinical results were impressive and he began to attract a small group of osteopaths who studied with him.

In the 1940s the American School of Osteopathy started a post-graduate course called 'Osteopathy in the Cranial Field' directed by Sutherland, and was followed by other schools. This new branch of practice became known as "cranial osteopathy". As the reputation of this form of treatment began to spread, Sutherland trained more teachers to meet the demand, notably Drs Viola Frymann, Edna Lay, Howard Lippincott, Anne Wales, Chester Handy and Rollin Becker.

The Cranial Academy was established in the US in 1947, and continues to teach DOs, MDs, and Dentists "an expansion of the general principles of osteopathy" [12] including a special understanding of the central nervous system and primary respiration.

Towards the end of his life Sutherland began to sense a "power" which generated corrections from inside his clients' bodies without the influence of external forces applied by him as the therapist. Similar to Qi and Prana, this contact with the Breath of Life changed his entire treatment focus to one of spiritual reverence and subtle touch. [13] This spiritual approach to the work has come to be known as both "biodynamic" craniosacral therapy and "biodynamic" osteopathy, and has had further contributions from practitioners such as Becker and James Jealous (biodynamic osteopathy), and Franklyn Sills (biodynamic craniosacral therapy).

In 1953 Sutherland established the Sutherland Cranial Teaching Foundation as a way of providing a continuity for his teaching. [14]

In 1970 osteopath Dr. John Upledger observed during a surgical procedure on the neck what he described as a slow pulsating movement within the spinal meninges. He then discovered the work of Sutherland, and thought that if movement of the cranial bones were possible, the pulse he had observed would be explained. From 1975 to 1983, Upledger worked at Michigan State University as a clinical researcher and professor, and set up a team of anatomists, physiologists, biophysicists, and bioengineers to investigate the pulse he had observed and study further Sutherland's theory of cranial bone movement. Upledger went on to publish his results, which showed support for both the concept of cranial bone movement and the concept of a cranial rhythm. [15] [16] [17]

Upledger developed his own treatment style, and when he started to teach his work to a group of students who were not osteopaths he generated the term 'CranioSacral therapy', based on the corresponding movement between cranium and sacrum. Craniosacral therapists often (although not exclusively) work more directly with the emotional and psychological aspects of the patient than osteopaths working in the cranial field. The Upledger Institute, formed in 1987, has many international affiliates [18] united by Upledger's International Association of Healthcare Practitioners. [19]

The Craniosacral Therapy Association of the UK (CSTA) was established to promote and regulate craniosacral therapists from various UK colleges. [20] Graduates from the College of Craniosacral Therapy who had their own register later became eligible for registration with the CSTA. The Craniosacral Therapy Association of North America was founded in 1998 for the recognition, registration, and as a referral service for certified Craniosacral Therapists and students. [21] The Craniosacral Therapy Association of Australia was established in 2004. [22]

Philosophy

Craniosacral therapy is originally based on Sutherland's 'Cranial Concept', [23] the Primary Respiratory Mechanism, which has been summarised in the following five phenomena:

The effect of the above five on the rest of the body, is suggested by Magoun [24] as a sixth phenomena.

Inherent motility of the central nervous system

Still referred to the inherant motion of the brain as a "dynamo," beginning with the cerebellum. According to modern radiological observations the pulsatility of the central nervous system is a function of the cardiac cycle, first described by Bergstrand in 1985. [25] The intracranial fluid fluctuation can be seen as an interaction between four main components: arterial blood, capillary blood (brain volume), venous blood and cerebrospinal fluid. [26] [27] The mechanism is based on a fulcrum created by the root of the cerebellum and its hemispheres moving in opposite directions, resulting in an increase in pressure which squeezes the third ventricle. This in turn causes fluctuation of the cerebrospinal fluid.

Fluctuation of the cerebrospinal fluid

Sutherland used the term "Tide" to describe the inherent fluctuation of fluids in the Primary Respiratory Mechanism. Under normal conditions the activity of the cerebrospinal fluid (CSF) is perceived as both ignited by and synchronised with the Breath of Life, fluctuating along the long axis of the midline of the body and also laterally from the midline.

