Craniosacral therapy
Encyclopedia
Craniosacral therapy is an alternative medicine
therapy used by osteopaths
, massage therapists
, naturopaths, and chiropractors
. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to "tune into the craniosacral rhythm". The practitioner gently works with the spine
and the skull
and its cranial sutures, diaphragms, and fascia
. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid
through the spinal cord
is said to be optimized, and misaligned bones are said to be restored to their proper position. Craniosacral therapists use the therapy to treat mental stress, neck and back pain, migraines, TMJ Syndrome
, and for chronic pain conditions such as fibromyalgia
. Several studies have reported that there is little scientific support for the underlying theoretical model for which no properly randomized, blinded, and placebo-controlled outcome studies have ever been published.
, DO
(1873-1954) in 1898-1900. While looking at a disarticulated skull
, Sutherland was struck by the idea that the cranial sutures
of the temporal bone
s where they meet the parietal bones were "beveled, like the gill
s of a fish, indicating articular mobility for a respiratory
mechanism."
Sutherland stated the dural membranes
act as 'guy-wire
s' 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. The RTM as described by Sutherland includes the spinal dura, with an attachment to the sacrum
. After his observation of the cranial mechanism, Sutherland stated that the sacrum moves synchronously
with the cranial bones. Sutherland began to teach this work to other osteopaths from about the 1930s, and 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.
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 knowledge 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"
including a special understanding of the central nervous system and primary respiration.
Biodynamics Discovered
Towards the end of his life Sutherland began to sense a "power" which generated corrections from inside his patients' bodies without the influence of external forces applied by him as the therapist. Similar to Qi
and prana
, this contact with what he perceived to be the Breath of Life changed his entire treatment focus to one of spiritual reverence and subtle touch. This spiritual approach to the work has come to be known as 'biodynamic' craniosacral therapy, 'biodynamic' osteopathy, and 'biodynamic cranial touch' and had further contributions from practitioners such as Becker and James Jealous (biodynamic osteopathy), Franklyn Sills (biodynamic craniosacral therapy, and Charles Ridley (biodynamic cranial touch).
The biodynamic approach recognizes that embryological forces direct the embryonic cells to create the shape of the body, and places importance on recognition of these formative
patterns for maximum therapeutic benefit, as this enhances the ability of the patient to access their health as an expression of the original intention
of their existence
.
From 1975 to 1983, osteopathic physician John E. Upledger and neurophysiologist and histologist Ernest W. Retzlaff
worked at Michigan State University
as clinical researchers and professors. They 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 and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement and the concept of a cranial rhythm. Later reviews of these studies have concluded that their research is of insufficient quality to provide conclusive proof for the effectiveness of craniosacral therapy and the existence of cranial bone movement.
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. He continues to teach this approach worldwide through the Upledger Institute in West Palm Beach, Florida. Craniosacral therapists often (although not exclusively) work more directly with the emotion
al and psychological
aspects of the patient than osteopaths working in the cranial field.
Craniosacral Therapy Associations have been formed in the UK, North America, and Australia.
is described as a "dynamo
," beginning with the cerebellum
. The postulated intracranial fluid fluctuation can be described as an interaction between four main components: arterial
blood
, capillary
blood (brain volume), venous blood
and cerebrospinal fluid (CSF).
The function of such a mechanism is postulated by Lee
as being based on a fulcrum
created by the root of the cerebellum and its hemisphere
s moving in opposite directions, resulting in an increase in pressure which squeezes the third ventricle
. The pulsation is described as essentially a recurrent expression of the embryological
development of the brain.
" to describe the inherent fluctuation of fluids in the Primary Respiratory Mechanism. Tide alludes to the concept of ebbing and flowing, but also the contrast between waves on the shore having one rhythm, with the longer rate of lunar
tides below. The Tide incorporates not only fluctuation of the CSF, but of a slow oscillation in all the tissues of the body, including the skull.
Practitioners work with cycles of various rates:
In 1960 Lundberg made a continuous recording of intracranial activities of traumatised patients, finding three waves, one of which Lee believes resembles the CRI.
There is research which demonstrates examiners are unable to measure craniosacral motion reliably, as indicated by a lack of interrater agreement among examiners. The authors of this research conclude this "measurement error may be sufficiently large to render many clinical decisions potentially erroneous". Alternative medicine practitioners have interpreted this result as a product of entrainment
between patient and practitioner, a principle which lacks scientific support. Another study reports craniosacral motion cannot be reliably palpated.
procedure on the neck what he described as a slow pulsating movement within the spinal meninges. He attempted to hold the membrane still and found that he could not due to the strength of the action behind the movement.
