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 influence the pressure and circulatory rhythm 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.”
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:
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.
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, “Cranial osteopathy: its fate seems clear,” Chiropractic & Manual Therapies, 2006
Unproven therapies should never be sold to patients without acknowledging the uncertainties — it’s just not ethical.12
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 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. If a therapist offers you CST but fails to acknowledge the uncertainties, you may wish to consider taking your business elsewhere.
I am a science writer, former massage therapist, and assistant editor of ScienceBasedMedicine.org. 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 and Google, but mostly Twitter.
This is a study of the effect of craniosacral therapy on rabbit skulls and their cerebrospinal fluid circulation. The researchers found that “low loads of force, similar to those used clinically when performing a craniosacral frontal lift technique, resulted in no significant changes in coronal suture movement or intracranial pressure in rabbits.”
If you can’t move rabbit skull bones or change their intracranial pressure, it’s safe to assume that you probably can’t do it to humans either — and without that mechanism in good working order, craniosacral therapy has no basis at all. The researchers concluded: “These results suggest that a different biological basis for craniosacral therapy should be explored.” But, of course, a “different biological basis” for craniosacral therapy has never even been suggested, let alone tested.BACK TO TEXT
There has never been any significant controversy over whether cerebrospinal fluid actually moves around (only whether or not it’s palpable or can be manipulated, with or without effect/benefit). This is an MRI study of how the fluid circulates, and it confidently concludes it’s pumped every time you take a breath in: “The present results unambiguously identify inspiration as the most important driving force for CSF flow in humans.”
This strongly suggests that the rhythm CST therapists claim to be able to feel is exactly in sync with respiration. Not so exotic! This is is just one paper, and it isn’t necessarily the last word about the mechanism of CSF circulation, but it does strongly suggest that there is indeed a CSF circulation phenomenon to explain, and it’s powered in a straightforward way that probably can’t be significantly manipulated by any means other than holding your breath.BACK TO TEXT
The first test of the claim that craniosacral therapists are able to palpate change in cyclical movements of the cranium. They concluded that “therapists were not able to measure it reliably,” and that “measurement error may be sufficiently large to render many clinical decisions potentially erroneous.” They also questioned the existence of craniosacral motion and suggested that CST practitioner might be imagining such motion. This prompted extensive and emphatic rebuttal from Upledger.BACK TO TEXT
“Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment” in craniosacral therapy. So, researchers compared the diagnostics methods of “two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.” Unfortunately, they couldn’t agree on much: “interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent.” Emphasis mine.BACK TO TEXT
This study reports that craniosacral therapy is an effective treatment for chronic neck pain, compared to “light touch,” in a few dozen patients.
Before I comment on the scientific value of this paper, I’d like to point out that it’s poorly written. It’s a mess. Just sayin’.
And the scientific value is probably nil. It’s in that awkward grey zone between good science and overt pseudoscience. The abstract begins with a glaringly disingenuous exaggeration of the scientific context — there is no credible “growing evidence” that craniosacral therapy works! Making such a claim betrays a strong bias that is clear throughout the paper. This experiment was conducted by researchers fishing for confirmation that CST works, the kind of research that finds what it’s looking for and that more objective researchers are never able to replicate.
The results were technically positive and statistically significant, but also clinically unremarkable and attributable to many possible confounding factors rather than “because CST works.” Even if the results could be accepted at face value, it wouldn’t validate the mechanisms of CST, which are just as dubious as ever. And we know that statistical significance validity, poor at the best of times, is even worse when testing highly implausible claims (see Pandolfi 2014). Either CST only appeared to outperform a sham, thanks to bias-powered mistakes, or it outperformed it only because the CST treatment ritual had more robust nonspecific effects.
This study will be undoubtedly be touted by CST practitioners as proof that CST works, but it is no such thing without replication that it will almost certainly never get. Remember, there are lots of “positive” studies of homeopathy and acupuncture too…and we know how much that means.BACK TO TEXT
From the abstract: “This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.”BACK TO TEXT
Anyone curious about craniosacral therapy should read this clear, compelling and harsh critique of it. As an osteopath himself, Dr. Hartman’s opinion carries considerable weight, and he writes well.BACK TO TEXT