Accepting Cranial

well...i haven't started school yet, so i don't know exactly how you feel, but i do relate. my girlfriend is a physical therapy student at the Mayo Clinic in MN, and she did her senior seminar project on CST, so need less to say, I had to watch her presentation quite a few times. I agree, it's hard to grasp and very hard to swallow. I find the theories to be ok, even acceptable, but the actual process of CST, the hands on stuff, is a little more difficult to agree with.

I remember something on another post about this topic too. I even think it was posted by a DMU student. Try and do a search on manipulation or something like that and you might come up with somethin'. If i remember correctly, this person was getting a little burnt out with OMM, especially cranial!

J

I did not know what this is ... so I did a search.

Here is the site I found... http://www.cranialacademy.org/

I don't have an opinion to this as of yet. I have not been exposed to it or studied it. The difference with cranial, it is a bit out of my scientific expertise and I wouldn't introduce it as a main part of Osteopathic Prof to people.


I found this interesting... just for laughs of course.

http://www.drfeely.com/osteopathy/cranial_faq2.htm

the DO's name is Dr.Feely.. he feels stuff.

Under the FAQ:

Q. Are there any after-treatment restrictions?

A. It is not good to do heavy exercise, consume alcohol, eat a heavy meal or engage in sexual activity within 12 hours after a treatment.

What you don't like the vulcan mindmeld? I appreciated not only learning modern, evidence based medicine, but the art of borrowing and translating people's memories. I think next month we learn the OMM rain dance...

IF a doc can actually feel the rhythm minute as it is. How on earth can the doc distinguish between normal and dysfunctional? The dysfunction will only be a fraction of the normal movement, interpret that??? It just isn't practical. unless you have a spidey sense.

I do not believe in it. I have senn chiros try to do it and it is a laugh. The cranial bones are pretty much solid with their fusing and it is next to impossible to establish a "rthym" with CSF flowing around the brain and within the membranes around the brain. I will just take it cause I have to have it to graduate. It is kind of like a boring class as a undergrad that you may have taken to fill a requirement for graduation. Just my two sense

AwesomeO-DO said:

just sitting there trying to feel the "innate motility of the CNS", my hands twitch and move so much by themselves I can't be sure if it's me moving the head or the head moving itself.

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All I can feel is a carotid pulse. I don't know how many hours I've been made to sit there and "feel" this imaginary rythmic pulse. The best part about cranial is when you get to be the patient and fall asleep! Cranialsacral sucks!

chadderdo21 said:

I do not believe in it. I have senn chiros try to do it and it is a laugh. The cranial bones are pretty much solid with their fusing and it is next to impossible to establish a "rthym" with CSF flowing around the brain and within the membranes around the brain. I will just take it cause I have to have it to graduate. It is kind of like a boring class as a undergrad that you may have taken to fill a requirement for graduation. Just my two sense

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This is exactly the problem though. If it is a bunch of bullsh*t we should be fighting for its removal from the curriculum not just sitting back and accepting it. I really don't know much about cranial as we have not got to that point yet, but from what I have read it sounds very fishy to me. We have enough stuff to learn about medicine that wasting time with this type of voodoo not only makes us look foolish, but also is a detriment to our education.

AwesomeO-DO said:

what i don't get is since it is relatively new to the DO profession, why does it suck so much. DO's should adopt new techniques that are not easily adaptable to FP and other primary care fields, or at least teaching such vague and specialized techniques should be reserved for elective courses and not forced fed to every DO student

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Yeah I don't understand why if there is a 40 hour course you need to take in it, why we need to be tested about it on boards. It's hard to believe something that doesn't have any really solid research with it. But awesomeO I"ll do anything that allows me to feel your beautiful head all afternoon. Go hawks.

I'm interested in how you learn cranial, because at PCSOM we aren't really having that much trouble with it and it's widely accepted.

I'm also highly skeptical of cranial. I'm sure counterarguments are coming up soon on this thread. So for those who do consider it a valid discipline, I've got two things I'm curious about:

--Our professors repeatedly refer to a "movement of angstroms" in the bones. A sheet of paper is about one million angstroms thick. The diameter of an average human cell is ten thousand angstroms. Is there any evidence at all that one can palpate changes on that level? It seems to me that if we're talking about movements less than the diameter of a human cell, we start running into mechanical impossibilities.

--How have studies in cranial rhythm been normalized for the investigator? It struck me that if Patient has a pulse of, say, 75 beats a minute, and Doc has a pulse of 60, and you graph both these as sine waves, there are going to be occasional troughs and peaks where the two match up. Someone better at math could figure this out exactly, but it seems to me that these peaks would happen around 5-15 times per minute, which seems suspiciously like another number that gets thrown around in cranial lit. Ditto with respiration. What steps have been taken to account for this?