Mobility of the intracranial and intraspinal dural membranes

Mobility of the cranial bones

Cranial sutures are often believed to be immobile after fusion, preventing cranial bone movement. This belief arose in the mid-1900s. According to Lee [28] this belief was misinterpreted from the work of authors hoping to correlate suture closure with the chronological age of a skull in archaeological specimens. The authors not only found that there was no correlation between suture closure and the chronological age of the individual, but also that most skulls demonstrated no suture closure at all except as structural evidence of pathological physical trauma. Lee cites many references giving evidence for mobility in human skulls. [28]

It is usual in cranial textbooks to say that the motion of the skull is possible during flexion and extension because the sutures are mobile, especially the spenobasilar synchondrosis - the junction between the base of the sphenoid and the occiput. Descriptions of cranial lesions traditionally relate to the relationship between the sphenoid and the occiput at this junction. An alternative theory to SBS motion suggests that sutures are lines of folding, like pre-folded marks on cardboard, rather than necessarily being fully open. [29]

Mobility of the sacrum between the ilia

Craniosacral treatment

Typically craniosacral treatment is carried out on a fully-clothed patient in a supine position. The therapist places their hands lightly on the patient's body, tuning in to the patient by ‘listening’ with their hands or, in Sutherland's words, "with thinking fingers". Therapeutic contact between the patient and therapist may involve entrainment between patient and practitioner. [30] Patients often experience a sense of deep relaxation during and after the treatment session, and may feel light-headed. This is popularly associated with increases in endorphins, but research shows the effects may actually be brought about by the endocannabinoid system. [31]

Craniosacral therapy is well known for its benefits to children. [32] Adverse side effects of treatment are uncommon: in a study of craniosacral manipulation in patients with traumatic brain syndrome the adverse effects of treatment was 5%. [33]

Practice

Training in craniosacral therapy does not involve education to the standard of a first line medical practitioner, and craniosacral therapists are not qualified to diagnose medical conditions unless they are also an osteopath or other type of physician.

In craniosacral practice, other therapies such as polarity therapy (based on the work of Randolph Stone) may form part of the basis of the treatment approach.

Criticisms

Skeptics exist both inside and outside the osteopathic profession.

Lack of evidence for the existence of "cranial bone movement"

The scientific evidence for cranial bone movement is insufficient to support the theories claimed by craniosacral practitioners. Scientific research supports the theory that the cranial bones fuse during adolescence, making movement impossible. [34]

Lack of evidence for the existence of the "cranial rhythm"

While evidence exists for cerebrospinal fluid pulsation, it is caused by the functioning of the cardiovascular system and not by the workings of the craniosacral system. [5]

Lack of evidence linking "cranial rhythm" to disease

No research to date has supported the link between the "cranial rhythm" and general health.[8]

Lack of evidence "cranial rhythm" is detectable by practitioners

Operator interreliability has been very poor in the studies that have been done. Five studies showed an operator interreliability of zero. [4] The one study showing some operator interreliability has been criticized as deeply flawed. [8]

Training and accreditation

Craniosacral therapy is not protected by statute either in the US or the UK, and there is currently no legal requirement to be trained to any standard or registered with a professional association. In the UK the Health Professions Council is consulting on whether to integrate all craniosacral therapists in the UK under their umbrella of state regulated professions.

Accreditation and training in the US

In 1985 Upledger established the Upledger Institute, a health center based in Florida and dedicated to the education and certification of practitioners in craniosacral and related therapies.

Accreditation and training in the UK

There are currently two different organisations in the UK offering registration of practitioners graduating in craniosacral therapy, the UK Craniosacral Therapy Association (CSTA), whose members may use the postnominal letters 'RCST', and The Cranio Sacral Society, based in Perth, Scotland and founded in 1993. The CSTA validates five training colleges, and the The Cranio Sacral Society offers regulation for those with postgraduate training with The Upledger Institute. Both registering bodies are self-governed and have their own code of ethics. They have made moves towards amalgamation into a common register via the Forum for Cranial Practitioners, but the diversity of their training programmes has prevented this.

Practitioner Organisations

Training Organisations (UK)

Training Organisations (US)

