Craniosacral therapy

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Craniosacral therapy (CST)
Cranial-sacral therapy
Cranial osteopathy
Cranial therapy
Craniopathy
Sacro-occipital technique
Bio-cranial therapy
Kraniosakralni terapie - biodynamika.jpg
Craniosacral therapy
Alternative therapy
NCCIH Classification Manipulation and body-based
School Osteopathy

Craniosacral therapy (CST) or cranial osteopathy is a form of alternative medicine that uses gentle touch to feel non-existent rhythmic movements of the skull's bones and supposedly adjust the immovable joints of the skull to achieve a therapeutic result. CST is a pseudoscience and its practice has been characterized as quackery. [1] [2] It is based on fundamental misconceptions about the anatomy and physiology of the human skull and is promoted as a cure-all for a variety of health conditions. [3] [4] [5]

Contents

CST was invented in the 1970s by John Upledger as an offshoot of cranial osteopathy, which had been devised in the 1930s by William Garner Sutherland. [4] [6]

Medical research has found no significant evidence that either CST or cranial osteopathy confers any health benefit, and attempts to manipulate the bones of the skull can be harmful, particularly for children or infants. [4] [7] [8] The basic assumptions of CST are not true, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients. [9]

Effectiveness and safety

Practitioners of CST claim it is effective in treating a wide range of conditions, sometimes claiming it is a cancer cure, or a cure-all. [3] [5] [8] Practitioners particularly advocate the use of CST on children. [5] The American Cancer Society cautions that CST should never be used on children under age two. [4] Pediatricians have expressed concern at the harm CST can cause to children and infants. [8]

There is no evidence that CST is of use for people with autism and its use is potentially harmful. [10] As of 2018 at least two deaths had been reported resulting from CST spinal manipulation. [11] In a small study, participants with head injuries suffered worsening symptoms as a result of CST. [4] Additionally, if used as the sole treatment for serious health conditions, choosing CST can have serious adverse consequences; the American Cancer Society recommends those with cancer or chronic conditions should consult their doctor before starting any therapy consisting of manual manipulation. [4]

According to the American Cancer Society, although CST may relieve the symptoms of stress or tension, "available scientific evidence does not support claims that craniosacral therapy helps in treating cancer or any other disease". [4] Cranial osteopathy has received a similar assessment, with one 1990 paper finding there was no scientific basis for any of the practitioners' claims the paper examined. [7] A 2019 systematic review found limited evidence that CST may bring some relief for up to 6 months for people with chronic pain. [12] However, the conclusions of this study were disputed by the Office for Science and Society at McGill University due to the poor methodological quality of the individual studies that made up the analysis. [13]

In October 2012, Edzard Ernst conducted a systematic review of randomized clinical trials of craniosacral therapy. He concluded that "the notion that CST is associated with more than non-specific effects is not based on evidence from rigorous randomised clinical trials." [14] Commenting specifically on this conclusion, Ernst wrote on his blog that he had chosen the wording as "a polite and scientific way of saying that CST is bogus." [5] Ernst also remarked that the quality of five of the six trials he had reviewed was "deplorably poor," a sentiment that echoed an August 2012 review that noted the "moderate methodological quality of the included studies." [15]

Ernst criticized a 2011 systematic review performed by Jakel and von Hauenschild for including observational studies and including studies with healthy volunteers. [14] This review concluded that the evidence base surrounding craniosacral therapy and its efficacy was sparse and composed of studies with heterogeneous design. The authors of this review stated that currently available evidence was insufficient to draw conclusions. [16]

The evidence base for CST is sparse and lacks a demonstrated biologically plausible mechanism. In the absence of rigorous, well-designed randomized controlled trials, [17] [18] it is a pseudoscience, [2] and its practice quackery. [1] Tests show that CST practitioners cannot in fact identify the purported craniosacral pulse, and different practitioners will get different results for the same patient. [19] The idea of a craniosacral rhythm cannot be scientifically supported. [20]