My overarching concern is that cranial osteopathy is based on a flawed understanding of science: Even if the cranial rhythm DOES exist, we seem to be using tools with an inherent inaccuracy larger than the phenomenon we're trying to measure.

One of the anatomy professors here at UNECOM has written (I'm pretty sure published) a paper discrediting cranial... kind of ironic huh!

No coincidence that the biggest fruitcake OMM instructor at our school is a specialist in cranial OMM and "energy medicine". I'm going to spend the entire time in that bullsh1t festival either laughing hysterically or crying.

Elysium said:

No coincidence that the biggest fruitcake OMM instructor at our school is a specialist in cranial OMM and "energy medicine". I'm going to spend the entire time in that bullsh1t festival either laughing hysterically or crying.

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If you are to where we are you'll be crying because you have so much other stuff to do that could be more productive (ie board review of half the stuff you forgot from first year)........you just think they could teach something that according to our teacher is "hard to diagnose because just placing your hands on the skull treats the patient so it changes so fast that its difficult to have to people make the same diagnosis". At least you can never be wrong in a practical situation.

I'm just pissed that we get tested on whether we feel what our professor seems to feel or not.... Also pissed that we spend a long amount of time on it...

Another point similar to the sin wave theory above, but shouldn't we be able to measure the bones moving is they actually do?

There's a really long cranial thread somewhere in which it's claimed that something like this, or the CRI, has been measured using doppler infrasomething (just look up cranial rhythmic impulse on pubmed and a few articles will come up). However, I'm not sure this (even if replicated, which I'm not sure has happened) proves anything.

Additionally, the inter-examiner reliability (also via one of those pubmed articles) for measuring cranial-*sacral* motion is absolutely nonexistent. Nutation and counternutation? Not through even expert hands!

I guess my problem with defenders of cranial is that there's a lot of talk of miniscule motions, high-tech equipment measuring said motions, etc., but no talk about whether and how we're sensitive enough to determine this. Additionally, like much of OMM, cranial osteopathy is brilliantly consistent in its theory, thought out with very clever logic indeed. But so are paranoid delusions--the question is not whether cranial's internally consistent, but whether it's consistent with everything *else* we know.

babyruth said:

I'm just pissed that we get tested on whether we feel what our professor seems to feel or not.... Also pissed that we spend a long amount of time on it...

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This is what I wonder about... its the main reason i get irked. I feel at times I am graded or evaluated upon what someone else thinks and it would be different from person to person.

here's my advice (as a 2nd year) to all of you about to learn cranial... pay attention!!! i don't buy it either, and because of that i didn't pay attention, didn't study it well, blah blah blah and now that i'm studying for boards i'm realizing that i should have paid more attention. whether you agree with it or not, you're going to have to learn it (which is unfortunate!!).

i couldn't distinguish the PRM from the movement during breathing, and those are apparently different things...

One of the best scientific articles that I've read on the biological basis and significance of the PRM is below. How all this actually translates into patient care is less clear. Still, I've found this description and explanation of the PRM more compelling than what was taught to me in medical school.


Link to article abstract and PDF

The cytological implications of primary respiration

Medical Hypotheses

P. N. Crisera

Rome, Italy

Received 7 September 1999; accepted 2 March 2000. ; Available online 26 February 2002.

Abstract
Observing the macroscopic complexities of evolved species, the exceptional continuity that occurs among different cells, tissues and organs to respond coherently to the proper set of stimuli as a function of self/species survival is appreciable. Accordingly, it alludes to a central rhythm that resonates throughout the cell; nominated here as primary respiration (PR), which is capable of binding and synchronizing a diversity of physiological processes into a functional biological unity. Phylogenetically, it was conserved as an indispensable element in the makeup of the subkingdom Metazoan, since these species require a high degree of coordination among the different cells that form their body. However, it does not preclude the possibility of a basal rhythm to orchestrate the intricacies of cellular dynamics of both prokaryotic and eukaryotic cells. In all probability, PR emerges within the crucial organelles, with special emphasis on the DNA (5), and propagated and transduced within the infrastructure of the cytoskeleton as wave harmonics (49). Collectively, this equivalent vibration for the subphylum Vertebrata emanates as craniosacral respiration (CSR), though its expression is more elaborate depending on the development of the CNS. Furthermore, the author suggests that the phenomenon of PR or CSR be intimately associated to the basic rest/activity cycle (BRAC), generated by concentrically localized neurons that possess auto-oscillatory properties and assembled into a vital network (39). Historically, during Protochordate-Vertebrate transition, this area circumscribes an archaic region of the brain in which many vital biological rhythms have their source, called hindbrain rhombomeres. Bass and Baker (2) propose that pattern-generating circuits of more recent innovations, such as vocal, electromotor, extensor muscle tonicity, locomotion and the extraocular system, have their origin from the same Hox gene-specified compartments of the embryonic hindbrain (rhombomeres 7 and 8) that produce rhythmically active cardiac and thoracic respiratory circuits. Here, it implies that PR could have been the first essential biological cadence that arose with the earliest form of life, and has undergone a phylogenetic ascent to produce an integrated multirhythmic organism of today. Finally, in its full manifestation, the breathing DNA (1) of the zygote could project itself throughout the cytoskeleton and modify the electromechanical properties of the plasma lamella (26), establishing the primordial axial-voltage gradients for the physiological control of development (53).

