Craniosacral (CS) Therapy on Trial


Considering cranio-sacral (CS) therapy has been practiced for over 50 years with hundreds of practitioners worldwide, one would expect at least some evidence to support the practice. Regrettably there is to date no evidence supporting the ability of CS therapists to be able to alter the movement of the cranial sutures and no credible study has demonstrated its effectiveness beyond that of placebo.

CS therapy involves the application of 5 to 10 g of force across a cranial suture with the purpose of normalizing suture movement and intracranial rhythm.

Due to ethical reasons, human studies cannot be done to measure intracranial pressure during the CS therapy, but a study on rabbits showed that the extremely light forces involved in CS therapy did not result in any suture movement or alterations in intracranial pressure in a rabbit model.

In fact, the rabbits did not exhibit any movement within the coronal suture until 500 g of force was applied, which is 100x greater than the suggested force (Downey et al 2006).

Remarkably, forces of up to 22 kg were needed to cause 1 mm of movement in the cranial sutures. One could always argue that rabbit skull is different than human skull, but can we believe that the human skull is more pliable than a rabbits?

I really hate to be bearer of bad news to CS therapists but here are a few quotes from various studies done mostly by experienced osteopaths ?

“The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably.” (Rogers et al 1998)

“The results fail to support the construct validity of the hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.” (Moran et al 2001)

In fact in this study, the inter-rater reliability of palpation by CS therapists was even LESS THAN CHANCE! (Moran et al 2001)

“Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably.” (Wirth-Pattullo et al 1994)

“This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy.” (Green et al 1999)

“It is possible that the perception of craniosacral rhythm (CSR) is illusory”.? (Hanten et al 1993)

And finally… the 2012 systematic review concluded:

“The notion that CST is associated with more than non-specific effects is not based on evidence from rigorous RCTs” (Ernst 2012) …That was a scientific way of saying that CS therapy is bogus!

I truly searched high and low to find some evidence to support CS therapy (after all, I know very nice people who practice CS therapy). Here is one of the “best” studies I could find on PubMed that somewhat supports CS therapy in Fibromyalgia (Matar�n-Pe�arrocha et al 2011).

After 25 weeks of CS therapy intervention, the pain score reduced from 9.13 on a VAS to 8.18. This is technically less than a drop of one (1) point on the VAS after 6 months!

Personal Comment: I am honestly not anti-cranio-sacral therapy as I have heard of anecdotal cases where patients have tremendously benefitted from treatments when everything else had failed.

I think if CS therapy is going to ever be proven to be effective, patient selection must be identified and the theory behind its effects must be revised.

There is no doubt that CS therapy (similar all other forms of manual therapy) affects the autonomic nervous system (Sergueef et al 2002). The autonomic nervous system is very very powerful in modulating pain, stress and anxiety.

The effect of CS therapy on the autonomic nervous system is worthy of research, far more than the futile studies attempting to prove that they are actually moving the sutures of the skull.

Posted on: December 22, 2014

Categories: Relevant Physical Therapy Articles

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