Other Organisations

Advocacy

Based on the Teachings and Writings of Franklyn Sills

Criticism

References

  1. ^ The Upledger Institute (2001). Craniosacral Therapy. Retrieved March 27, 2004.
  2. ^ Ferrett, Mij (1998). What Is Craniosacral Therapy? Retrieved March 27, 2004.
  3. ^ The Sutherland Society General information on Cranial Osteopathy Retrieved January 24, 2006
  4. ^ a b S.E. Hartman, J.M. Norton (2002) Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine. 6(1): 23-34 PDF full report
  5. ^ a b Ferre JC, Chevalier C, Lumineau JP, Barbin JY (1990) Cranial osteopathy, delusion or reality? Actualites Odonto-Stomatologiques 44: 481-494. PMID 2173359
  6. ^ Wirth-Pattullo V, Hayes KW (1994) Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Physical Therapy 74(10): 908-916. PMID 8090842]
  7. ^ Rogers JS and others (1998) Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons. Physical Therapy 78(11): 1175-1185. PMID 9806622
  8. ^ a b c Green C and others (1999) A systematic review and critical appraisal of the scientific evidence on craniosacral therapy. BCOHTA PDF full report
  9. ^ Sutherland A (1962). With Thinking Fingers. Indianapolis, IN: Cranial Academy, 13.
  10. ^ Sutherland W (1939). The Cranial Bowl. Mankato, MN: Self-published. Republished 1986, Indianapolis, IN: Cranial Academy.
  11. ^ Retzlaff EW, Michael DK, Roppel RM. Cranial bone mobility. J Am Osteopath Assoc. 1975 May;74(9):869-73. PMID 804505
  12. ^ The Cranial Academy Accessed 10th July 2006
  13. ^ The Cranial Academy Osteopathy in the Cranial Field Retrieved January 24, 2006.
  14. ^ Sutherland Cranial Teaching Foundation Accessed 10th July 2006
  15. ^ Upledger JE (1977) The reproducibility of craniosacral examination findings: a statistical analysis. J Am Osteopath Assoc 76(12):890-899. PMID 7899490
  16. ^ Upledger JE (1978) The relationship of craniosacral examination findings in grade school children with developmental problems. J Am Osteopath Assoc 77(10): 760-776. PMID 659282
  17. ^ Upledger JE, Karni Z (1979) Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment. J Am Osteopath Assoc 78(11):782-791. PMID 582820
  18. ^ The Upledger Institute Accessed 10th July 2006
  19. ^ International Association of Healthcare Practitioners Accessed 10th July 2006
  20. ^ Craniosacral Therapy Association of the UK Accessed 10th July 2006
  21. ^ Craniosacral Therapy Association of North America Accessed 10th July 2006
  22. ^ Craniosacral Therapy Association of Australia Accessed 10th July 2006
  23. ^ Sutherland, W G. The Cranial Bowl. Self-published, 1939. Reprinted by the Cranial Academy, 1948.
  24. ^ Magoun H I (ed.), Osteopathy in the Cranial Field. The Cranial Academy, 3rd edn, 1976, 23.
  25. ^ Bergstrand G et. al. Cardiac gated MR imaging of cerebrospinal fluid flow. J Comput Assist Tomogr, 1985 Nov-Dec;9(6):1003-6. PMID 2932480.
  26. ^ Greitz D, Franck A, Nordell B. On the pulsatile nature of intracranial and spinal CSF-circulation demonstrated by MR imaging. Acta Radiol. 1993 Jul;34(4):321-8. PMID 8318291.
  27. ^ Greitz D, Wirestam R, Franck A et. al. Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging. The Monro-Kellie doctrine revisited. Neuroradiology. 1992;34(5):370-80. PMID 1407513.
  28. ^ a b Lee R P. Interface: Mechanisms of Spirit in Osteopathy. Portland, OR: Stillness Press, 2005, 130-33. ISBN 9780967585139. Cite error: The named reference "Lee1" was defined multiple times with different content (see the help page).
  29. ^ Cook, Andrew, An alternative to Spenobasilar Synchondrosis (SBS) Motion. Self-published online, Sep 2005. PDF
  30. ^ McPartland JM, Mein EA. Entrainment and the cranial rhythmic impulse. Altern Ther Health Med. 1997 Jan;3(1):40-5. PMID 8997803
  31. ^ McPartland JM, Giuffrida A, King J et. al. Cannabimimetic effects of osteopathic manipulative treatment. J Am Osteopath Assoc. 2005 Jun;105(6):283-91. PMID 16118355
  32. ^ Frymann VM, Carney RE, Springall P. Effect of osteopathic medical management on neurologic development in children. J Am Osteopath Assoc, Vol. 92, No. 6. (June 1992), pp. 729-744. PMID 1377192
  33. ^ Greenman PE, McPartland JM. Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopath Assoc. 1995 Mar;95(3):182-8; 191-2.
  34. ^ Madeline LA, Elster AD. (1995) Suture closure in the human chondrocranium: CT assessment. Radiology 196(3):747-756. PMID 7644639
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