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Craniosacral therapy (CST) or cranial osteopathy is a form of alternative therapy that uses gentle touch to
palpate Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...
the synarthrodial joints of the cranium. CST is a
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or falsifiability, unfa ...
and its practice has been characterized as
quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, ...
. It is based on fundamental misconceptions about the physiology of the
human skull The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...
and is promoted as a
cure-all A panacea , named after the Greek goddess of universal remedy Panacea, is any supposed remedy that is claimed (for example) to cure all diseases and prolong life indefinitely. It was in the past sought by alchemists in connection with the elixir ...
for a variety of health conditions. 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. Medical research has found no good evidence that either CST or cranial osteopathy confers any health benefit, and they can be harmful, particularly if used on children or infants. The basic assumptions of CST are not true, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients.


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 A panacea , named after the Greek goddess of universal remedy Panacea, is any supposed remedy that is claimed (for example) to cure all diseases and prolong life indefinitely. It was in the past sought by alchemists in connection with the elixir ...
. Practitioners particularly advocate the use of CST on children. The
American Cancer Society The American Cancer Society (ACS) is a nationwide voluntary health organization dedicated to eliminating cancer. Established in 1913, the society is organized into six geographical regions of both medical and lay volunteers operating in more than ...
cautions that CST should never be used on children under age two.
Pediatrician Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
s have expressed concern at the harm CST can cause to children and infants. CST is potentially harmful. There have been cases of people with head injuries suffering further injury as a result of CST. If used as an alternative for legitimate therapy for a serious condition, choosing CST can have serious adverse consequences. 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". 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. A 2019
systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
found limited evidence that CST may bring some relief for up to 6 months for people with
chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between Acute (medicine), acute and Chronic condition, chronic pain is sometimes determined by the amount of time since onset. Two commonly ...
. However, the conclusions of this study were disputed by the
Office for Science and Society The Office for Science and Society (OSS) is an organization dedicated to science education, operating from Montreal's McGill University. Its staff and contributors use courses, mass media, special events and books to debunk pseudo-scientific my ...
at
McGill University McGill University (french: link=no, Université McGill) is an English-language public research university located in Montreal, Quebec, Canada. Founded in 1821 by royal charter granted by King George IV,Frost, Stanley Brice. ''McGill Universit ...
due to the poor methodological quality of the individual studies that made up the analysis. In October 2012,
Edzard Ernst Edzard Ernst (born 30 January 1948) 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, alleged ...
conducted a
systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
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." 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." 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." Ernst criticized a 2011 systematic review performed by Jakel and von Hauenschild for including observational studies and including studies with healthy volunteers. 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. The evidence base for CST is sparse and lacks a demonstrated biologically plausible mechanism. In the absence of rigorous, well-designed
randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical te ...
s, it is a
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or falsifiability, unfa ...
, * * * * * and its practice
quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, ...
. * * * Tests show that CST practitioners cannot in fact identify the purported craniosacral pulse, and different practitioners will get different results for the same patient. The idea of a craniosacral rhythm cannot be scientifically supported.


Regulation

Edzard Ernst wrote that in 2005 in the United Kingdom, a foundation of then-
Prince Charles Charles III (Charles Philip Arthur George; born 14 November 1948) is King of the United Kingdom and the 14 other Commonwealth realms. He was the longest-serving heir apparent and Prince of Wales and, at age 73, became the oldest person to ...
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 In antiquity, publicans (Greek τελώνης ''telōnēs'' (singular); Latin ''publicanus'' (singular); ''publicani'' (plural)) were public contractors, in whose official capacity they often supplied the Roman legions and military, managed the ...
."


History

Cranial osteopathy, a forerunner of CST, was originated by Sutherland in 1898–1900. While looking at a disarticulated
skull The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...
, Sutherland was struck by the idea that the
cranial sutures In anatomy, fibrous joints are joints connected by fibrous tissue, consisting mainly of collagen. These are fixed joints where bones are united by a layer of white fibrous tissue of varying thickness. In the skull the joints between the bones ar ...
of the
temporal bone The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples, and house the structures of the ears. Th ...
s where they meet the
parietal bones The parietal bones () are two bones in the skull which, when joined at a fibrous joint, form the sides and roof of the cranium. In humans, each bone is roughly quadrilateral in form, and has two surfaces, four borders, and four angles. It is named ...
were "beveled, like the
gill A gill () is a respiratory organ that many aquatic organisms use to extract dissolved oxygen from water and to excrete carbon dioxide. The gills of some species, such as hermit crabs, have adapted to allow respiration on land provided they are ...
s of a fish, indicating articular mobility for a
respiratory The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies grea ...
mechanism." From 1975 to 1983, Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at
Michigan State University Michigan State University (Michigan State, MSU) is a public university, public Land-grant university, land-grant research university in East Lansing, Michigan. It was founded in 1855 as the Agricultural College of the State of Michigan, the fi ...
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. 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.


Conceptual basis

Practitioners of both cranial osteopathy and CST assert that there are small, rhythmic motions of the
cranial bones In human anatomy, the neurocranium, also known as the braincase, brainpan, or brain-pan is the upper and back part of the skull, which forms a protective case around the brain. In the human skull, the neurocranium includes the calvaria (skull), ...
attributed to
cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the bra ...
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. However, there is no evidence that the bones of the human skull can be moved by such manipulations. The fundamental concepts of cranial osteopathy and CST are inconsistent with the human skull, brain, and spine's known anatomy and physiology. Edzard Ernst has written "to anyone understanding a bit of physiology, anatomy etc. STlooks like pure nonsense." In common with many other varieties of
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alt ...
, CST practitioners believe all illness is caused by
energy In physics, energy (from Ancient Greek: ἐνέργεια, ''enérgeia'', “activity”) is the quantitative property that is transferred to a body or to a physical system, recognizable in the performance of work and in the form of heat a ...
or fluid blockages which can be released by physical manipulation. They believe that the bones of the skull move in a rhythmic pattern which they can detect and correct. The therapist lightly
palpate Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...
s 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''.


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." 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."


References

{{DEFAULTSORT:Craniosacral Therapy Manual therapy Osteopathic manipulative medicine Alternative medicine Osteopathic techniques Pseudoscience Chiropractic treatment techniques Health fraud