I didn't spend long on the article, and so maybe am missing something, but it seemed to me to be entirely speculative. Between the hypothesizing, the unnecessarily confusing phrasings, and the holistic vibe, this doesn't strike me as remotely credible science.

My personal hypothesis is that osteopaths have become so intent on justifying their modalities that they've built up an elaborate system of apologetics without basis in fact. Mainstream medicine doesn't have to do this: if it works, no one's going to quibble too much over the mechanism. It's the things that *don't* work that require compelling reasoning to justify continued practice. Though again, I might be missing something important, this article seems to me sort of a case study in that.

Here's that journal article....

Read it and you'll see why there really is no scientific basis for Craniosacral motion....

http://faculty.une.edu/com/shartman/sram.pdf

jonb12997 said:

One of the anatomy professors here at UNECOM has written (I'm pretty sure published) a paper discrediting cranial... kind of ironic huh!

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docslytherin said:

here's my advice (as a 2nd year) to all of you about to learn cranial... pay attention!!! i don't buy it either, and because of that i didn't pay attention, didn't study it well, blah blah blah and now that i'm studying for boards i'm realizing that i should have paid more attention. whether you agree with it or not, you're going to have to learn it (which is unfortunate!!).

i couldn't distinguish the PRM from the movement during breathing, and those are apparently different things...

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I'm a fourth year student and have taken both COMLEX I and II. I have to agree with the above. As with many things in our profession, the way they make you learn something they know none of us want to learn is by testing on it. On ever step of the boards, you are going to have a ton of Cranial questions. On my step I, this was the majority of all OMM questions. Pay attention and learn it.

That said, yes I totally agree that it is a bunch of BS. One question I have always had is, if the motion is translated to the sacrum by the movement of the duramater-spinal chord-and its attachment to the sacrum, how in the world are we able to bend forward. Wouldn't that increase the arc and yank our sacrum way out of place?

Now, for those who think they feel something, another thing I remember doing as a kid. We would tie a bolt to a string. Hold the string against our forehead and then stay as still as possible. We would then think about moving the bolt in a circular motion (clockwise or counterclockwise)-without moving. Eventually, it would start to move in that direction. As we were kids, we thought our brain power as moving it. Of course, even though we couldn't detect our own motion, the consistently thinking of its motion caused us to undetectably move in such a way as to create this exagerated and perceivable movement in the bolt.

I think this is much the same as cranial. You are told over and over what you should feel. Is it not more reasonable that this phenomenon is more likely based on our hands increasing and decreasing pressure on the skull versus the skull causing the changes of pressure in our hands? It would be so easy to definitively prove its existance. All you would have to do is place manometers on the skull and graph the results. Incredibly easy research. Why don't they do it?

David
KCOM 2005

dkwyler94 said:

I'm a fourth year student and have taken both COMLEX I and II. I have to agree with the above. As with many things in our profession, the way they make you learn something they know none of us want to learn is by testing on it. On ever step of the boards, you are going to have a ton of Cranial questions. On my step I, this was the majority of all OMM questions. Pay attention and learn it.

That said, yes I totally agree that it is a bunch of BS. One question I have always had is, if the motion is translated to the sacrum by the movement of the duramater-spinal chord-and its attachment to the sacrum, how in the world are we able to bend forward. Wouldn't that increase the arc and yank our sacrum way out of place?

Now, for those who think they feel something, another thing I remember doing as a kid. We would tie a bolt to a string. Hold the string against our forehead and then stay as still as possible. We would then think about moving the bolt in a circular motion (clockwise or counterclockwise)-without moving. Eventually, it would start to move in that direction. As we were kids, we thought our brain power as moving it. Of course, even though we couldn't detect our own motion, the consistently thinking of its motion caused us to undetectably move in such a way as to create this exagerated and perceivable movement in the bolt.

