Accepting Cranial

homeboy said:

Cranial is a joke.

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Thats pretty much the way the majority of my classmates feel.


I mean honestly, how can cranial logically make sense?

The worst is doing the vault hold during a practical. Are you ****ing kidding me? I can't feel this ******* PRM....mainly because it doesnt exist.

I just had the opportunity to see one of the clinicians at WVSOM demonstrate OMM. As he did it, I would glance around the classroom to see everybody's reaction.

It was quite receptive. And I thought the physician gave a very interesting and meaningful demonstration.

But we got to the cranial part. And he simply put his hands on the girl's head for about 5 seconds and then said, "And that's cranial" and the class sort of laughed a little.

I'm not sure if he did that to mock cranial, or he was being serious. But I will say that I thought the OMM presentation was interesting as a whole.

I understand your difficulty and that of most others.

RE: "I mean honestly, how can cranial logically make sense?"

The logic is in the anatomical structure of the cranial sutures: their beveling, interdigitation, and degree of compliance to stress, and the dural attachments: the meningeal and periosteal dura and its penetration through the suture to the external periosteum of the cranial bones.

Where I think the HUGE problem is, is the palpation of the PRM or CRI, which is extremely difficult, subtle, and for all intents and purposes, questionable at best, to someone attempting to learn this palpation skill. The issue is that there are subtle pulsations, which are even in dispute amongst those who purported saying they feel PRM or CRI.

However it is likely that muscular contractions into the skull or repeated tension to the craniofacial region by way of TMJ related activities would best have the tensile stressed dissipated by a cranium that had some degree of balanced flexibility. Likewise internal pressure variants affecting CSF pulse waves or pressure variations such as a heart beat or associated with pulmonary respiration would likely offer some degree of readily available palpatory sensation to the palpating doctor/student.

Palpating for PRM pulsations, which are described as many magnitudes less than a heartbeat, would seem ludicrous until one could at least feel a heartbeat at individual cranial bones and along sutures. It could be possible that the lack of "heart beat reverberation" at a cranial bone or along a suture might be indicative of some reduced cranial bone compliance or internal dural tensions.

The plausibility is there the problem is when it jumps to extrapolations that defy logic. Something seems to be taking place clinically but specifically what is not really clear at this time.

The mechanical model of OCF has never made any sense and the basic science to support it is weak. The idea of palpation CSF flucuations is very weak.

What's always seemed plausible to me is that OCF is a version of myofascial release for the skull. The cranial sutures are innervated with nociceptors and do receive cervicotrigeminal afferents which synapse in brainstem and spinal cord. Why isn't more plausible to believe that the "therapeutic" effects of OCF are mediated by neurologically. Patients with migraines and tension cephalgia get relief from Botox injections to the temporalis, frontalis, occipitalis, etc. Not because THESE muscles have ANYTHING to do with the patho-etiology of migraine, but because botulinum toxin is actively taken by peripheral nociceptors (in this case the very cervicotreminal system described above).

The mechanical model needs to be actively disproven (there's nothing wrong with being wrong--even the brightest psychiatrists 40 years ago believed that autism was caused by maternal rejection of her fetus in utero) and purported benefits related to OCF (which I've had patients SWEAR BY) should be investigated with an eye toward neurologically mediated mechanisms grounded in known scientific mechanisms of analgesia (such as counter-irritation). In other words, apply Occam's razor.

drusso said:

The mechanical model of OCF has never made any sense and the basic science to support it is weak. The idea of palpation CSF flucuations is very weak.

What's always seemed plausible to me is that OCF is a version of myofascial release for the skull. The cranial sutures are innervated with nociceptors and do receive cervicotrigeminal afferents which synapse in brainstem and spinal cord. Why isn't more plausible to believe that the "therapeutic" effects of OCF are mediated by neurologically. Patients with migraines and tension cephalgia get relief from Botox injections to the temporalis, frontalis, occipitalis, etc. Not because THESE muscles have ANYTHING to do with the patho-etiology of migraine, but because botulinum toxin is actively taken by peripheral nociceptors (in this case the very cervicotreminal system described above).