Regulation

Edzard Ernst wrote that in 2005 in the United Kingdom, a foundation of then-Prince Charles issued a booklet listing CST as one of several popular alternative therapies, but admitted that the therapy was unregulated and lacked either a defined training program or the oversight of a professional body. Ernst writes that this makes the therapists practising CST "less regulated than publicans." [21]

History

Cranial osteopathy, a forerunner of CST, was originated by Sutherland 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 parietal bones were "beveled, like the gills of a fish, indicating articular mobility for a respiratory mechanism." [15]

From 1975 to 1983, Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at Michigan State University as clinical researchers and professors. They assembled a research team to investigate the purported pulse and further study Sutherland's theory of cranial bone movement. [22] [23] [24] Later independent reviews of these studies concluded that they presented no good evidence for the effectiveness of craniosacral therapy or the existence of the proposed cranial bone movement. [25]

Conceptual basis

Practitioners of both cranial osteopathy and CST assert that there are small, rhythmic motions of the cranial bones attributed to cerebrospinal fluid pressure or arterial pressure. The premise of CST is that palpation of the cranium can be used to detect this rhythmic movement of the cranial bones and selective pressures may be used to manipulate the cranial bones to achieve a therapeutic result. [26] However, there is no evidence that the bones of the human skull can be moved by such manipulations. [25]

The fundamental concepts of cranial osteopathy and CST are inconsistent with the human skull, brain, and spine's known anatomy and physiology. [4] Edzard Ernst has written "to anyone understanding a bit of physiology, anatomy etc. [CST] looks like pure nonsense." [5]

In common with many other varieties of alternative medicine, CST practitioners believe all illness is caused by energy or fluid blockages which can be released by physical manipulation. [8] They believe that the bones of the skull move in a rhythmic pattern which they can detect and correct. [8]

The therapist lightly palpates the patient's body, and focuses intently on the communicated movements. A practitioner's feeling of being in tune with a patient is described as entrainment. [27]

Cranial osteopathy vs CranioSacral therapy

Comparing it to cranial osteopathy Upledger wrote: "Dr. Sutherland's discovery regarding the flexibility of skull sutures led to the early research behind CranioSacral Therapy– and both approaches affect the cranium, sacrum and coccyx– the similarities end there." [28] However, modern-day cranial osteopaths largely consider the two practices to be the same, but that cranial osteopathy has "been taught to non-osteopaths under the name CranialSacral therapy." [29]

Related Research Articles

Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability or evidence of effectiveness. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of medical science and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.

<span class="mw-page-title-main">Osteopathy</span> Alternative medicine emphasizing muscle and bone manipulation

Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.

Magnetic therapy is a pseudoscientific alternative medicine practice involving the weak static magnetic field produced by a permanent magnet which is placed on the body. It is similar to the alternative medicine practice of electromagnetic therapy, which uses a magnetic field generated by an electrically powered device. Magnet therapy products may include wristbands, jewelry, blankets, and wraps that have magnets incorporated into them.

<span class="mw-page-title-main">Reiki</span> Pseudoscientific healing technique

Reiki is a Japanese form of energy healing, a type of alternative medicine. Reiki practitioners use a technique called palm healing or hands-on healing through which, according to practitioners, a "universal energy" is transferred through the palms of the practitioner to the patient, to encourage emotional or physical healing.

Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of science-based medicine, often referred to in this context as allopathic medicine, with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are graduates of American osteopathic medical colleges and are licensed to practice the full scope of medicine and surgery in all 50 US states. The field is distinct from osteopathic practices offered in nations outside of the U.S., whose practitioners are generally not considered part of core medical staff nor of medicine itself, but rather are alternative medicine practitioners. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.

Orthomolecular medicine is a form of alternative medicine that aims to maintain human health through nutritional supplementation. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence, and the therapy is not effective for chronic disease prevention; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

Therapeutic touch, known by some as "non-contact therapeutic touch" (NCTT), is a pseudoscientific energy therapy which practitioners claim promotes healing and reduces pain and anxiety. "Therapeutic Touch" is a registered trademark in Canada for the "[s]tructured and standardized healing practice performed by practitioners trained to be sensitive to the receiver's energy field that surrounds the body;...no touching is required."