I think this is much the same as cranial. You are told over and over what you should feel. Is it not more reasonable that this phenomenon is more likely based on our hands increasing and decreasing pressure on the skull versus the skull causing the changes of pressure in our hands? It would be so easy to definitively prove its existance. All you would have to do is place manometers on the skull and graph the results. Incredibly easy research. Why don't they do it?

David
KCOM 2005

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why dont they? i dont know, maybe its like, how if i punch through some glass, i know my hand will be bloody? i dindt research that, i just that is how it works from experience. why do i need to reseach that??

i dunno about you guys, but i for one WANT to learn this. i want to learn as much as i can. what is the point in doing all of this if you are just going to limit yourselves? everything you guys are saying about crainial has been said basically of all of omm by our md counterparts. now recently harvard has embraced some of the basic teachings here. i dunno guys... im not even in school yet so i guess maybe im just naive, but i still want to learn it...

Harvard is not accepting cranial but other more legitimate forms of OMM that have research behind them, that means evidence based medicine. By not accepting cranial doesn't mean that we are throwing out OMM as a whole, but just those that cannot be backed up. I think we as osteopaths need to paradigm shift. Just like the psychotherapists accepted Freudian theories without question because they sounded good; they eventually realized that though some of Freud'a ideas were innovative, they cannot be proven and thus are not used anymore (though they love to still teach Freud in intro to psych classes).

By not basing care on evidence based medicine, we are more likely to not use the most beneficial or cost-effective treatment available and are devating from the standards of care. Does that mean we shouldn't try new things to see if they work? No, but that does mean we shouldn't tout stuff as fact and base a large chunk of our curriculum off of them.

AwesomeO-DO said:

our professor for cranial told us that the inherant motility of the CNS has been seen by neurosurgeons during operations and that the motility couldn't be explained by respiratory or circulatory changes in pressure. Anyone know if this is totally bogus?

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i would say to that that it still would not count as a "research" entry. you need a double blind on this. that is the only way you will get all opposed to it to agree.

either way, i dont really care if they THINK it is good or bad, i still wanna learn and decide for myself.

cooldreams said:

why dont they? i dont know, maybe its like, how if i punch through some glass, i know my hand will be bloody? i dindt research that, i just that is how it works from experience. why do i need to reseach that??

i dunno about you guys, but i for one WANT to learn this. i want to learn as much as i can. what is the point in doing all of this if you are just going to limit yourselves? everything you guys are saying about crainial has been said basically of all of omm by our md counterparts. now recently harvard has embraced some of the basic teachings here. i dunno guys... im not even in school yet so i guess maybe im just naive, but i still want to learn it...

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Well, I know that there is a push in the DO community to improve research, especially OMM research. Just because you believe that something works does not mean that it is true. They used to believe in blood letting and mercury therapy do you think that it would be wise to continue to teach that despite research that showed the danger involved? I'm not saying that cranial is dangerous just not proven and the farthest thing from evidence based medicine that we as DO's use. I don't want to waste my valuable time learning this stuff when I could be perfecting my techniques in things that have been shown to be effective such as strain-counterstrain and muscle energy.

cooldreams said:

what is the point in doing all of this if you are just going to limit yourselves? everything you guys are saying about crainial has been said basically of all of omm by our md counterparts. now recently harvard has embraced some of the basic teachings here. i dunno guys... im not even in school yet so i guess maybe im just naive, but i still want to learn it...


either way, i dont really care if they THINK it is good or bad, i still wanna learn and decide for myself.

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We *have* learned it and decided for ourselves. I'm sure I've looked at far more cranial "research" in more depth than the vast majority of my classmates, some 60-70% of whom claimed to be able to feel the cranial rhythm after one lab session.

There's a difference between keeping an open mind while one learns the details of a hypothesis and keeping an open mind after the details are abundantly clear. I posed a few straightforward questions near the beginning of this thread; I've yet to receive answers. The same fate has befallen the specific questions that others have asked. One can only ask so many questions without satisfactory answers before suspecting that there are no good answers.

Look at the study drusso posted and see if you can find a shred of evidence supporting its hypotheses. Look at the "scientific" diagrams and terminology and consider whether, like good science does, it's simplifying and systematizing data and providing predictive value, or whether it's just repeating unsupported hypotheses in language so complex as to prevent easy criticism. All hat and no cattle.

