It's all in the mind! Does craniosacral do what it says?

[Physiobase]

Well here's the question. At birth it is evident that the plates of the skull move to permit movement of the head through the birth canal (well sometimes it does...ouch!....)

But with craniosacral work becoming ever popular, especially in the UK, does a rational of moving plates in the skull hold true. I would agree it can be effective as a treatment, perhaps by releasing internal tension (mm, emotional stress, etc) or addressing energy meridians but what do you think? Are people who have a positive outcome simply people who needed to be held..touched...reassured? What say you all? 8o

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[somasimple]

Hi,

When we grow, all our bones present the same laxity at their extremities but at adulthood, it seems difficult to find a possible motion in these areas!

No evidence about this motion for now!

[nickhedonia]

some years ago on Australian TV , there was an ad running for a particular hospital/medical benefits scheme, I think it was MBF, anyway the ad ran a series of short vignettes of various types of practitioners doing their stuff. A physio, a chiro, a masseur etc , at the end there was one asian looking fellow holding two large fish over a "patient", occasionaLY slapping them together while producing a humming chant.The message was , that pretty much any type of "therapy" was covered by this insurance. Even down to the patently ridiculous.
I venture to say cranio sacral techniques could be grouped under Fish Slapping , along with many others.

[MrPhysio+]

Fish slapping, I love it. I believe that craniosacral therapy is only as good as the patients belief system is strong. The therapy itself is very unlikely to work.

[zaofer2000]

physical therapy is not only evidence base you need to trust in your hands because you are doing art too, so i am physical therapist who learned craniosacral, maitland, mooligan and others..so if you can't feel what are you doing is your problem, is very difficult to judge something if didin't practice... is other technique and depend of our clinical reasoning to use it

[MrPhysio+]

There is the art of self and patient delusion. Evidence exists of patients wanting to please enthusiastic therapists by telling them that improvement has occurred, whenit has not. This encourages the therapist to believe that a technique is worthy, when it is not. Placebo effects are well known, but do not validate a therapy. If a patient or therapist believes that craniosacral therapy works, the belief system takes over, skewing results positively, despite no real effect. Wanting to feel something via your hands is not good enough. If bones are fused, feeling movement is a worry.

[mageshanand]

you are right Mr. physio, feeling movement at a fused joint is a cause to worry

[HygeiaUK]

I have done a Feldenkrais Training and received Cranio-sacral from an Osteopath colleague as an exchange. I found that the pressures he used had a whole system effect, and that he took me into patterns via my skull, through my whole structure. In some ways it reminded me of some Functional Integration processes we use. The most common start point in Feldenkrais FI is taking the person into their pattern, with support. This can cause a deep physiological shift. I have also referred clients for cranio sacral, most have reported early stage changes, but later stage failure. I also practice NLP, and strongly associate with the belief theory. I have worked with clients who have trauma patterns locked kinesthetically, into their physical memory system.Their pain settles once they release the event. My own concerns with Cranio-sacral, is that it is very much a hands on power of the therapist to perfom the technique. I also dont here much about follow on, ie how the person can maintain the change, and what the practitioner did that made the difference. When I asked my Osteopath friend what he did, I was given an enigmatic smile. Do cranio-sacrla therapists know what they are doing?

[friendlypain]

Hey All,

We all know that placebos do work and if it relieves a patient of their pain then I do think it is a valid therapy... no matter what kind of seafood is involved.

But as professionals I believe we must do ourselves a favor and check under the hood about cranio-sacral.

The plates move due to CSF flow. To feel the plates move (CSF rhythm) you place your hands on the occipital "plate". Attached to the occipital bone is the ligamentum nuchae. The ligamentum nuchae is connected to the vertebral body. Attached to the vertebral body is the scalenes. Scalenes are a secondary muscle of respiration. The primary muscle of respiration is the diaphragm. When contracting, the diaphragm pushes the abdominal contents down, creating a potbelly. The average person is overweight and embarrassed by it. They use the diaphragm sparingly to avoid having a bigger belly and to fit in their one size too small pair of jeans. They rely on their (very developed) secondary muscles of respiration in order to stay alive.

ok.... so.... The circulation of CSF through the ventricular system and subarachnoid space has been attributed to:

i) pressure waves generated by pulsatile arterial blood flow and brain expansion,

ii) pressure gradients produced by the production and absorption of CSF,

iii) currents induced by ependymal cilia. It is likely, however, that ciliary currents contribute only to local movement of CSF rather than to bulk flow and,

iv) gravity (?)