It has been theorized that during craniosacral treatment the membranes act as a fulcrum for fascia
l restrictions throughout the body, and craniosacral therapists may perceive a change in quality as a result of disturbance such as infection or allergic
irritation.
age of a skull in archaeological
specimens. Lee suggests the authors found there was no correlation between suture closure and the chronological age of the individual, and also 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, and modern anatomy books suggest incomplete fusion of some sutures. According to Gray's Anatomy
, "[w]hen such sutures are tied by sutural ligament and periosteum, almost complete immobility results", which would make moving these fused bones with gentle massage extremely improbable.
Cranial textbooks propose that motion of the skull is possible during flexion and extension because the sutures are mobile. The sphenobasilar synchondrosis (SBS) - the junction between the base of the sphenoid and the occiput- is thought to fuse by the mid- to late twenties, but still retain limited mobility . An alternative theory to SBS Motion taught in craniosacral training suggests that sutures are "lines of folding", like pre-folded marks on cardboard, rather than necessarily being fully open.
, and usually lasts about one hour. In the Upledger method of craniosacral therapy, a ten-step protocol serves as a general guideline, which includes (1) analyzing the base (existing) cranial rhythm, (2) creating a still point in that rhythm at the base of the skull, (3) rocking the sacrum, (4) lengthening the spine in the lumbar-sacral region, (5) addressing the pelvic, respiratory and thoracic diaphragms, (6) releasing the hyoid bone in the throat, and (7-10) addressing each one of the cranial bones. The practitioner may use discretion in using which steps are suitable for each client, and may or may not follow them in sequential order, with time restraints and the extent of trauma being factors.
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". A practitioner's feeling of being in tune with a patient is described as entrainment
.
Patients often report a sense of deep relaxation
during and after the treatment session, and may feel light-headed. This is popularly associated with increases in endorphin
s, but research shows the effects may actually be brought about by the endocannabinoid system
.
There are few reports of Adverse side effects
from CST treatment. In one study of craniosacral manipulation in patients with traumatic brain syndrome
, the incidence of adverse effects from treatment was 5%.
While studies have reported evidence of the existence of the primary respiratory rhythm, the link between any such mechanism and states of health or disease has also been contested. One meta-analysis from the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that "there is evidence for a craniosacral rhythm, impulse or 'primary respiration' independent of other measurable body rhythms", however it was noted that "these and other studies do not provide any valid evidence that such a craniosacral 'rhythm' or 'pulse' can be reliably perceived by an examiner" and that "The influence of this craniosacral rhythm on health or disease states is completely unknown." The examiners concluded (1) there is little science in any aspect of cranial of the PRM; (2) the only publication purporting to show diagnostic reliability with sufficient detail to permit evaluation is deeply flawed and stands alone against other reports that show reliabilities of zero; and (3) there is no scientific evidence of treatment efficacy.
, craniosacral therapy is to be regulated on a voluntary basis by the Complementary and Natural Healthcare Council
(CNHC) from late 2009 onwards. The standards of competence required for registration are craniosacral therapy techniques plus hands-on practice, anatomy and physiology, business, legal and ethical issues. Registrants must have full public and professional liability insurance
and annual continuing professional development is a condition of re-registration.
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
therapy used by osteopaths
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
, massage therapists
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
, naturopaths, and chiropractors
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to "tune into the craniosacral rhythm". The practitioner gently works with the spine
Vertebral column
In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...
and the skull
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
and its cranial sutures, diaphragms, and fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
through the spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
is said to be optimized, and misaligned bones are said to be restored to their proper position. Craniosacral therapists use the therapy to treat mental stress, neck and back pain, migraines, TMJ Syndrome
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
, and for chronic pain conditions such as fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
. Several studies have reported that there is little scientific support for the underlying theoretical model for which no properly randomized, blinded, and placebo-controlled outcome studies have ever been published.
History
Cranial Osteopathy was originated by physician William SutherlandWilliam Garner Sutherland
William Garner Sutherland was an American physician. He was an important figure in American osteopathic medicine. Several of his manual therapy techniques are still practiced today by a small minority of practitioners of osteopathic medicine. Sutherland was the first osteopath to conceptualize...
, DO
Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine is a professional doctoral degree for physicians in the United States. Holders of the MD degree, Doctor of Medicine, have the same rights, privileges and responsibilities as osteopathic physicians in the United States.The American Osteopathic Association’s Commission...