It's admirable that you're willing to keep an open mind. You might want to reconsider, however, the idea that we're "limiting" ourselves by rejecting the bulk of cranial osteopathy. We are in fact limiting ourselves, but that's what good science is: setting limits between true and false, and moreover in medicine, useful and useless.

So to answer your original question, there's no point at all in "doing all this" as far as cranial goes. This is particularly true for those schools that teach it in nine or ten hours over a few weeks. If cranial has value, it can't possibly be taught at all effectively in the short period of time it's given. If it's quackery, it shouldn't be taught at all. Either way, it ends up being a waste of time and only has the staying power it does because it makes for easy-to-write and indisputably "osteopathic" board questions.

Be careful of backing a dog you haven't seen fight; this one's lame.

DORoe said:

Well, I know that there is a push in the DO community to improve research, especially OMM research. Just because you believe that something works does not mean that it is true. They used to believe in blood letting and mercury therapy do you think that it would be wise to continue to teach that despite research that showed the danger involved? I'm not saying that cranial is dangerous just not proven and the farthest thing from evidence based medicine that we as DO's use. I don't want to waste my valuable time learning this stuff when I could be perfecting my techniques in things that have been shown to be effective such as strain-counterstrain and muscle energy.

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odd, i thought DOs even from the start were always agaisnt blood letting and mercury therapies...

and just because i believe that there is another side of the moon than the one we see everyday does not mean that it is not true. sure sure, we have been to the moon and back but for many millenia it was always assumed to have an opposite side.

you are not going to perfect your "techniques" in medical school that comes in residency. please, correct me if i am wrong...

back to the point, you can decide if it works for you or not. if you want to know more, research it. i still want to learn.

cooldreams said:

odd, i thought DOs even from the start were always agaisnt blood letting and mercury therapies...

and just because i believe that there is another side of the moon than the one we see everyday does not mean that it is not true. sure sure, we have been to the moon and back but for many millenia it was always assumed to have an opposite side.

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The fact that true things have in the past been disbelieved does not support the argument that something false should be believed. That's the faulty logic that's kept the more dubious methods of osteopathy alive for so long, and has allowed new ones to take root--it's absolutely amazing that this cranial stuff gained steam not in the scientifically-dubious early 20th century, but in the second half when you'd think people would have learned better.

Osteopathy is full of little parasitic philosophies that drag down the better ones, and an overly-defensive set of powers that be have been reluctant to separate the wheat from the chaff for fear of casting doubt on the whole game. Until that separation happens, though, osteopathy's reputation as a safe haven for dubious science, unfounded speculation, and pet theories at the expense of patient outcomes will persist.

LukeWhite said:

We *have* learned it and decided for ourselves. I'm sure I've looked at far more cranial "research" in more depth than the vast majority of my classmates, some 60-70% of whom claimed to be able to feel the cranial rhythm after one lab session.

There's a difference between keeping an open mind while one learns the details of a hypothesis and keeping an open mind after the details are abundantly clear. I posed a few straightforward questions near the beginning of this thread; I've yet to receive answers. The same fate has befallen the specific questions that others have asked. One can only ask so many questions without satisfactory answers before suspecting that there are no good answers.

Look at the study drusso posted and see if you can find a shred of evidence supporting its hypotheses. Look at the "scientific" diagrams and terminology and consider whether, like good science does, it's simplifying and systematizing data and providing predictive value, or whether it's just repeating unsupported hypotheses in language so complex as to prevent easy criticism. All hat and no cattle.

It's admirable that you're willing to keep an open mind. You might want to reconsider, however, the idea that we're "limiting" ourselves by rejecting the bulk of cranial osteopathy. We are in fact limiting ourselves, but that's what good science is: setting limits between true and false, and moreover in medicine, useful and useless.

So to answer your original question, there's no point at all in "doing all this" as far as cranial goes. This is particularly true for those schools that teach it in nine or ten hours over a few weeks. If cranial has value, it can't possibly be taught at all effectively in the short period of time it's given. If it's quackery, it shouldn't be taught at all. Either way, it ends up being a waste of time and only has the staying power it does because it makes for easy-to-write and indisputably "osteopathic" board questions.

Be careful of backing a dog you haven't seen fight; this one's lame.

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i dont care dood. how many martial arts today use pressure points? I studied one that does in depth from the very start. in 3 months i knocked out my first opponent. it was so simple to do, an old lady could have done it. why is this not taught?? it feels the same as MD vs DO today, most ppl think of martials arts as doing some amazing acrobatic spinning jump kick or something and smashing your foot on someones head, that is if they dont duck about 8 inches first. "oh because it doesnt work, that is all magic, blah blah blah"... again i say you are limiting yourself.

true, i do not know much about cranial, but i assure you that will change, that is part of the reason i am going to a DO school. i KNOW there is a ton of stuff going on in the body that "modern science" still has no clue on, so no way am i saying so easily that it does not work. i am not saying that this stuff DOES work, i am just countering your arguements, because i have not seen anything that would conclusively lead me to believe it in fact will never work.

