Craniosacral therapy is not medicine.

To the Editor:

Although the prescientific thinking emblematic of most "alternative" health care may lead infrequently to fortuitous insights, many of these techniques have been tested, have failed, and should be abandoned.

For example, we have observed in our laboratory and described in Scientific Review of Alternative Medicine (1) one of the manipulation procedures (craniosacral therapy/cranial osteopathy) used by many physical therapists, occupational therapists, osteopathic physicians, and others. Based on our observations, we have drawn several conclusions.

We believe that Sutherland's Primary Respiratory Mechanism is invalid. "Cranial" rhythms cannot be generated through organic motility of brains because neurons and glial cells lack the dense arrays of actin and myosin filaments required to produce such movement. Other hypotheses regarding genesis of this rhythm (eg, Upledger's "pressurestat" model (2)) remain purely speculative. Movement between the sphenoid and occipital bones at their bases is impossible past late adolescence because, by then, they have become one very robust bone. (3-6) Movement among components of the cranial vault also is impossible in most adults because coronal and sagittal sutures usually have begun to ossify by age 25 to 30 years and the lambdoidal suture only slightly later. (7-9) Interexaminer reliability is approximately zero, many published coefficients have been negative, and the most parsimonious explanation for data collected thus far is that practitioners are imagining the cranial rhythm. (1) Finally, even if purported cranial and intracranial movements are real, are being propagated to the scalp, and are being assessed accurately by practitioners, there is no reason to believe that parameters of such movements should be related to health and no scientific evidence that they can be manipulated to a patient's health advantage.

Similarly, in 1997, the authors of a report prepared for The Insurance Corporation of British Columbia concluded that "no plausible functional background and no empirical evidence of effectiveness of craniosacral therapy could be discerned from the materials reviewed." (10) In 1998, the National Council Against Health Fraud concluded that "cranial osteopathy is more a belief system than a science." (10) In 1999, independent reviewers "found insufficient evidence to support" (12) or "recommend craniosacral therapy to patients, practitioners or third-party payers for any clinical condition." (13)

We are aware of no scientific research supporting the clinical value of these techniques. We should not teach our students that health-related restrictions and imbalances in cranial and intracranial movements can be manipulated to a patient's health advantage, because there is no evidence supporting such claims. We are still deliberating these issues only because craniosacral therapy/ cranial osteopathy is a belief system--not medicine--and as such has been impervious to disconfirmation for most of a century.

We are not characterizing craniosacral therapy as just another approach to health care about which knowledge is incomplete. To the contrary, we believe that craniosacral therapy bears approximately the same relationship to real medicine that astrology bears to astronomy. That is, this approach to "health care" is medical fiction, and it is not appropriate to teach fiction as part of medical or allied health curricula.

We intend no disrespect for practitioners who may feel that their professional identities are challenged by our views. However, until researchers have replicated demonstrations of efficacy--using properly controlled scientific trials--we believe that craniosacral therapy/cranial osteopathy should be removed from all medical and allied health curricula.

Steve E Hartman, PhD
Professor
Department of Anatomy
College of Osteopathic Medicine
University of New England
Biddeford, ME 04005
([e-mail])

James M Norton, PhD
Professor
Department of Physiology
College of Osteopathic Medicine
University of New England

References

(1) Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine. 2002;6:23-40.

(2) Upledger JE, Vredevoogd JD. Craniosacral Therapy. Chicago, Ill: Eastland Press; 1983:11-12.

(3) Melsen B. Time and mode of closure of the spheno-occipital synchondrosis determined on human autopsy material. Acta Anat. 1972;83:112-118.

(4) Madeline LA, Elster AD. Suture closure in the human chondrocranium: CT assessment. Radiology. 1995; 196:747-756.

(5) Okamoto K, Ito J, Tokiguchi S, Furusawa T. High-resolution CT findings in the development of spheno-occipital synchondrosis. Am J Neuroradiol. 1996;17:117-120.

(6) Sahni D, Jit I, Neelam, Suri S. Time of fusion of the basisphenoid with the basilar part of the occipital bone in northwest Indian subjects. Forensic Sci Int. 1998;98:41-45.

(7) Cohen MM Jr. Sutural biology and the correlates of craniosynostosis. Am J Med Genet. 1993;47:581-616.

(8) Perizonius WRK. Closing and non-closing sutures in 256 crania of known age and sex from Amsterdam (A.D. 1883-1908). J Hum Evol. 1984;13:201-216.

(9) Verhulst J, Onghena P. Cranial suture closing in Homo sapiens: evidence for circaseptennian periodicity. Ann Hum Biol. 1997;24:141-156.

(10) Oppel L, Beyerstein BL, Mathias R, et al. Craniosacral Therapy: A Review of the Scientific Evidence. Report prepared by the Alternative Therapy Evaluation Committee for The Insurance Corporation of British Columbia; 1997.

(11) Cranial Manipulative Therapy: Information for Prudent Consumers From the National Council Against Health Fraud Inc. Loma Linda, Calif: National Council Against Health Fraud Inc; 1998.

(12) Green C, Martin CW, Bassett K, Kazanjian A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med. 1999;7:201-207.

(13) Green C, Martin CW, Bassett K, Kazanjian A. A Systematic Review and Critical Appraisal of the Scientific Evidence on Craniosacral Therapy. Vancouver, British Columbia, Canada: British Columbia Office of Health Technology Assessment; 1999.