Craniosacral therapy#Conceptual basis

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.{{cite web |website=Science-Based Medicine |author=Crislip M |title=Alas poor Craniosacral. A SCAM of infinite jest, of most excellent fancy |date=16 December 2011 |url=https://sciencebasedmedicine.org/alas-poor-craniosacral/ |quote=In reality what do CST practitioners do? They lightly massage your head. To treat everything from Downs to headache to PMS. It is an all purpose diagnostic and therapeutic intervention, like all SCAMs.}}{{cite web |first=Edzard |last=Ernst |author-link=Edzard Ernst |title=Up the garden path: craniosacral therapy |url=https://edzardernst.com/2012/12/up-the-garden-path-craniosacral-therapy/ |date=12 December 2012 }}{{cite book |vauthors=Cassileth BR |title=The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals |chapter-url=https://books.google.com/books?id=XAlqDQAAQBAJ&pg=PA248 |year=2011 |publisher=World Scientific |isbn=978-981-4335-16-4 |pages=247–250 |chapter=Chapter 42: Craniosacral Therapy}} Practitioners particularly advocate the use of CST on children. The American Cancer Society cautions that CST should never be used on children under age two. Pediatricians have expressed concern at the harm CST can cause to children and infants.

There is no evidence that CST is of use for people with autism and its use is potentially harmful.{{cite book |chapter=Chapter 9: The Problem of Alternative Therapies in Autism |vauthors=Pavone L, Ruggieri M |editor=Coleman, M |title=Neurology of Autism |publisher=Oxford University Press |year=2005 |page=189 |quote=According to our opinion and experience in the field of autism, there is no scientific justification for this approach. Furthermore, this method could be harmful.}} {{asof|2018}} at least two deaths had been reported resulting from CST spinal manipulation.{{cite journal |vauthors=Daelemans S, Peeters L, Hauser B, Vandenplas Y |title=Recent advances in understanding and managing infantile colic |journal=F1000Res |volume=7 |issue= |date=2018 |page=1426 |pmid=30271572 |pmc=6134333 |doi=10.12688/f1000research.14940.1 |type=Review |doi-access=free |issn=2046-1402}} In a small study, participants with head injuries suffered worsening symptoms as a result of CST. 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.

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.

The evidence base for CST is sparse and lacks a demonstrated biologically plausible mechanism. In the absence of rigorous, well-designed randomized controlled trials,{{cite web |author=Agency for Healthcare Research and Quality |year=2012 |title=Best evidence statement (BESt). Craniosacral therapy for children with autism and/or sensory processing disorder |url=http://guideline.gov/content.aspx?id=34414 |url-status=dead |archive-url=https://web.archive.org/web/20121007203912/http://www.guideline.gov/content.aspx?id=34414 |archive-date=7 October 2012 |access-date=19 May 2013 |publisher=U.S. Department of Health & Human Services}}{{cite web |year=2012 |title=Craniosacral Therapy |url=http://www.bcbst.com/mpmanual/Craniosacral_Therapy.htm |url-status=dead |archive-url=https://web.archive.org/web/20080922100516/http://www.bcbst.com/mpmanual/Craniosacral_Therapy.htm |archive-date=22 September 2008 |access-date=19 May 2013 |work=Blue Cross Blue Shield of Tennessee Medical Policy Manual |publisher=Blue Cross Blue Shield of Tennessee}} it is a pseudoscience, and its practice quackery. Tests show that CST practitioners cannot in fact identify the purported craniosacral pulse, and different practitioners will get different results for the same patient.{{cite news |last1=O'Donoghue |first1=Paul |title=Cranial therapy is just a hare-brained theory |url=https://www.irishtimes.com/news/health/cranial-therapy-is-just-a-hare-brained-theory-1.1002860 |access-date=8 December 2024 |work=The Irish Times |date=6 January 2006 |language=en |archive-url=https://web.archive.org/web/20231206105103/https://www.irishtimes.com/news/health/cranial-therapy-is-just-a-hare-brained-theory-1.1002860 |archive-date=6 December 2023 |url-status=live}} The idea of a craniosacral rhythm cannot be scientifically supported.{{cite web |last1=Schwarcz |first1=Joe |title=People who opt for craniosacral therapy should have their head examined |url=https://www.mcgill.ca/oss/article/controversial-science-news-quackery/people-who-opt-craniosacral-therapy-should-have-their-head-examined |website=Office for Science and Society |publisher=McGill University |access-date=8 December 2024 |language=en |date=20 March 2017 |archive-url=https://web.archive.org/web/20240617202317/https://www.mcgill.ca/oss/article/controversial-science-news-quackery/people-who-opt-craniosacral-therapy-should-have-their-head-examined |archive-date=17 June 2024 |url-status=live}}

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."{{cite journal |doi=10.1111/j.2042-7166.2012.01174.x |title=Craniosacral therapy: A systematic review of the clinical evidence |year=2012 |last1=Ernst |first1=Edzard |journal=Focus on Alternative and Complementary Therapies |volume=17 |issue=4 |pages=197–201}} 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."{{cite journal |doi=10.1016/j.ctim.2012.07.009 |title=A systematic review to evaluate the clinical benefits of craniosacral therapy |year=2012 |last1=Jäkel |first1=Anne |last2=Von Hauenschild |first2=Philip |journal=Complementary Therapies in Medicine |volume=20 |issue=6 |pages=456–65 |pmid=23131379}}