(1873-1954) in 1898-1900. While looking at a disarticulated skull
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
, Sutherland was struck by the idea that the cranial sutures
Cranial sutures
*Surgical suture, to describe stitches and other techniques for holding tissues together.* Geology, to describe a certain type of boundary between layers of rock....
of the temporal bone
Temporal bone
The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebrum.The temporal bone supports that part of the face known as the temple.-Parts:The temporal bone consists of four parts:* Squama temporalis...
s where they meet the parietal bones were "beveled, like the gill
Gill
A gill is a respiratory organ found in many aquatic organisms that extracts dissolved oxygen from water, afterward excreting carbon dioxide. The gills of some species such as hermit crabs have adapted to allow respiration on land provided they are kept moist...
s of a fish, indicating articular mobility for a respiratory
Respiratory system
The respiratory system is the anatomical system of an organism that introduces respiratory gases to the interior and performs gas exchange. In humans and other mammals, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles...
mechanism."
Sutherland stated the dural membranes
Meninges
The meninges is the system of membranes which envelopes the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.-Dura...
act as 'guy-wire
Guy-wire
A guy-wire or guy-rope, also known as simply a guy, is a tensioned cable designed to add stability to structures . One end of the cable is attached to the structure, and the other is anchored to the ground at a distance from the structure's base...
s' 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
Cartesian coordinate system
A Cartesian coordinate system specifies each point uniquely in a plane by a pair of numerical coordinates, which are the signed distances from the point to two fixed perpendicular directed lines, measured in the same unit of length...
axes held in reciprocal tension, or tensegrity
Tensegrity
Tensegrity, tensional integrity or floating compression, is a structural principle based on the use of isolated components in compression inside a net of continuous tension, in such a way that the compressed members do not touch each other and the prestressed tensioned members delineate the...
, creating the cyclic movement of inhalation
Inhalation
Inhalation is the movement of air from the external environment, through the air ways, and into the alveoli....
and exhalation
Exhalation
Exhalation is the movement of air out of the bronchial tubes, through the airways, to the external environment during breathing....
of the cranium. The RTM as described by Sutherland includes the spinal dura, with an attachment to the sacrum
Sacrum
In vertebrate anatomy the sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx...
. After his observation of the cranial mechanism, Sutherland stated that the sacrum moves synchronously
Synchronization
Synchronization is timekeeping which requires the coordination of events to operate a system in unison. The familiar conductor of an orchestra serves to keep the orchestra in time....
with the cranial bones. Sutherland began to teach this work to other osteopaths from about the 1930s, and 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.
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 knowledge 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"
including a special understanding of the central nervous system and primary respiration.
Biodynamics Discovered
Towards the end of his life Sutherland began to sense a "power" which generated corrections from inside his patients' bodies without the influence of external forces applied by him as the therapist. Similar to Qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...
and prana
Prana
Prana is the Sanskrit word for "vital life" .It is one of the five organs of vitality or sensation, viz. prana "breath", vac "speech", chakshus "sight", shrotra "hearing", and manas "thought" Prana is the Sanskrit word for "vital life" (from the root "to fill", cognate to Latin plenus...
, this contact with what he perceived to be the Breath of Life changed his entire treatment focus to one of spiritual reverence and subtle touch. This spiritual approach to the work has come to be known as 'biodynamic' craniosacral therapy, 'biodynamic' osteopathy, and 'biodynamic cranial touch' and had further contributions from practitioners such as Becker and James Jealous (biodynamic osteopathy), Franklyn Sills (biodynamic craniosacral therapy, and Charles Ridley (biodynamic cranial touch).
The biodynamic approach recognizes that embryological forces direct the embryonic cells to create the shape of the body, and places importance on recognition of these formative
Morphogenesis
Morphogenesis , is the biological process that causes an organism to develop its shape...
patterns for maximum therapeutic benefit, as this enhances the ability of the patient to access their health as an expression of the original intention
Intention
Intention is an agent's specific purpose in performing an action or series of actions, the end or goal that is aimed at. Outcomes that are unanticipated or unforeseen are known as unintended consequences....
of their existence
Existence
In common usage, existence is the world we are aware of through our senses, and that persists independently without them. In academic philosophy the word has a more specialized meaning, being contrasted with essence, which specifies different forms of existence as well as different identity...
.