The average human head weighs in and about 8 pounds...

We are not bags of mostly water that if you touch it causes ripples like water spiders on a pond. We are sacks of highly efficient shock dispersing gel (ie. glycosaminoglycans).

They claim that since the rhythm of the craniosacral system is subtle, so must the touch of the therapist be subtle. Cranial rhythm is palpated with a touch that is about 5 grams, or the weight of a nickel..... 5 GRAMS! With 5 grams of pressure they claim that this ebb and flow of cerebral spinal fluid is felt as a slight pressure outward (flexion), and a slight drawing inward (extension). The whole body is connected through fascia or connective tissue therefore, this flexion/extension movement can be palpated anywhere in the body via the fascia. Variances in amplitude and quality or distortions within the fascia, can be felt... ummmm... have I mentioned the amazing properties of the gel of our extracellular matrix... that they absorb mechanical distortion by the molecular properties of the glycosaminoglycan molecule.

So... IMHO, I believe that the practitioner does not feel this ebb and flow. So what do they feel? (I think everyone knows where I am going)

The patient lies on the table and the practitioner places their hands on the occipital. The fingers are placed on the origin of the upper traps stimulating a gto release. The very nature of the supine position will further create a laxity of the upper traps. At this point the patient starts to breathe deeply and the practitioner believes to feel the ebb and flow of the CSF. What happens is that the scalenes contract, pulling on their origins on the cervical spine, which is attached to the ligamentum nuchae which attaches to the occipital bone which the practitioner’s fingers are placed. The ebb and flow is really the patients breathing through their secondary muscles of respiration. The gel matrix does NOT allow subtle motions to reach through to the surface as the glycosaminoglycan molecule absorbs the shock of those movements... especially through 8 pounds of human meat.

I look forward to your responses as I love these conversations
Adamo

[jerryhesch]

What is needed is a large study in which sham "craniosacral" treatments are provided in a very similar manner, meaning hand placements, duration, force, etc but by untrained clinicians. A large number would be needed, a statistician should be consulted. The other group of course would be craniosacral therapists. Pre and post pain and functional outcomes would be measured. Long term results should also be addressed; how are they say 3 months post treatment?
I think that something therapeutic can indeed happen when one is given an opportunity to deeply relax and become more aware of their own bodies. Thus, if CS therapy were marketed as a deeply relaxing method, maybe there would be more clinical honesty at the start. I think that we have a moral obligation to communicate with our clients at the start that this is not standard Physical Therapy, etc. On rare occasions I may consult and the client may travel to see me. I always give them the option of seeing someone local who utilizes the traditional approach versus my approach to the pelvis/sacroiliac joint. When the see me- it gets video taped. Not a luxury that all clinics can provide.
Cheers
Jerry Hesch, MHS, PT

[alophysio]

Hi,

Nice post Adamo.

Please don't write CST off. I have seen it work and settle pain and take years worth of headaches away.

There is a rhythm to be felt. I can feel it, others i know can see it in the movement of legs or arms.

It is very subtle and the evidence base may not be there.

I haven't pursued futher study in it as it is too time consuming...and other things i do work.

[friendlypain]

Hey alophysio,

Thanks for the post.

The thing that baffels me is what am I feeling.... The CSF flow is so gentle that it can't be measured unless you puncture the dura.

So here is my thought. What if (in the legs especially) you are getting a rythm from the diaphragm and/or intercostals. The force they generate CAN be felt through fascia and muscle.

Another question is "can we feel the rythm in animals?" Where is the rythm coming from in an animal on all fours? Is it different and why?

Adamo

[alophysio]

Hi Adamo,

Thanks for your reply and questions.

I agree that the CSF is gentle. But the rhythm is definitely different to the breathing rhythm.