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.{{cite journal |pmid=22182954 |year=2011 |last1=Jäkel |first1=Anne |last2=Von Hauenschild |first2=Phillip |title=Therapeutic Effects of Cranial Osteopathic Manipulative Medicine: A Systematic Review |volume=111 |issue=12 |pages=685–93 |journal=The Journal of the American Osteopathic Association |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=22182954 |access-date=13 May 2013 |archive-date=7 August 2020 |archive-url=https://web.archive.org/web/20200807135041/https://jaoa.org/?view=long&pmid=22182954 |url-status=dead }}

A 2019 systematic review found limited evidence that CST may bring some relief for up to six months for people with chronic pain.{{cite journal |vauthors=Haller H, Lauche R, Sundberg T, Dobos G, Cramer H |date=December 2019 |title=Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials |url= |journal=BMC Musculoskelet Disord |volume=21 |issue=1 |pages=1 |doi=10.1186/s12891-019-3017-y |pmc=6937867 |pmid=31892357 |doi-access=free}} 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.{{cite journal |last=Jarry M.Sc. |first=Jonathan |date=6 Feb 2020 |title=Even the Best Scientific Studies Can Lie: The Case of Craniosacral Therapy |url=https://www.mcgill.ca/oss/article/pseudoscience/even-best-scientific-studies-can-lie-case-craniosacral-therapy |journal=Office for Science and Society |language=en}}

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 wrote that this makes the therapists practising CST "less regulated than publicans."{{cite book |vauthors=Ernst E, Rose LB |title=Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine |publisher=Societas Imprint Academic |year=2008 |chapter=CAM and Politics |pages=102–3 }}

Cranial osteopathy, a forerunner of CST, was devised in the 1930s by William Garner Sutherland.{{cite web |year=2012 |title=Craniosacral Therapy |url=http://www.upmc.com/services/integrative-medicine/services/pages/craniosacral-therapy.aspx |access-date=19 May 2013 |publisher=UPMC Center for Integrative Medicine}} 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."

CST was invented by John Upledger, as an offshoot of cranial osteopathy. 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. {{cite journal|last1=Upledger|first1=John E|year=1995|title=Craniosacral Therapy|journal=Physical Therapy|volume=75|issue=4|pages=328–30|doi=10.1093/ptj/75.4.328|pmid=7899490}}{{Dead link|date=August 2018|bot=InternetArchiveBot|fix-attempted=yes}}{{cite journal|last1=Upledger|first1=JE|year=1978|title=The relationship of craniosacral examination findings in grade school children with developmental problems|journal=The Journal of the American Osteopathic Association|volume=77|issue=10|pages=760–76|pmid=659282}}{{cite journal|last1=Upledger|first1=JE|last2=Karni|first2=Z|year=1979|title=Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment|journal=The Journal of the American Osteopathic Association|volume=78|issue=11|pages=782–91|pmid=582820}} 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.{{cite journal|last1=Green|first1=C.|last2=Martin|first2=C.W.|last3=Bassett|first3=K.|last4=Kazanjian|first4=A.|year=1999|title=A systematic review of craniosacral therapy: Biological plausibility, assessment reliability and clinical effectiveness|journal=Complementary Therapies in Medicine|volume=7|issue=4|pages=201–7|doi=10.1016/S0965-2299(99)80002-8|pmid=10709302}}

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.{{cite journal |doi=10.1016/j.ijosm.2012.05.001 |title=An investigation of cranial motion through a review of biomechanically based skull deformation literature |year=2012 |last1=Seimetz |first1=Christina N. |last2=Kemper |first2=Andrew R. |last3=Duma |first3=Stefan M. |journal=International Journal of Osteopathic Medicine |volume=15 |issue=4 |pages=152–65}} 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. [CST] looks like pure nonsense."

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. They believe that the bones of the skull move in a rhythmic pattern which they can detect and correct.

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.{{cite journal|last1=McPartland|first1=JM|last2=Mein|first2=EA|year=1997|title=Entrainment and the cranial rhythmic impulse|journal=Alternative Therapies in Health and Medicine|volume=3|issue=1|pages=40–5|pmid=8997803}}

Comparing CST 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."{{cite journal|last=Upledger|first=John E.|year=2002|title=CranioSacral Therapy vs. Cranial Osteopathy: Differences Divide|journal=Massage Today|volume=2|issue=10}} 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."{{Cite journal|last1=Ferguson|first1=A.J.|last2=Upledger|first2=John E.|last3=McPartland|first3=John M.|last4=Collins|first4=M.|last5=Lever|first5=R.|year=1998|title=Cranial osteopathy and craniosacral therapy: current opinions|journal=Journal of Bodywork and Movement Therapies|volume=2|issue=1|pages=28–37|doi=10.1016/s1360-8592(98)80044-2}}

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