The mechanical model needs to be actively disproven (there's nothing wrong with being wrong--even the brightest psychiatrists 40 years ago believed that autism was caused by maternal rejection of her fetus in utero) and purported benefits related to OCF (which I've had patients SWEAR BY) should be investigated with an eye toward neurologically mediated mechanisms grounded in known scientific mechanisms of analgesia (such as counter-irritation). In other words, apply Occam's razor.

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This is an excellent post and I think it poses some good questions.

The "myofascial" belief of cranial is not uncommon among many people in the osteopathic community, even the hardcore OMM-ites.

What CAN be argued is the mechanism contributing to the palpatory experience that some have, its ability to be palpated, its ability to be manipulated and altered, and the relationship that this has to a patients health.

What CANT be argued is the difference that thousands (I wont go so far as tens of thousands) of patients who have been treated primarily with cranial and find it to be not only beneficial, but often the last resort of treatment.

In my humble opinion any modality, from cranial to osyter crackers, that has such a profound impact on a group of patients has benefit. Does this mean that we are altering the flexion/extension phases of the sphenoid? Of course not...not necessarily. But it does mean that somehow our patients are benefitting from these types of treatments, however abstract the mechanism may be.

There are documented results of certain techniques (OM suture spread for instance) that can be monitored physiologically and show alterations. Some patients in sustained tachycardia, for example, have responded to OM suture spread in a similar manner that patients respond to other manuevers, such as valsalva. This seems to work in 40-50% of patients. Rock solid evidence? Not at all, but still 3x more successful than other brady maneuvers that cardiologists talk about. Of course, any of these are totally physician dependant as far as proper use of technique.

So is cranial the end-all, be-all of osteopathy? Not in the least.

Can it be completely discounted and discredited? I dont think so...not any more than hundreds of other alternative treatment modalities that exist in our world that are still used without scientific evidence of efficacy.

Should cranial still be taught in osteopathic schools and should it be incorporated into boards as much as it is? Well, I have my own personal opinion and I dont think it should and heres why.

OMT has a great number of valuable uses. More than 90% of these will be used for musculoskeletal complaints and illnesses (for lack of better word). The other 10% are useful on a viscerosomatic level.

Where is the average osteopathic medical student going to ahev the greatst proficiency? In those muculoskeletal areas.

I think that the future of OMT education needs to focus on these core concepts. Other areas such as cranial can be taught as theory, and those students who are interested in further learning in this area should have coursework available to them. I know PCOM does this with regular accredited cranial courses offered for under $100 (basically paying for lunch for the 4 days it encompasses plus membership to the cranial academy).

Just my opinion.

I don't understand why folks who don't want to use Cranial make such a big deal out of trying to discredit it.

It is really very simple. If you think it is crap, don't use it.

If you think it might be interesting, useful, etc, then learn about it.

And, as far as it being on standardized tests, I guess the bottom line there is to: a) suck it up and memorize the basics of Cranial if you want the points for it, or b) study other stuff and simply guess on the Cranial questions.

And, as far as it being on standardized tests, I guess the bottom line there is to: a) suck it up and memorize the basics of Cranial if you want the points for it, or b) study other stuff and simply guess on the Cranial questions.

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it is this very logic (or lack thereof) that truly frightens me for the future of our profession...

jhug said:

it is this very logic (or lack thereof) that truly frightens me for the future of our profession...

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I agree entirely and thought Hazelton had a good quote a few back, with one modification:

Can it be completely discounted and discredited? I dont think so...not any more than hundreds of other alternative treatment modalities that exist in our world that are still used without scientific evidence of efficacy.

--The only thing is, the medical community can't as a whole support / endorse those alternative modalities if there's no proven efficacy to back them up.

And the mentality along the lines as that of "tempest" is what is preventing the advancement of our profession's principles. That mentality, along with the rare few than actually believe all the cranial hooplah, as well as the AOA big-whigs that fear any modification of our beliefs and practices will cast doubts on the profession as a whole.

Regardless of what the majority of DOs believe, the AOA will continue to protect the identity of the profession at the expense of actualy utility to the patient.

I do agree that we need need evidence to substantiate what we do but evidence involves multi-level assessments of data. Aside from the accepted RCTs or other levels of quality regarding research studies, often discussed as an afterthought is the practitioner's clinical judgement.