I take a pragmatic approach to Cranio - much like i do with acupuncture... The descriptions of what is going on may not be technically correct but the end result is there and i have seen them (both CST and acu) work. May not be the best scientific approach but the patients benefit. Besides, isn't it easier to prove something doesn't work than it is to prove something does?

Seeing as though CST work is less than 1% of my work, i would much prefer those of you who have more knowledge to come up with the answers to the interesting questions that are posed. I had never thought about animals and CST - it would be interesting to find out.

What do you think?

[friendlypain]

Hey alophysio,

So the next questions are:

What rythm are you talking about? How do you know for sure it is not the respiratory rythm? What is the cycle of the CSF rythm (how many seconds between push and pull)? Does the rythm change post concussion? Is the rythm altered with migrane or sinus infection? Does the rythm change with diet? Does the rythm change with high blood pressure? Does the rythm change in different body positions? Is the rythm different between different body types?

Now the really hard questions:

If your patient is treated with Cranio, how long are the symptoms the patient complained about resolved before they return? If they resolved completely then why? If locating fascial adhesions are the main focus of this therapy then why do I have to pay thousands to be fully certified if all I have to do is assess muscle length and PCIR to come to the same conclusions?

My personal thoughts (can be convinced otherwise however):

I dont believe that the Sphenoid bone can be manipulated without trauma to its supporting structures.

I dont believe we can affect/effect dural adhesions (this includes hematomas). If we could I think the world would be a better place.

I dont believe we can feel CSF rythm because *I* CANT feel simple surface capillary pressure and direction. (maybe some one else can)

I DO believe that it is OUR reponsibility to prove without a doubt that these techniques work. That is what science is all about. That's why we DONT use butter to heal burns anymore. Galen was a great man but if we followed all his treatment protocols there would have been alot more amputations and septic shock deaths. To say that a treatment protcol worked but we dont know why and that it should be respected in the medical field goes against everything that I (and many others) believe in. After all, lay persons have sworn on Echinacea to cure/prevent all sorts of illnesses and there was so much media coverage over it that medical doctors were instructing their patient to use it. NOW it has been proven that it does nothing to prevent or cure illness and that the plant is toxic if taken for long periods of time. <shrugs> Such is the power of media I guess.... What WE should do is allow all treatments that work but cant be explained to be in the realm of shammanism (ie. faith healing) and be used as a last resort for the placebo effect until WE can PROVE otherwise.

I am honestly very open minded... just very critical to new and/or unproven treatments because I feel that I should be personally responsible to the health and well being of my patients.

alophysio or anyone else who use cranio should still try to convince me the treatment is valid (I am actually hoping you can) but as practioners of cranio it falls on your shoulders to do so and not to be discouraged that it comes under so much criticism because it needs to be put under a microscope before we know it can work. Since you have the courage to practice it you should have the courage to prove it does work. If not, then why on earth would you have studied it to begin with?

Just being a good scientist,
Adamo

[alophysio]

Dear Adamo,

Thanks for your remarks.

I agree with you to be honest...but as i stated in my earlier reply, i simply do not use it that much to prove it works simply because i use other techniques that seem to work quickly.

I guess i am saying that what i do is use CST when all else seems to fail or if they are very irritable. I mainly use it for headaches.

As for some responses to your statements,
1. The respiratory rhythm is definitely different ot the CSF rhythm because it is easy to see and monitor the resp rhythm.
2. I have personally seen and felt changes made by CST therapists on people during the course that i did on it.
3. I am not a big proponent of CST. I would recommend you spend your money on other things - do it if you have an interest in it and want to prove it works (so you can prove it to Adamo and me! :lol !)

THanks again,

btw, where do you get your info from??? (see post on studying!)

[HygeiaUK]

To add another direction. What if the feeling the practitioner senses is actually similar to the feeling that Reiki and Healing practitioners feel under their hands as the 'aura' changes? I practice Reiki, and my hands feel hot to the client, but never to touch if I take my hands off and they feel them. I am kinesthetic and feel depths, textures, warms, around people, also areas of cold, hollow, flatness. many years ago studies showed that healers can tune their brain wavelengths into the wavelengths of their clients. Getting on the same wavelength is the same in NLP rapport terms, matching and mirroring the client. What if in CST the therapist was tapping in to the energy aura of the person as opposed to the actual flow of fluid?