No one can deny that craniosacral therapy is relaxing. But, then again, so is a nap & a nap is cheaper.

Does Craniosacral Therapy Work?

Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility

SUMMARY Craniosacral therapy (CST) was founded by an osteopath, John Upledger, and it is mainly provided by osteopaths, massage therapists, and a few chiropractors. It’s a “subtle” therapy that involves light holding of the skull and sacrum with almost imperceptible movements. Supposedly such manipulations affect the circulation of cerebrospinal fluid and have profound therapeutic effects and are “good for” just about anything that ails you. Recent and good quality scientific research has shown that it is not possible to affect the circulation of cerebrospinal fluid, and that CST therapists routinely come to different diagnostic conclusions when assessing the same patient. Even the journal of Complementary Therapies in Medicine “found insufficient evidence to support CST,” and Dr. Steve Hartman — an osteopathic physician himself — harshly criticizes CST: “Craniosacral therapy lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown … patients should invest their time, money, and health elsewhere.” Virtually the only thing CST is good for is that it is a relaxing touch therapy, but of course it is possible to provide relaxing touch to patients without grandiose claims of exotic therapeutic effectiveness. full article 2500 words

Craniosacral therapy ( CST ) involves light holding of the skull and sacrum and barely detectable movements. Indeed, the action of craniosacral therapy is so gentle and slight that it is the best example of the so-called “subtle” therapies, which claim to achieve profound health benefits with minor and safe interventions. Practitioners believe that the tiny manipulations of CST affect the pressure and circulation of cerebrospinal fluid, the fluid that surrounds and cushions the brain and spinal cord.

The modern founder of CST, John Upledger, an osteopath,1 is one of the most famous personalities in complementary and alternative medicine. He built on much older ideas.2 Mr. Upledger says that CST “works with natural and unique rhythms of our different body systems to pinpoint and correct source problems.”

Does craniosacral therapy work as advertised?

Skeptics have always had many concerns about craniosacral therapy (here’s an excellent CST reading list from EBM-First.com). I have some concerns about it too. I guess I’m a skeptic:

There is good, recent scientific evidence that the most important and basic assumption about how CST works is not true — research has (once again) shown that craniosacral therapists cannot actually move the bones of the skull enough to affect the pressure or circulation of the fluid surrounding the brain and spinal column.4 And although CST fluid circulates, we know that it’s pumped almost entirely by respiration5 — not skull movement. There is also a logical problem: the cranial bones do not move to relieve the pressure of dangerous swelling in the cranium, so they are probably not going to move for therapist’s fingers either.6 There is both old and recent evidence that CST therapists produce conflicting diagnoses of the same patients.78 That is, when asked to assess a patient, CST therapists came to mutually exclusive conclusions. Any effect that CST has on people must be a complex and subtle one, since it cannot be measured. Subtle effects of therapy certainly exist — just because it can’t be measured doesn’t mean it isn’t there. However, it seems unlikely that any therapist is wise and knowing enough to reliably produce a therapeutic effect by leveraging a phenomenon so subtle that it can’t be measured. There just aren’t any good quality studies showing that CST does anything to CSF circulation or helps patients. The closest is probably a 2015 study comparing CST to light touch for neck pain: it claimed to find evidence of a modest benefit, but it was quite flawed and probably got it wrong.9

Despite more than 50 years of investigation & the promotion of CST by some practitioners, there remains a void in credible evidence supporting the ability of these techniques to alter the movement of the cranial sutures or improve patient-centered outcomes. … The time is past due for advocates of CST to contribute well-designed studies evaluating the efficacy of these techniques to the peer-reviewed literature. The challenge is clear: prove that it works, or move on. ~ Flynn et al, 2006, Journal of Orthopaedic & Sports Physical Therapy

At least it’s relaxing!

I have experienced CST, and I can attest that it is truly, deeply relaxing and comforting to have your head held for a long time by a craniosacral therapist with the best intentions to provide a soothing experience. Receiving craniosacral therapy is one of the most relaxing experiences I have ever had on any massage table. That said, those experiences were not much different from any other soothing massage or even just a good nap. I have been just as relaxed on my couch with my cat in my lap.