The issue becomes if a doctor finds a procedure such as cranial offers a patients a positive outcome and the treatment ends up being patient centered and patient driven, how much will extensive research studies fit into the determination of the clinical intervention. Particularly a clinical intervention such as cranial that offers low risk and appears to offer some benefit.

Clinical judgement is what has allowed for the grandfathering or off label use of medications. Within the healthcare community this type of clinical judgement is commonly accepted with a wink and a nod. Is cranial being held to different standard?

On the other hand I do understand the frustration about learning something you will likely never use and then being tested on it in order to be licensed.

NoBarsHeld said:

I do agree that we need need evidence to substantiate what we do but evidence involves multi-level assessments of data. Aside from the accepted RCTs or other levels of quality regarding research studies, often discussed as an afterthought is the practitioner's clinical judgement.

The issue becomes if a doctor finds a procedure such as cranial offers a patients a positive outcome and the treatment ends up being patient centered and patient driven, how much will extensive research studies fit into the determination of the clinical intervention. Particularly a clinical intervention such as cranial that offers low risk and appears to offer some benefit.

Clinical judgement is what has allowed for the grandfathering or off label use of medications. Within the healthcare community this type of clinical judgement is commonly accepted with a wink and a nod. Is cranial being held to different standard?

On the other hand I do understand the frustration about learning something you will likely never use and then being tested on it in order to be licensed.

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The only problem is that good results are not consistently reproducible; what works for one patient might not work for another, and even if it does work, there's no guarantee it's not a placebo.

Bottom line: patients claim the efficacy of chiropractic, acupuncture, massage, etc...the list goes on and on. The difference is that physicians are supposed to employ discriminitory judgements based on definite reproducible results. If not, we tell the patient that we can't as physicians give a battery of alternative medicines, but they're welcome to try what they want to (ie, we don't say, "well, let's try acupuncture and if that doesn't work we'll get some magnets...").

I'm not saying all those alternative medicine modalities are wrong (though certainly some to many of them are); I'm saying it's not the role of physicians to employ them unless they meet certain criteria and are reproducible on a consistent basis.

Perhaps you fail to recognize that not every physician plans to practice purely evidence-based medicine. Perhaps some will choose to practice empirically as well as in an evidence-based world view.

My question is, does the treatment WORK? Does the patient subjectively feel better? Is their quality of life improved?

If any treatment allows the patient to enjoy an improved quality of life, then it WORKS for them.

Not every patient who walks into your office will want another prescription. As my mentor stated today, evidence-based medicine works for POPULATIONS, empiric medicine works for INDIVIDUALS.

In order to be a physician, I must practice within the accepted scope of the standard of care set forth by my profession and within the guidelines of my area of specialty. Fortunately for me, cranial osteopathy is an accepted standard of care for patients I will treat. I will choose to utilize it when it is appropriate and perhaps helpful to the patient.

Your opinion and mileage may vary, but the ability to use cranial and omm techniques is the reason that I chose to attend an osteopathic school.

Not everyone is interested in surgery, peds, ob or medicine. Not everyone is interested in using omm or learning cranial. So, again, if you ARE NOT INTERESTED in using cranial techniques, then DON'T. If all you want to practice is evidence-based medicine, then by all means, do so. But stop telling me that my profession appears *less than* other doctors, meaning MD's, because of cranial.

tempest_fugit said:

Perhaps you fail to recognize that not every physician plans to practice purely evidence-based medicine. Perhaps some will choose to practice empirically as well as in an evidence-based world view.

My question is, does the treatment WORK? Does the patient subjectively feel better? Is their quality of life improved?

If any treatment allows the patient to enjoy an improved quality of life, then it WORKS for them.

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I saw a patient today on my cardiology rotation who swore up and down that drinking 3 shots of Jack Daniels in a row corrected her atrial fib. Does this mean I will recommend or even mention that to any future? Of course not.

tempest_fugit said:

In order to be a physician, I must practice within the accepted scope of the standard of care set forth by my profession and within the guidelines of my area of specialty. Fortunately for me, cranial osteopathy is an accepted standard of care for patients I will treat. I will choose to utilize it when it is appropriate and perhaps helpful to the patient.

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According to whom is cranial standard of care and for which patients?
Standard of care is mostly based on empirical evidence which for cranial there is none.

tempest_fugit said:

Not every patient who walks into your office will want another prescription. As my mentor stated today, evidence-based medicine works for POPULATIONS, empiric medicine works for INDIVIDUALS.