LukeWhite said:

The fact that true things have in the past been disbelieved does not support the argument that something false should be believed.

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well that wasnt what i said, but i think i see what you are trying to say. again i was just pointing out the counter arguement, i have no way to definitively tell one way or the other that it is true or not. how do you decide beyond that?

someways:

1) you 'think' it works but not sure how
2) other ppl think what you did works and keep coming back

any suggestions? all you have told me thus far is that cranial does not work becuase you cannot 'feel' anything...

cooldreams said:

i KNOW there is a ton of stuff going on in the body that "modern science" still has no clue on, so no way am i saying so easily that it does not work. i am not saying that this stuff DOES work, i am just countering your arguements, because i have not seen anything that would conclusively lead me to believe it in fact will never work.

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Again: The fact that we don't know some things that are true doesn't support the idea that False Proposition X is true. With that in mind, you're not countering any arguments. Again, you're welcome to keep an open mind; I'm certainly doing the same, and will be more willing to accept the validity of the discipline if my very simple questions, which should be easy to answer, are answered. However, you've got the research in front of you; it's a mistake to think things will be any clearer once you get to school.

What *will* happen, if your school is anything like ours, is that you'll be subjected to the longest lectures of the quarter in which terms most med students are unfamiliar with are thrown around with abandon (angstroms anyone?) and labs in which you sit for hours at a time with no other instruction but to feel a rhythm that may or may not exist. This is not going to to give you a better vantage point from which to judge the science of cranial osteopathy; it will simply serve to make skepticism less socially acceptable.

And incidentally, I don't think that cranial is bogus because I don't "feel" anything--in fact, if you read towards the beginning I gave my own little hypothesis for what it is people feel. I think cranial is bogus because the science doesn't support it, and because the hypotheses for mechanisms given are unpersuasive. Again: movement of angstroms? Even if true, how are we going to test that, let alone feel or treat that? It's not science; it's Tom-Swiftery.

Complex and obscure terminology, claims that the true secrets require far more time (and money) to learn, endurance-sapping lectures, dark rooms with psychologically suggestive techniques, special uniforms for the instructors...all we need is the incense and the baby sacrificng and we'll be able to finally apply for that cult tax deduction.

AwesomeO-DO said:

It's like cranial is put up on this pedestal and the entire OMM department has formed a protective ring around it, so that no one can question its legitimacy. And then they force us to bow down before it and praise it's name. Those that do not will be smited

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lol, when one of us would question whether a pressure point would work or not, the teacher would break class and demonstrat the point on the one who asked, and we would all then break off and work on each other. could get painful sometimes... it also always seemed to work. is this something that is not done in school?

I was shadowing at a student OMM clinic, and two of the students were attempting to feel the cranial pulse, and were reflecting that they never had any luck feeling it. I tried, without success, to feel it as well.

What else does 'cranial' encompass? ie-what manipulations, etc...It just doesn't seem like there is much you can do with the head besides some massage....

One of the problems is that cranial bites off more than it can chew. I'm reasonably convinced that some good osteopathic work can be done on kids, be it to treat OM, some cranial abnormalities, etc. These treatments seem legitimate, and needn't have anything to do with the rhythms and tides of life that are shoehorned in with them.

In OMM lecture today our guest DO claimed to have converted "full blown Downs Syndrome to mosaic" through the help of cranial osteopathy. HIghly discouraging to see so little scientific rigor.

We also need to take into account the power of somatitization (sp?). Sometimes therapies work based upon the just the thought they they are getting treated and will therefore feel better. Therefore, as stated again, double-blind studies need to be done of the efficacy of cranial treatments, as well as other OMM txs.

Cool, I am glad to see you so excited and we definately want to encourage your enthusiasm. The problem is that we can't always base truth on personal experience, but on, what we would almost call, universal truths. In medicine, this means evidence behind the science. If you think cranial works, great!, then prove it to me and keep improving on its efficacy just like we do with any other mode of therapy.

My only gripe about Cranial is that too little time is spent in the lab palpating. Dr. Stiles and Dr. Litman at PCSOM do a decent job of explaining the theory, but the students don't get enough time to really calm down (stressed getting ready for the practical) and feel the CRI and more importantly, sutural dysfunctions.