From 1975 to 1983, osteopathic physician John E. Upledger and neurophysiologist and histologist Ernest W. Retzlaff
Ernest W. Retzlaff
Ernest Walter Retzlaff, Ph.D. was an American neurophysiologist and histologist who helped develop a form of manipulative healing therapy called Craniosacral therapy with Dr...
worked at Michigan State University
Michigan State University
Michigan State University is a public research university in East Lansing, Michigan, USA. Founded in 1855, it was the pioneer land-grant institution and served as a model for future land-grant colleges in the United States under the 1862 Morrill Act.MSU pioneered the studies of packaging,...
as clinical researchers and professors. They set up a team of anatomists
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, physiologists
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, biophysicists
Biophysics
Biophysics is an interdisciplinary science that uses the methods of physical science to study biological systems. Studies included under the branches of biophysics span all levels of biological organization, from the molecular scale to whole organisms and ecosystems...
, and bioengineers to investigate the pulse he had observed and study further Sutherland's theory of cranial bone movement. Upledger and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement and the concept of a cranial rhythm. Later reviews of these studies have concluded that their research is of insufficient quality to provide conclusive proof for the effectiveness of craniosacral therapy and the existence of cranial bone movement.
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. He continues to teach this approach worldwide through the Upledger Institute in West Palm Beach, Florida. Craniosacral therapists often (although not exclusively) work more directly with the emotion
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
al and psychological
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
aspects of the patient than osteopaths working in the cranial field.
Craniosacral Therapy Associations have been formed in the UK, North America, and Australia.
The primary respiratory mechanism
The Primary Respiratory Mechanism (PRM) has been summarized in five ideas.Inherent motility of the central nervous system
The inherent motion of the brainHuman brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
is described as a "dynamo
Electrical generator
In electricity generation, an electric generator is a device that converts mechanical energy to electrical energy. A generator forces electric charge to flow through an external electrical circuit. It is analogous to a water pump, which causes water to flow...
," beginning with the cerebellum
Cerebellum
The cerebellum is a region of the brain that plays an important role in motor control. It may also be involved in some cognitive functions such as attention and language, and in regulating fear and pleasure responses, but its movement-related functions are the most solidly established...
. The postulated intracranial fluid fluctuation can be described as an interaction between four main components: arterial
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, capillary
Capillary
Capillaries are the smallest of a body's blood vessels and are parts of the microcirculation. They are only 1 cell thick. These microvessels, measuring 5-10 μm in diameter, connect arterioles and venules, and enable the exchange of water, oxygen, carbon dioxide, and many other nutrient and waste...
blood (brain volume), venous blood
Venous blood
Venous blood is deoxygenated blood in the circulatory system. It runs in the systemic veins from the organs to the heart. Deoxygenated blood is then pumped by the heart to lungs via the pulmonary arteries, one of the few arteries in the body that carries deoxygenated blood .Venous blood is...
and cerebrospinal fluid (CSF).
The function of such a mechanism is postulated by Lee
as being based on a fulcrum
Lever
In physics, a lever is a rigid object that is used with an appropriate fulcrum or pivot point to either multiply the mechanical force that can be applied to another object or resistance force , or multiply the distance and speed at which the opposite end of the rigid object travels.This leverage...
created by the root of the cerebellum and its hemisphere
Sphere
A sphere is a perfectly round geometrical object in three-dimensional space, such as the shape of a round ball. Like a circle in two dimensions, a perfect sphere is completely symmetrical around its center, with all points on the surface lying the same distance r from the center point...
s moving in opposite directions, resulting in an increase in pressure which squeezes the third ventricle
Third ventricle
The third ventricle is one of four connected fluid-filled cavities comprising the ventricular system within the human brain. It is a median cleft between the two thalami, and is filled with cerebrospinal fluid ....
. The pulsation is described as essentially a recurrent expression of the embryological
Embryology
Embryology is a science which is about the development of an embryo from the fertilization of the ovum to the fetus stage...
development of the brain.
Fluctuation of the cerebrospinal fluid
Sutherland used the term "TideTide
Tides are the rise and fall of sea levels caused by the combined effects of the gravitational forces exerted by the moon and the sun and the rotation of the Earth....
" to describe the inherent fluctuation of fluids in the Primary Respiratory Mechanism. Tide alludes to the concept of ebbing and flowing, but also the contrast between waves on the shore having one rhythm, with the longer rate of lunar
Moon
The Moon is Earth's only known natural satellite,There are a number of near-Earth asteroids including 3753 Cruithne that are co-orbital with Earth: their orbits bring them close to Earth for periods of time but then alter in the long term . These are quasi-satellites and not true moons. For more...
tides below. The Tide incorporates not only fluctuation of the CSF, but of a slow oscillation in all the tissues of the body, including the skull.
