Craniosacral therapy

Template:Short description Template:Pp-extended Template:Use dmy dates Template:Infobox alternative medical intervention Template:Alternative medicine sidebar Craniosacral therapy (CST) or cranial osteopathy is a form of alternative medicine that uses gentle touch to feel non-existent rhythmic movements of the skull's bones and supposedly adjust the immovable joints of the skull to achieve a therapeutic result. CST is a pseudoscience and its practice has been characterized as quackery.<ref name="quack">Template:Bulleted list</ref><ref name="ps">Template:Bulleted list</ref> It is based on fundamental misconceptions about the anatomy and physiology of the human skull and is promoted as a cure-all for a variety of health conditions.<ref name=mc/><ref name=acs/><ref name=garden/>

Medical research has found no significant evidence that either CST or cranial osteopathy confers any health benefit, and attempts to manipulate the bones of the skull can be harmful, particularly for children or infants.<ref name="acs">Template:Cite book</ref><ref name="Ferré 481–494">Template:Cite journal</ref><ref name=cass/> The basic assumptions of CST are not true, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients.<ref>Template:Cite journal</ref>

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.<ref name=mc>Template:Cite web</ref><ref name=garden>Template:Cite web</ref><ref name=cass>Template:Cite book</ref> Practitioners particularly advocate the use of CST on children.<ref name=garden/> The American Cancer Society cautions that CST should never be used on children under age two.<ref name="acs"/> Pediatricians have expressed concern at the harm CST can cause to children and infants.<ref name=cass/>

There is no evidence that CST is of use for people with autism and its use is potentially harmful.<ref name=aut>Template:Cite book</ref> Template:Asof at least two deaths had been reported resulting from CST spinal manipulation.<ref>Template:Cite journal</ref> In a small study, participants with head injuries suffered worsening symptoms as a result of CST.<ref name=acs/> 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.<ref name=acs/>

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".<ref name="acs"/> 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.<ref name="Ferré 481–494"/>

The evidence base for CST is sparse and lacks a demonstrated biologically plausible mechanism. In the absence of rigorous, well-designed randomized controlled trials,<ref>Template:Cite web</ref><ref>Template:Cite web</ref> it is a pseudoscience,<ref name="ps" /> and its practice quackery.<ref name="quack" /> Tests show that CST practitioners cannot in fact identify the purported craniosacral pulse, and different practitioners will get different results for the same patient.<ref>Template:Cite news</ref> The idea of a craniosacral rhythm cannot be scientifically supported.<ref>Template:Cite web</ref>

Systematic reviews

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."<ref name="rev2012">Template:Cite journal</ref> 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."<ref name=garden/> 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."<ref name="Jakel">Template:Cite journal</ref>

Ernst criticized a 2011 systematic review performed by Jakel and von Hauenschild for including observational studies and including studies with healthy volunteers.<ref name="rev2012"/> 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.<ref>Template:Cite journal</ref>

A 2019 systematic review found limited evidence that CST may bring some relief for up to six months for people with chronic pain.<ref>Template:Cite journal</ref> 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.<ref name="McGill University">Template:Cite journal</ref>

Regulation

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."<ref name=hh>Template:Cite book</ref>

History

Cranial osteopathy, a forerunner of CST, was devised in the 1930s by William Garner Sutherland.<ref name="acs" /><ref name=":0">Template:Cite web</ref> 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."<ref name="Jakel" />

CST was invented by John Upledger, as an offshoot of cranial osteopathy.<ref name="acs" /><ref name=":0" /> 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.<ref name="therapy6">Template:Cite journalTemplate:Dead link</ref><ref name="therapy7">Template:Cite journal</ref><ref name="therapy8">Template:Cite journal</ref> 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.<ref name="Green">Template:Cite journal</ref>

Conceptual basis

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.<ref name="International">Template:Cite journal</ref> However, there is no evidence that the bones of the human skull can be moved by such manipulations.<ref name="Green" />

The fundamental concepts of cranial osteopathy and CST are inconsistent with the human skull, brain, and spine's known anatomy and physiology.<ref name="acs" /> Edzard Ernst has written "to anyone understanding a bit of physiology, anatomy etc. [CST] looks like pure nonsense."<ref name="garden" />

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.<ref name="cass" /> They believe that the bones of the skull move in a rhythmic pattern which they can detect and correct.<ref name="cass" />

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.<ref name="Mcpartland1">Template:Cite journal</ref>

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."<ref name="notco">Template:Cite journal</ref> 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."<ref>Template:Cite journal</ref>