Also, there was one published study at MSU, I believe, claiming a 0.87 inter-rater reliability (nope, I don't have the reference handy, but can dig it up).

I have witnessed many folks getting relief from cranial from Fellows (some forms of headaches, sinus drainage, and one or two kids with chronic OM). I've received cranial a few times and couldn't tell much difference, but I didn't have major dysfunction.

I was able to pick up the CRI on the first day of lab, but then again, I've got pretty good palpatory skills (I picked up functional, etc) pretty quickly. I also really work at it (why just sit in lab with a bad attitude, wasting time, when you can at least TRY to learn new skills?). I've been able to help a couple of people already with simple torsions and side-bending dysfunctions, but am by no means an expert (note: I've not been to the Cranial Academy and I'm not a Fellow, just a better than average student).

As for needing additional evidence, I agree! We spend too much time as a profession worrying about whether our graduates do a rotating internship (with NO OMT!!!), than focusing on simple trials that will add to the literature about the efficacy of specific OMT vs. generalized therapeutic touch. That said, with our academic schedules as full as they are, who has time to do it? I think Sutherland, Fryeman, etc are on to something with cranial, but it has been poorly explained, by and large, and poorly demonstrated for a majority of students required to take it and regurgitate it on boards. The educators have to get to some sort of consensus with regard to OMT, standardize the way that it is taught, and then get it out to the students. Otherwise, we are a bunch of confused MD-wannabe's (stepping off of that soapbox now).

Give cranial another shot, if you can. If not, just learn the definitions for the boards, but realize that there may just be more to it than you are able to appreciate.

cooldreams said:

odd, i thought DOs even from the start were always agaisnt blood letting and mercury therapies...

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I realize this that was kinda a point I was trying to make, but if you want I can find 100 other examples where something was proven to be ineffective after it was used for a long time. Please try to address the point of what I wrote in the future.

cooldreams said:

and just because i believe that there is another side of the moon than the one we see everyday does not mean that it is not true. sure sure, we have been to the moon and back but for many millenia it was always assumed to have an opposite side.

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That's fine if you want to believe this stuff by all means do it, learn it, use it, live it whatever floats your boat. I am just saying that I would like to see a little bit of proof to justify everyone being forced to learn it.

cooldreams said:

you are not going to perfect your "techniques" in medical school that comes in residency. please, correct me if i am wrong...

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Really so I will perfect my HVLA techniques during my psychiatry residency? How about my gas residency? Dermatology? Radiology? Not much call for perfecting OMM in those fields is there? I choose to try to perfect my techniques now because I don't know if I will do a residency that will allow the opportunity to do OMM. Even if I don't go into a field that I can use my OMM skills on a daily basis I still want to know how to do it for friends and family.

cooldreams said:

back to the point, you can decide if it works for you or not. if you want to know more, research it. i still want to learn.

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Let me propose a hypothetical. I want to learn homeopathy. Do you think that all DO students should then be forced to learn homeopathy? Homeopathy, like cranial, is scientifically unproven. Again, learn it if you want I have no problem with that. You can learn anything your heart desires, just don't make me learn something that is so unproven.

phd2b said:

As for needing additional evidence, I agree! We spend too much time as a profession worrying about whether our graduates do a rotating internship (with NO OMT!!!), than focusing on simple trials that will add to the literature about the efficacy of specific OMT vs. generalized therapeutic touch. That said, with our academic schedules as full as they are, who has time to do it?

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Phd,

I think that we're talking about two different kinds of evidence...you're suggesting we get evidence to prove that cranial is what it says it is; I'm interested in evidence that resists attempts to disprove it. Accepting something as valid and then setting about to prove that it's true is dangerous, and certainly not science.

Are you sure that what you felt was the CRI? How are you sure? I certainly don't doubt that you felt something, but what leads you to believe that it's the rhythmic pulsing of the CSF?

You say that those of us skeptical of the modality should give it another shot. Are you saying that we should attempt to believe that it's valid despite the evidence against it? I certainly don't trust my own palpatory skills enough to determine whether something I'm feeling is the angstroms-scale pulsing of CSF, and I'm doubtful of anyone else's individual abilities in that regard. That's what trials and studies are for.

In other words, though I certainly don't doubt your experiences with cranial, I'm not sure they're a valid defense. There seems to be a current of thought on this thread that those of us who disbelieve the jargon would experience a new realm of insight if only we suspended our scientific principles. That may have a place in certain areas of life, but it seems to me that a medical school should not be one of them.

