Craniosacral Therapy
Craniosacral Therapy
Other names for, or variations of this treatment:
- cranial sacral therapy
- CST
- Biodynamic Craniosacral Therapy
- Cranial Osteopathy
I’m slightly hesitant to tackle this topic, because it has been fairly controversial among physical therapists, and other practitioners (osteopaths, chiropractors, etc.) There is a strong push by the American Physical Therapy Association, and among many physical therapy schools in the USA, for evidenced-based practice. In other words, to use only those treatments that are well supported by high-quality research. As you will read, the theories behind CST do not have much support by research, but there are MANY healthcare providers who use this treatment and claim great results. (A search of the “Find a Practitioner” database on the American Craniosacral Therapy Association website pulled up 10 in my zip code alone. Here’s a link to their site: http://www.acsta.com/)
This is a big topic to cover, so I’m going to start with the most simplified definition possible, and then progress into more depth. Stop reading when you get bored. Or skip to the bottom of the page for the Bottom-Line.
Craniosacral treatment can be loosely defined as attempting to influence the body’s pain, disease, or dysfunction through one of the many forms of hands-on treatment applied to the bones of the skull (or the cranium).
First a little history lesson, to clarify the different terms above:
There are many different forms of craniosacral treatment, and all are sometimes lumped under the term craniosacral therapy.
In the early 1900s, Dr William Sutherland began developing the ideas that eventually became the many versions we have today (passed on and expounded upon by people like James Still and John Upledger). Sutherland’s work and treatment were first taught in osteopathic medical schools in the 1940s. So the “original version” of this treatment was called cranial osteopathy. John Upledger modified this treatment and began teaching it to healthcare practitioners other than osteopaths around the early 1980s, and called his version craniosacral therapy (because it could obviously not be called cranial osteopathy if non-osteopaths were utilizing it). There was a lot of disapproval from the osteopathic community when Upledger began teaching this treatment to physical therapists, massage therapists, chiropractors, acupuncturists, and anybody holding a healthcare license or certificate of some kind. The osteopaths felt that it was irresponsible to allow the practice of this treatment without a full medical education in anatomy and physiology. The debate continues today, and you will find a very broad spectrum of knowledge and training among people who perform cranial work.
The Upledger version of craniosacral treatment seems to focus on anatomical corrections of the cranial bones and associated structures, but they do recognize the quality of the practitioner’s intention to be important, and support what they call SomatoEmotional Release (SER) as a treatment combined with CST, or on it’s own. SER involves releasing emotional trauma stored within the body, which was causing or contributing to the pain or disease.
“Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.” (www.acsta.com)
Another popular version of craniosacral therapy is called Biodynamic Craniosacral Therapy. It emphasizes what Sutherland called the “Breath of Life,” or organizing force within the body system. They attempt to allow this organizing force to guide their treatments, rather than follow any set protocols or techniques. You could say that it drifts more toward a form of “energetic” healing, with less focus on anatomical or structural adjusting or alignment.
Here’s a link to the Biodynamic Craniosacral Therapy Association of North America, if you want more information. Or here’s another in-depth description:
WHAT does it do?
The brain is encased in a skull, or cranium, made up of several bones that are attached to each other at areas we call sutures. The spinal cord exits the skull and travels down through the vertebrae, or spine, all the way to the sacrum, or tailbone area. The entire brain and spinal cord is enclosed in a membrane, and lubricated by a substance called craniosacral fluid.
A very simplified version of the theory behind CST is that the craniosacral fluid moves around the brain and spinal cord in a rhythmical fashion, and that rhythm can be felt very subtly by motion of the cranial bones. If the cranial bones are not moving freely or correctly, then the rhythmical flow of craniosacral fluid is altered, which can lead to a wide array of problems and pains throughout the body. CST pracitioners claim to sense obstructions in cranial bone and craniosacral fluid movement, and then correct these obstructions through very light pressure with their hands.
Does it work?
Let’s cut right to the chase: My opinion is that it DOES provide some of the benefits it claims to provide, but not through the mechanism of altering cranial bone structure or craniosacral fluid rhythm. Here’s why:
First of all, many sources will tell you that the bones of the skull (the cranial bones) are completely fused before the age of 20 years. Meaning, there would be no motion between the bones….therefore no craniosacral evaluation or treatment is doing what it claims to be doing. Here are some studies that support the opinion that the cranial bones are fused at an early age: Radiology, American Journal of Neuroradiology, Forensic Science International. (click on the journal name for a link to the article)
To be fair, some will also tell you that the cranial bones are NOT fused at any age. But whether the bones of the skull are fused or not, the entire process relies on the ability of the practitioner to reliably sense altered rhythm of the craniosacral fluid, and it’s effects on the cranial bones (in other words, feel the craniosacral rhythm).
Well, apparently they can’t.
In an article published in The Scientific Review of Alternative Medicine in 2002, the examiners analyzed 5 different experimental studies, involving craniosacral practitioners who were osteopaths, physical therapists, and registered nurses. They found that these practitioners could not measure the cranial rhythm reliably. “Different examiners tended to measure very different rates for the same subject, but a single examiner tended to measure very similar rates for different subjects.” They concluded that, if there is such a thing as a craniosacral rhythm, “it appears that perceived rates are characteristics of practitioners, not patients.” The authors of this article are professors at a school of osteopathy, and they recommended that cranial osteopathy be removed from the curriculum.
Until quality research demonstrates the existence of a perceivable rhythm to the flow of craniosacral fluid, and perceivable movement of the cranial bones, I can’t support the theory behind CST. HOWEVER, I will admit that something of value might be achieved through CST.
As a physical therapist, I’ve come across many patients who rave about CST. And I’ve had a few patients who were seeing very little benefit from my version of manual therapy (joint and muscle mobilization), so they went to receive CST, and I noted significant observable improvements in their condition after only a treatment or two of CST. Seeing is believing. So I’m a believer that CST has the potential to help some people.
I’ve also noted that perhaps practitioners of CST are generally more expressively caring, empathetic, spiritual, and nurturing in the way they interact with patients than are many non-CST practitioners. Many chiropractors and physical therapist I’ve met who don’t ascribe to CST, but focus more strongly on treatments with strong scientific backing tend to be more stoic and distant in their patient interactions….treating specific joint restrictions, rather than the person’s emotional and spiritual reactions to their joint dysfunction as well. This is just my own idea, but perhaps it is the quality of treatment, rather than the type of treatment, that promotes improved health in those who respond well to CST?
I haven’t found much quality research on the effects of craniosacral treatment vs other forms of treatment. But in 2011, Clnical Rehabilitation published a study which found that craniosacral therapy improved pain symptoms in patients with fibromyalgia.