Practitioners work with cycles of various rates:
- 10-14 cycles per minute - the original "Cranial Rhythmic Impulse" (CRI) (also described as 6-14 times per minute)
- 2-3 cycles per minute - the "fluid Tide"
- 6 cycles every 10 minutes - the "long Tide"
- No rate - "Dynamic Stillness"
- All rates sealed inside Dynamic Stillness - 'Pure Breath of Love'
- 'Enfleshment' - realization of the utter union of Pure Breath of Love and body.
In 1960 Lundberg made a continuous recording of intracranial activities of traumatised patients, finding three waves, one of which Lee believes resembles the CRI.
There is research which demonstrates examiners are unable to measure craniosacral motion reliably, as indicated by a lack of interrater agreement among examiners. The authors of this research conclude this "measurement error may be sufficiently large to render many clinical decisions potentially erroneous". Alternative medicine practitioners have interpreted this result as a product of entrainment
Brainwave synchronization
Brainwave entrainment or "brainwave synchronization," is any practice that aims to cause brainwave frequencies to fall into step with a periodic stimulus having a frequency corresponding to the intended brain-state , usually attempted with the use of specialized software...
between patient and practitioner, a principle which lacks scientific support. Another study reports craniosacral motion cannot be reliably palpated.
Mobility of the intracranial and intraspinal dural membranes
In 1970, Upledger observed during a surgicalSurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
procedure on the neck what he described as a slow pulsating movement within the spinal meninges. He attempted to hold the membrane still and found that he could not due to the strength of the action behind the movement.
It has been theorized that during craniosacral treatment the membranes act as a fulcrum for fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
l restrictions throughout the body, and craniosacral therapists may perceive a change in quality as a result of disturbance such as infection or allergic
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
irritation.
Mobility of the cranial bones
Cranial sutures are almost immobile after fusion, inhibiting movement between cranial bones. According to Lee (2005), this understanding arose in the mid-1900s and was misinterpreted from the work of authors hoping to correlate suture closure with the chronologicalChronology
Chronology is the science of arranging events in their order of occurrence in time, such as the use of a timeline or sequence of events. It is also "the determination of the actual temporal sequence of past events".Chronology is part of periodization...
age of a skull in archaeological
Archaeology
Archaeology, or archeology , is the study of human society, primarily through the recovery and analysis of the material culture and environmental data that they have left behind, which includes artifacts, architecture, biofacts and cultural landscapes...
specimens. Lee suggests the authors found there was no correlation between suture closure and the chronological age of the individual, and also most skulls demonstrated no suture closure at all except as structural evidence of pathological physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
. Lee cites many references giving evidence for mobility in human skulls, and modern anatomy books suggest incomplete fusion of some sutures. According to Gray's Anatomy
Gray's Anatomy
Gray's Anatomy is an English-language human anatomy textbook originally written by Henry Gray. The book is widely regarded as an extremely influential work on the subject, and has continued to be revised and republished from its initial publication in 1858 to the present day...
, "[w]hen such sutures are tied by sutural ligament and periosteum, almost complete immobility results", which would make moving these fused bones with gentle massage extremely improbable.
Cranial textbooks propose that motion of the skull is possible during flexion and extension because the sutures are mobile. The sphenobasilar synchondrosis (SBS) - the junction between the base of the sphenoid and the occiput- is thought to fuse by the mid- to late twenties, but still retain limited mobility . An alternative theory to SBS Motion taught in craniosacral training suggests that sutures are "lines of folding", like pre-folded marks on cardboard, rather than necessarily being fully open.
Craniosacral treatment
A typical craniosacral therapy session is performed with the client fully clothed, in a supine positionSupine position
The supine position is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the...
, and usually lasts about one hour. In the Upledger method of craniosacral therapy, a ten-step protocol serves as a general guideline, which includes (1) analyzing the base (existing) cranial rhythm, (2) creating a still point in that rhythm at the base of the skull, (3) rocking the sacrum, (4) lengthening the spine in the lumbar-sacral region, (5) addressing the pelvic, respiratory and thoracic diaphragms, (6) releasing the hyoid bone in the throat, and (7-10) addressing each one of the cranial bones. The practitioner may use discretion in using which steps are suitable for each client, and may or may not follow them in sequential order, with time restraints and the extent of trauma being factors.