Your opinion and mileage may vary, but the ability to use cranial and omm techniques is the reason that I chose to attend an osteopathic school.

Not everyone is interested in surgery, peds, ob or medicine. Not everyone is interested in using omm or learning cranial. So, again, if you ARE NOT INTERESTED in using cranial techniques, then DON'T. If all you want to practice is evidence-based medicine, then by all means, do so. But stop telling me that my profession appears *less than* other doctors, meaning MD's, because of cranial.

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Not practicing cranial does not a poor DO make, practicing medicine without proof of it's merit and blindly accepting that which has never been proven makes poor physicians.

FutureNavyDOc said:

Not practicing cranial does not a poor DO make, ....

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How true a quote such wise Yoda...

Not practicing cranial does not a poor DO make, practicing medicine without proof of it's merit and blindly accepting that which has never been proven makes poor physicians.

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Blind acceptance?

HMMM. Do you know how to do much more besides blindly insult others?

I am open to dialogue with a colleague. I am not open to insult.

The proof and the merit is in the entire interaction with the patient. It has to do with the physician-patient relationship and is much more involved than simply putting my hands on the patient's head and then blindly believing that what I am doing will help. I don't believe in cranial. I know that it is helpful. I have had patients who have been helped by it.

I will try, one last time, to make MY point. I don't care if you think cranial is bull****. If you don't find it useful, don't learn it. But stop insulting your colleagues who want to learn it. It is within my scope of practice because it is a treatment modality that is taught to osteopathic students. And I don't think that a person is a *bad* DO if they don't use cranial or omm. But stop thinking that folks are "poor physicians" if *they* choose to use it.

BTW: If Jack Daniels stops a fib and works for the patient, then it probably is safer than cardioversion or antiarrythmics.

tempest_fugit said:

Blind acceptance?

HMMM. Do you know how to do much more besides blindly insult others?

I am open to dialogue with a colleague. I am not open to insult.

The proof and the merit is in the entire interaction with the patient. It has to do with the physician-patient relationship and is much more involved than simply putting my hands on the patient's head and then blindly believing that what I am doing will help. I don't believe in cranial. I know that it is helpful. I have had patients who have been helped by it.

I will try, one last time, to make MY point. I don't care if you think cranial is bull****. If you don't find it useful, don't learn it. But stop insulting your colleagues who want to learn it. It is within my scope of practice because it is a treatment modality that is taught to osteopathic students. And I don't think that a person is a *bad* DO if they don't use cranial or omm. But stop thinking that folks are "poor physicians" if *they* choose to use it.

BTW: If Jack Daniels stops a fib and works for the patient, then it probably is safer than cardioversion or antiarrythmics.

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Oh get over yourself--this isn't about some angry DOs picking on some fellow DOs for doing cranial. This is about physicians who are concerned with the efficacy of certain treatment modalities and the honesty of a profession that would rather maintain its integrity than evaluate true benefit to the patient.

The unwavering endorsement of cranial goes hand-in-hand with the AOAs insistent proclamations that DOs are more caring physicians...that DOs are better doctors. It's the whole stubborn, good-ol-boy mentality that is more loyal to historic ideas than practical ones.

The AOA preserves itself at all costs, and in order to maintain absolute autonomy it separates itself in every way possible from the rest of medicine (which is mainly in the form of testing / certification / superficial claims--eg. "we treat the patient, not the disease."), while at the same time, we assimilate into an allopathic world...their board exams, their residencies...
It is hypocrisy to embrace MDs cordially, then when the doors close, whisper to each other, "We're better then them..."

As for your desire to do cranial...
Should the AMA endorse magnetic therapy because a handful of MDs want to practice it and a certain patient population wants to receive it?

Are the AMA and AOA bound to endorse the every whim of patients across the country, whether it be cranial, acupuncture, magnets, whatever...?

It is not the act of YOU performing cranial I object to; it is the official endorsement of cranial by the AOA as a treatment modality.

homeboy...another very important question along those lines is...should those untested, unproven, yet some "feel" it might help topics make up a larger percent of our *boards* than some other minor topic like...cardiovascular disease, cancer, or diabetes?
i object to the fact that anything cranial shows up on our boards at all...let alone outnumber the biggest killer in america!!!

