A Systematic Review of Craniosacral Therapy: Biological Plausibility, Assessment Reliability and Clinical Effectiveness.

A Systematic Review of Craniosacral Therapy: Biological Plausibility, Assessment Reliability and Clinical Effectiveness Green C, Martin CW, Bassett K, Kazanjian A (University of British Columbia, Canada), Contemporary Therapies in Medicine. 1999;7:201-207.

The purpose of this study was to critically review craniosacral therapy as an intervention with a scientific basis. A systematic review of 7 databases from their start date through February 1999 explored 3 areas: (1) the correlation of craniosacral interventions and health outcomes, (2) the reliability of craniosacral assessment, and (3) the pathophysiology of the craniosacral system. Each of the 33 studies identified met the criteria of providing primary data on craniosacral therapy or primary research on related aspects of the craniosacral system. Two reviewers conducted the critical appraisal using accepted standardized criteria and forms.

Seven studies that reported a positive relationship between craniosacral interventions and health outcomes were found to be of poor quality and were categorized with the lowest grade of evidence using the Canadian Task Force on Preventive Health Care ranking system. One of these studies reported negative health outcome effects. Four out of 5 studies that examined agreement by practitioners on craniosacral assessment findings reported low reliability, with intraclass correlation coefficients ranging from .02 to .20 across these studies.

The remaining 22 studies examined pathophysiology and craniosacral dysfunction both within and outside of the context of craniosacral therapy. Nine studies were found that support the possibility that minute movements may occur between the bones of the adult cranium. The idea that cerebrospinal fluid may flow in a pulse-like manner was likewise supported by 11 studies. No evidence, however, supported the supposition that cranial sutures can be manually moved or that manual techniques can affect cerebrospinal fluid flow. Research was not able to definitively demonstrate a causal relationship between restrictions or misalignments of the cranial bones and health outcomes. The authors concluded that insufficient evidence currently exists to support craniosacral therapy as an effective intervention.

Karen Maloney Backstrom, PT, OCS University of Colorado Health Sciences Center Denver, Colo