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". A practitioner's feeling of being in tune with a patient is described as entrainment
Entrainment
Entrainment may refer to:* Air entrainment, the intentional creation of tiny air bubbles in concrete* Brainwave entrainment, the practice of entraining one's brainwaves to a desired frequency...
.
Patients often report a sense of deep relaxation
Relaxation (psychology)
In psychology, relaxation is the emotional state of low tension, in which there is an absence of arousal that could come from sources such as anger, anxiety, or fear. Relaxation is a form of mild ecstasy coming from the frontal lobe of the brain in which the backward cortex sends signals, or...
during and after the treatment session, and may feel light-headed. This is popularly associated with increases in endorphin
Endorphin
Endorphins are endogenous opioid peptides that function as neurotransmitters. They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce...
s, but research shows the effects may actually be brought about by the endocannabinoid system
Endocannabinoid system
The endocannabinoid system refers to a group of neuromodulatory lipids and their receptors that are involved in a variety of physiological processes including appetite, pain-sensation, mood, and memory; it mediates the psychoactive effects of cannabis and, broadly speaking, includes:* The...
.
There are few reports of Adverse side effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
from CST treatment. In one study of craniosacral manipulation in patients with traumatic brain syndrome
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...
, the incidence of adverse effects from treatment was 5%.
Criticisms
There are extensive criticisms of cranialsacral therapy from the scientific and health care professions as to the validity and efficacy of Cranial Type techniques and principles. The following criticisms are cited against this form of therapy.- Lack of evidence cranialsacral therapy provides a therapeutic benefit
- Lack of evidence for the existence of "cranial bone movement":
- Scientific evidence does not support the theories for cranial bone movement claimed by craniosacral practitioners. This research shows that partial fusion between cranial bones occurs during growth and development.
- Lack of evidence for the existence of the "cranial rhythm":
- While evidence exists for cerebrospinal fluid pulsation, one study states it is caused by the functioning of the cardiovascular system and not by the workings of the craniosacral system.
- Lack of evidence linking "cranial rhythm" to disease:
- Research to date to support the link between the "cranial rhythm" and general health is cited as "low grade" and "unacceptable to meet scientific measures".
- Lack of evidence "cranial rhythm" is detectable by practitioners:
While studies have reported evidence of the existence of the primary respiratory rhythm, the link between any such mechanism and states of health or disease has also been contested. One meta-analysis from the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that "there is evidence for a craniosacral rhythm, impulse or 'primary respiration' independent of other measurable body rhythms", however it was noted that "these and other studies do not provide any valid evidence that such a craniosacral 'rhythm' or 'pulse' can be reliably perceived by an examiner" and that "The influence of this craniosacral rhythm on health or disease states is completely unknown." The examiners concluded (1) there is little science in any aspect of cranial of the PRM; (2) the only publication purporting to show diagnostic reliability with sufficient detail to permit evaluation is deeply flawed and stands alone against other reports that show reliabilities of zero; and (3) there is no scientific evidence of treatment efficacy.
- Inter-operator reliability has been very poor in studies that have been done. Five studies showed an inter-operator reliability of zero. In a report to the British Columbia Office of Health Technology Assessment one study in this report shows some inter-operator reliability but has been criticized as deeply flawed.
Regulation
In the United Kingdom, resulting from a regulation programme facilitated by The Prince's Foundation for Integrated HealthThe Prince's Foundation for Integrated Health
The Foundation for Integrated Health was a controversial charity run by Charles, Prince of Wales and founded in 1993. The Foundation promoted alternative and complementary medicine and lobbied for its inclusion in the National Health Service...
, craniosacral therapy is to be regulated on a voluntary basis by the Complementary and Natural Healthcare Council
Complementary and Natural Healthcare Council
The Complementary and Natural Healthcare Council is an industry body which provides a voluntary register of alternative medicine therapists in the UK...
(CNHC) from late 2009 onwards. The standards of competence required for registration are craniosacral therapy techniques plus hands-on practice, anatomy and physiology, business, legal and ethical issues. Registrants must have full public and professional liability insurance
Professional liability insurance
Professional liability insurance , also called professional indemnity insurance but more commonly known as errors & omissions in the US, is a form of liability insurance that helps protect professional advice- and service-providing individuals and companies from bearing the full cost of defending...
and annual continuing professional development is a condition of re-registration.