Seems to me that there are two separate issues here:

1. The level or relevance or importance to material to be tested on for board examinations. This can be extremely frustrating since obviously diabetes, cancer, and cardiac related conditions should take precedence over any cranial related questions. I also do not see the need to include cranial questions other then specific current anatomy or physiology questions.

2. On the other hand the issue of evidence of the efficacy of cranial care is a different subject. Any manually related clinical intervention will have some degree of question to its reliability and validity, since sham treatments are so difficult to perform. It seems at this time instead of focusing on reliability it is more about focusing on mounting clinical studies that investigate the phenomena of cranial diagnosis and treatment. [1,2]

The level of evidence for cranial care is one that is sufficient to use in practice, teach in the colleges and offer in postgraduate seminars, however I do not believe it is sufficient to warrant being part of a board examination, as a substitute for important information related to diabetes, cancer or cardiovascular related conditions.

1. Nelson KE, Sergueef N, Glonek T. The effect of an alternative medical procedure upon low-frequency oscillations in cutaneous blood flow velocity. J Manipulative Physiol Ther. 2006 Oct;29(8):626-36.

2. Cutler MJ, Holland BS, Stupski BA, Gamber RG, Smith ML. Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: a pilot study. J Altern Complement Med. 2005 Feb;11(1):103-8.

You know there are many things in medicine that are questionable, Cranial is not at the top of the list.

thanks for pointing that out maybe I'm just well read on the subject, I guess even if you are you can't know anything about it because only by taking a class can you learn anything. Doing research on it doesn't count. There are many questionable aspects of our current medical profession that injur and or even kill thousands every year, how many people has cranial killed?

czanetti said:

There are many questionable aspects of our current medical profession that injur and or even kill thousands every year, how many people has cranial killed?

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At the very least, This person:

http://www.chirobase.org/16Victims/gallagher.html

Cranial is not at the top of the list of things that are questionable in medicine because there is a concensus in the medical community that, without question, cranial therapy is NOT a legitimate modality for diagnosing or treating disease. There is no controversy on this in the real world.

EBM incorporates all aspects of "evidence" from RCTs to case reports and from biological plausibility to the practitioner's clinical judgement.


There is no question that cranial procedures are relatively safe, particularly compared to other more invasive procedures [1]. To use one case posted on chirobase relating to a practitioner with questionable clinical ethics, and then extrapolate that to a whole method of care is inappropriate. Gallagher reportedly told the patient to go off all anti-seizure medications and when the patient became virtually unconscious as her seizures increased during care told the parents it was a healing crisis. That has nothing to do with cranial but everything to do with abominable clinical ethics.

Whether you agree with cranial or not there has been some evidence [2] that at the very least warrants cranial greater study and supports some of what clinicians using this method of care in their practice, report.

1. Greenman PE, McPartland JM Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome J Am Osteopath Assoc 1995;95(3): 182.

2. Blum CL, Cuthbert S, Cranial Therapeutic Care: Is There any Evidence?, Journal of Chiropractic and Osteopathy, 2006; 14(10).

NoBarsHeld said:

EBM incorporates all aspects of "evidence" from RCTs to case reports and from biological plausibility to the practitioner's clinical judgement.

[RE: "There are many questionable aspects of our current medical profession that injur and or even kill thousands every year, how many people has cranial killed?"

"At the very least, This person:

http://www.chirobase.org/16Victims/gallagher.html

"Cranial is not at the top of the list of things that are questionable in medicine because there is a concensus in the medical community that, without question, cranial therapy is NOT a legitimate modality for diagnosing or treating disease. There is no controversy on this in the real world."]​

There is no question that cranial procedures are relatively safe, particularly compared to other more invasive procedures [1]. To use one case posted on chirobase relating to a practitioner with questionable clinical ethics, and then extrapolate that to a whole method of care is inappropriate. Gallagher reportedly told the patient to go off all anti-seizure medications and when the patient became virtually unconscious as her seizures increased during care told the parents it was a healing crisis. That has nothing to do with cranial but everything to do with abominable clinical ethics.

Whether you agree with cranial or not there has been some evidence [2] that at the very least warrants cranial greater study and supports some of what clinicians using this method of care in their practice, report.