DORoe said:

I realize this that was kinda a point I was trying to make, but if you want I can find 100 other examples where something was proven to be ineffective after it was used for a long time. Please try to address the point of what I wrote in the future.

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i feel i did adequately address the base point with a simple example to discount your conclusion.

DORoe said:

That's fine if you want to believe this stuff by all means do it, learn it, use it, live it whatever floats your boat. I am just saying that I would like to see a little bit of proof to justify everyone being forced to learn it.

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i agree that more research would be highly valued on this subject. however, you signed up for this long ago knowing full well what you were in store for. if you did not want to learn osteopathy, why did you go to an osteopathic school? if you have no proof to request that osteopathy drop cranial, then what is your real motive for such a request? if you MUST see more proof one way or another, why have you done no research? as medical students we should be at the forefront of research, and we could easily be toe to toe with phd's researching this stuff.

DORoe said:

Really so I will perfect my HVLA techniques during my psychiatry residency? How about my gas residency? Dermatology? Radiology? Not much call for perfecting OMM in those fields is there? I choose to try to perfect my techniques now because I don't know if I will do a residency that will allow the opportunity to do OMM. Even if I don't go into a field that I can use my OMM skills on a daily basis I still want to know how to do it for friends and family.

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if you wish to mock me, go ahead, you wont be the first, not by a long shot, nor the last, so dont get a big head about yourself.

do you really believe you perfect anything in medical school? that is a joke... we are really just learning the language and going through the motions. if you disagree with any i just said, ask a doctor or resident.

further if you chose to work on your OMM skills no more after school that is your choice. but please do not call yourself a master at it when there are residencies that do nothing BUT OMM for 3-4 years just to be the best they possibly can at it.

DORoe said:

Let me propose a hypothetical. I want to learn homeopathy. Do you think that all DO students should then be forced to learn homeopathy? Homeopathy, like cranial, is scientifically unproven. Again, learn it if you want I have no problem with that. You can learn anything your heart desires, just don't make me learn something that is so unproven.

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doesnt matter what YOU want. YOU didnt start osteopathy, and YOU are not currently an osteopath teaching this to many students who had to jump through hundreds of hurdles and pay thousands of dollars just for the chance at occupying a seat in a class where it is taught.

again if you desire research, why not perform some? you ask many questions and demand many changes but you perform no "walk" if you know what i mean.

ok now. we have each spoken on this to each other twice. let me propose a truce until more research can be performed or dug up from somewhere eh??

cool,

The idea that one supports a hypothesis by setting about to disprove it isn't an opinion; it's the scientific method. If someone's opinion, as you say, can't produce replicable and predictive results, and is not susceptible to disproof, it may be all sorts of useful things, but it's not science.

As far as posting facts, not opinions, I'm not quite sure where you get the idea that you're providing us with anything resembling facts. Not to be unkind, but it's again good to keep in mind that you've had no experience with this. While you may be able to mount a defense for the modality, it's not going to be by simply impugning others' grasp of the scientific method.

You surely know from the rigorous science you're made to learn in the fast-changing world of electrical engineering that the burden of proof rests on the scientist proposing a mechanism. Moreover, that support needs to be vulnerable to modification and disproof. I long ago on this thread asked questions that, if unanswered, severely weaken the basic tenets of cranial osteopathy. I've yet to see answers. Given how much more science you know than those of us who doubt cranial, you must surely have very scientific reasons for being gung-ho on something you've no experience with. Otherwise, I'd have to suspect that you're defending the modality out of blind chauvinism rather than scientific judgment, and I surely think better of the DO applicant pool than all that.

As for *my opinion*: My opinion is that my patients are best served by utilizing medicine that's been proven to work with replicable and testable results. While I'm not about to say that all treatments associated with cranial are without merit, I'm also not inclined to shortchange my patients by pursuing amateur science with no demonstrable benefits. If cranial can't nutate on its own sacrum, it's of no use to me. If it can, I'll find that out through statistics, not anecdote and censure. So far, the evidence I've seen (how many studies have you cited here, again?) is unpersuasive.

I shall respond as asked on Friday after 700pm. I am sure you will be proud.

It will be in Word Format as an attachment. I am mounting an arguement. I really hoped it would not come to this.



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cooldreams said:

I shall respond as asked on Friday after 700pm. I am sure you will be proud.

It will be in Word Format as an attachment. I am mounting an arguement. I really hoped it would not come to this.



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Hoped it wouldn't come to defending claims with scientific evidence? That's an odd hope indeed. Anything that reduces the ratio of emoticons to evidence is more than welcome, and as this thread seems to have been stickified, I'm sure we'll all get a lot out of a rigorous defense of cranial osteopathy.