<span class="mw-page-title-main">Chelation therapy</span> Medical procedure to remove heavy metals from the body

Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. Chelation therapy has a long history of use in clinical toxicology and remains in use for some very specific medical treatments, although it is administered under very careful medical supervision due to various inherent risks, including the mobilization of mercury and other metals through the brain and other parts of the body by the use of weak chelating agents that unbind with metals before elimination, exacerbating existing damage. To avoid mobilization, some practitioners of chelation use strong chelators, such as selenium, taken at low doses over a long period of time.

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.

Anthroposophic medicine is a form of alternative medicine based on pseudoscientific and occult notions. Devised in the 1920s by Rudolf Steiner (1861–1925) in conjunction with Ita Wegman (1876–1943), anthroposophical medicine draws on Steiner's spiritual philosophy, which he called anthroposophy. Practitioners employ a variety of treatment techniques based upon anthroposophic precepts, including massage, exercise, counselling, and substances.

<span class="mw-page-title-main">Edzard Ernst</span> German academic physician and researcher (born 1948)

Edzard Ernst is a retired British-German academic physician and researcher specializing in the study of complementary and alternative medicine. He was Professor of Complementary Medicine at the University of Exeter, the world's first such academic position in complementary and alternative medicine.

Energy medicine is a branch of alternative medicine based on a pseudo-scientific belief that healers can channel "healing energy" into a patient and effect positive results. The field is defined by shared beliefs and practices relating to mysticism and esotericism in the wider alternative medicine sphere rather than any sort of unified terminology, leading to terms such as energy healing or vibrational medicine being used as synonymous or alternative names. In most cases there is no empirically measurable energy involved: the term refers instead to so-called subtle energy. Practitioners may classify the practice as hands-on, hands-off, and distant where the patient and healer are in different locations. Many schools of energy healing exist using many names: for example, biofield energy healing, spiritual healing, contact healing, distant healing, therapeutic touch, Reiki or Qigong.

William Garner Sutherland, D.O. (1873–1954) was an American osteopathic physician and important figure in American osteopathic medicine. Several of his manual therapy techniques are still practiced today by practitioners of osteopathy, although craniosacral therapy is regarded as pseudoscience by the medical community. Sutherland was the first osteopathic physician to conceptualize the cranial approach and teach it systematically. However, Sutherland acknowledged Andrew Taylor Still as the developer of all osteopathy, including the cranial approach. Sutherland was the first person to claim to feel a rhythmic shape change in the bones of the cranium. He later applied this movement to all body tissues and this movement is the agent of change in dysfunctional tissues. He later named this motion the body's "Primary Respiration."

Osteomyology is a multi-disciplined form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. It is a results-based physical therapy tailored specifically to the needs of the individual patient. Osteomyologists have been trained in osteopathy and chiropractic, but do not require to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC).

Zero balancing is a type of manual therapy devised by American osteopathic doctor Frederick "Fritz" Smith in the 1970s. Drawing from principles of osteopathy, Chinese medicine and Structural Integration, Smith proposed that the energy field within the human body could be affected by manual manipulations, thus bringing health benefits. The practice teaches that currents of energy are stored within the human skeleton, and that these affect both physical and mental wellbeing.

<span class="mw-page-title-main">Friends of Science in Medicine</span> Australian association which supports science-based medicine

The Friends of Science In Medicine (FSM) is an Australian association which supports evidence-based medicine and strongly opposes the promotion and practice of unsubstantiated therapies that lack a scientifically plausible rationale. They accomplish this by publicly raising their concerns either through direct correspondence or through media outlets. FSM was established in December 2011 by Loretta Marron, John Dwyer, Alastair MacLennan, Rob Morrison and Marcello Costa, a group of Australian biomedical scientists and clinical academics.

Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon.

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