Also on the bright side, I have no doubt at all that there are many great emotional and psychological benefits to the touch therapy involved. And I am even happy to admit that there may be some “interesting” neurological effects, some of which may even be therapeutic — and which are probably not medically harmful. It is, after all, a gentle therapy.

Despite my own professional expertise, I do not begin to have the power to micro-manage such subtle and “interesting” neurological effects … assuming they exist at all. This is a simple matter of humility. Anyone who has studied physiology and neurology honestly must admit to profound ignorance. No one knows how that system really works. There are just too many blank areas on the map.

Yet, craniosacral therapists claim to “know” what is going on well enough to reliably produce a therapeutic effect. They believe that they have that power … and they believe it enough to charge patients for the service.

What do other osteopaths think?

Even Complementary Therapies in Medicine — a journal that is much friendlier to alternative therapies than mainstream scientific journals — published a review of the available research in 1999 and “found insufficient evidence to support craniosacral therapy.”10 Wouldn’t you expect such a journal to say just the opposite?

There hasn’t been any research supporting CST since then.

In 2006, craniosacral therapy was strongly questioned in yet another journal that you might expect to be friendlier to an alternative therapy, Chiropractic & Manual Therapies .11 Dr. Steve Hartman, a professor of anatomy at a college of osteopathic medicine, writes with much greater authority on this subject than I have:

Craniosacral therapy lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, “cranial” methods remain popular with many practitioners and patients. Until outcome studies show that these techniques produce a direct and positive clinical effect, they should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health elsewhere. As a scientist in this age of evidence-based practice, I have grown frustrated in my dealings with the “cranial” faithful. As a group, evidence carries little weight with them. ~ Hartman, 2006, Chiropractic & Manual Therapies

Should patients buy craniosacral therapy?

Unproven therapies should never be sold to patients without acknowledging the uncertainties — it’s not ethical.12 More importantly, there’s a risk of harm: not from the therapy, but from belief in a non-existent pathology.13

I can imagine a health care professional who sells CST but strictly limits her therapeutic predictions and is conspicuously humble. Such a therapist might integrate CST as one component of treatment, a relaxing touch therapy, hoping but not really believing or trusting that it might also have some other subtle benefits. This would have to be extremely clear to the patient.

That would be a responsible use of CST — presented with a grain of salt, and offered as just one component of therapy, not the centerpiece.

How many CST therapists actually practice in this way? In my experience, CST practitioners like this are quite rare. It’s more likely that anyone who practices craniosacral therapy is a “true believer” — ideologically committed to the modality, unaware of the substantial scientific evidence that CST is ineffective (and not interested in it either), and quite likely to integrate other dubious methods into treatment (especially “energy” medicine, like therapeutic touch/Reiki).

Summary

Craniosacral therapy (CST) — founded by an osteopath, John Upledger — is usually practiced by osteopaths, chiropractors and massage therapists. CST is a “subtle” therapy that involves light holding of the skull and sacrum with almost imperceptible movements. The idea is that such manipulations affect the circulation of cerebrospinal fluid and have profound therapeutic effects and are “good for” just about anything that ails you. Scientific research has shown that it is not possible to affect the pressure or circulatory rhythm of cerebrospinal fluid, and that CST therapists routinely come to different diagnostic conclusions when assessing the same patient. Even Complementary Therapies in Medicine “found insufficient evidence to support CST,” and Dr. Steve Hartman, as an osteopathic physician himself, harshly criticizes CST: “Craniosacral therapy lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown … patients should invest their time, money, and health elsewhere.” Virtually the only thing CST is good for is that it is a relaxing touch therapy, but of course it is possible to provide relaxing touch to patients without the grandiose claims of exotic therapeutic effectivenes.

The good

medical harm is unlikely

relaxing, pleasant, gentle

The bad

no plausible mechanism of action

practitioners can’t agree on diagnoses

complete failure to pass fair scientific tests

ineffective — i.e. harm to your wallet is inevitable

The ugly

practitioners tend to be “true believers” who hold other pseudoscientific beliefs

About Paul Ingraham I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

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