Craniosacral therapy or how to take advantage of desperate parents?

Craniosacral therapy is the use of hand manipulation in order to massage the dural sack and reposition the joints of cranial bones. It is based on concepts of osteopathy readapted by John Upledger in the 1970’s. The story goes that John Upledger assisted in a surgical procedure of the neck and observed forceful pulsations of the dural sack that could not be easily explained by either heartbeat or respiratory incursions. Dr. Upledger secured some research funding to study this phenomenon but results thus far have only sparingly appeared in the medical literature. At present, practitioners of craniosacral therapy believe that you can massage the “dural tube” and reposition cranial bones by external manipulations. The general intent of manipulating the dural sac is to synchronize and normalize oscillations in its pulse and thus correct the circulation of cerebrospinal fluid.

I have asked chiropractors about the apparent similarities of their field of practice to craniosacral therapy, that is, using manipulations in order to adjust bones in your body. However, chiropractors confine themselves to the vertebral column while craniosacral therapy includes the cranium, sacrum and even the coccyx. Among many illusory claims practitioners of craniosacral therapy publicize positive outcomes for diverse conditions such as posttraumatic stress disorder, obsessive-compulsive disorders, seizures, osteoarthritis and autism. According to practitioners mechanisms underlying obsessive-compulsive disorders and autism are similar and are borne from displacement or “wobbling” of two skull bones; the sphenoid and temporal bones.

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Figure: The large number of conditions that reportedly benefit from this therapy serves as a warning sign to those interested in pursuing it.

The sphenoid bone sits inside of the skull and provides the bony cradle for the pituitary gland. Lateral to the pituitary fossa, and hugging the sphenoid bone, veins enlarge (the structure formed is called the cavernous sinus) to provide a space transversed by multiple cranial nerves and the internal carotid artery. Movement of this bone would certainly imperil vital functions of the central nervous system. Even if possible, I would certainly not allow anybody to attempt moving this bone. It would be extremely dangerous.

The sphenoid bone is adjacent to the temporal bone. Part of the temporal bone is the petrous ridge; petrous means rock-hard. I have only seen movement in this bone in cases of extensive cranial fractures due to car accident or an assault with a crow bar that resulted in a catastrophic hinge fracture.

The extent to which cranial bones can move in an adult individual is practically nil. After adolescence, once sutures close/fuse, manual manipulation is highly unlikely to readjust the position of cranial bones. Similarly, Ii is highly unlikely that tactile manipulations can be used to infer the pulsation of cerebrospinal fluid. However, it is highly likely that examiners may feel pulsations of their own fingertips after resting them against a boy surface for a period of time.

I did submit myself to craniosacral therapy to see if there was anything salvageable to this theory. For the therapy session, I lied flat on my back on a massage table and the therapist placed her hands over some of my bony protuberances, “listening” as she said to my body parts. Then she proceeded to adjust my body parts, finding along the way every single piece of false information I had provided in my medical history. During the twenty-minute session she adjusted both my sphenoid and hyoid bones. What caught my attention was the fact that the therapist talked to me during the session using the same cold-reading technique employed by fortune tellers (see http://en.wikipedia.org/wiki/Cold_reading).

It should not be surprising that craniosacral therapy has been called quackery and characterized as pseudoscience (see http://en.wikipedia.org/wiki/Craniosacral_therapy). The technique itself has been extensively discussed in Quackwatch (see http://www.quackwatch.com/01QuackeryRelatedTopics/cranial.html) including the report of 2 deaths associated with this intervention. Mark Crislip in Science-Based Medicine calls craniosacral therapy a scam of infinite jest, of most excellent fancy: (see http://www.sciencebasedmedicine.org/alas-poor-craniosacral/).

A comprehensive review of published studies clearly indicates that the theory has no factual basis and that practitioners can’t measure what they claim to be modifying. The report (68 pages long) concludes that “there is insufficient evidence to recommend craniosacral therapy to patient) (Kazanjian et al., 1999). In 2002 two professors of Osteopathic Medicine concluded that due to gross scientific deficiencies (i.e., lack of properly randomized, blinded placebo controlled trials) cranial osteopathy should be removed from their own curriculum (Hartman and Norton, 2002)!

Thus far craniosacral therapy has moved across different conditions playing on the plight of desperate people. Claims about cranial movements as a pathophysiological mechanism of autism are nonsensical. For those of you considering possible interventions be aware of the facts not the fiction.

References

Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine 6(1):23-34, 2002.

Kazanjian A and others. A systematic review and appraisal of the scientific evidence on craniosacral therapy. BCOHTA, May 1999.

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