1. Greenman PE, McPartland JM Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome J Am Osteopath Assoc 1995;95(3): 182.

2. Blum CL, Cuthbert S, Cranial Therapeutic Care: Is There any Evidence?, Journal of Chiropractic and Osteopathy, 2006; 14(10).

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You're right, in that the link I posted clearly does not demonstrate that cranial directly results in harm. But I think it does demonstrate that people who are zealous about cranial manipulation are probably more likely to reject mainstream medicine in favor of quackery. (Like using Jack Daniels to treat atrial fibrillation, because of its safety(!) profile no less. )

But I think there is more harm in cranial beyond just patient safety. When insurance companies reimburse for this, they are wasting money on unproven (and, some would argue, scientifically implausible) therapy. This kind of wasteful spending drives up the cost of healthcare and makes it less accessible to the population as a whole. When you see enough self-employed (and unable to afford insurance) 50-something year olds who develop colon cancer within 10 years that could have been detected earlier by routine screening colonoscopy, you start to take a dim view on wasteful healthcare spending.

And believe me, if doctors weren't getting paid for it, they would not be doing it. If patients want to pay out of pocket, then I have no problem with it. But I am sure some D.O.'s regularly bill insurance for cranial and do get paid. This is what is borderline unethical.

McDoctor said:

You're right, in that the link I posted clearly does not demonstrate that cranial directly results in harm. But I think it does demonstrate that people who are zealous about cranial manipulation are probably more likely to reject mainstream medicine in favor of quackery.

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We need to be extremely cautious how we look at unscrupulous practitioners and not extrapolate that behavior to a method or intervention. Can you substantiate your statement by studies published in the peer review literature noting a relationship between doctors using cranial manipulative protocols and patient harm, that is greater than what is found in the general healthcare population?

McDoctor said:

But I think there is more harm in cranial beyond just patient safety. When insurance companies reimburse for this, they are wasting money on unproven (and, some would argue, scientifically implausible) therapy. This kind of wasteful spending drives up the cost of healthcare and makes it less accessible to the population as a whole. When you see enough self-employed (and unable to afford insurance) 50-something year olds who develop colon cancer within 10 years that could have been detected earlier by routine screening colonoscopy, you start to take a dim view on wasteful healthcare spending.

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Unreasonable diagnosis and treatment in my experience do not equate to cranial manipulative protocols in the therapeutic environment but faulty patient care delivered by the practitioner. Again I would be extremely cautious not to mix apples and oranges. When you consider insurance companies and payment for care rendered you must consider what alternative care might be rendered for the same procedure. What are the risk benefit ratios for that care? I would estimate that cranial care, if it is covered by the insurance company, makes a very small percentage of anything paid out in comparison for the alternative types of care for the same condition.

If finances were the issue for the practitioner then cranial manipulative care would be a poor choice, since it is time consuming and more money could be made in shorter times with other modalities of care.

McDoctor said:

And believe me, if doctors weren't getting paid for it, they would not be doing it. If patients want to pay out of pocket, then I have no problem with it. But I am sure some D.O.'s regularly bill insurance for cranial and do get paid. This is what is borderline unethical.

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My experience is that most cranial care is patient driven and that insurance reimbursement has a very small part of any incentive for the patient. RE: "When insurance companies reimburse for this, they are wasting money on unproven (and, some would argue, scientifically implausible) therapy." This is a very strong statement and warrants some clarity on your part as to what do you mean by "unproven?" I would recommned reviewing the following web-page: "What proportion of healthcare is evidence based? Resource Guide?"

Also there has been sufficient clinical studies and biologically plausible investigations into the field of cranial manipulation that the term "unproven" or "scientifically implausible" suggests someone who has not fully read the literature and personally investigated the clinical application. While there have been more studies published since the publication of the prior article I referenced, these references from the table, will give you something to review for issues of plausibility and clinical evidence (the journal is open assess so sharing of the following information is within legal boundaries):

Biological Plausibility and Efficacy of Treatment.

Cuthbert S. Motion Sickness Disorder: A Review, Treatment Strategy, and Case Series Report J Chiro Med Spring 2006.

Nelson KE, Sergueef N. Recording the Rate of the Cranial Rhythmic Impulse J Am Osteopath Assoc, Jun 2006;106(6): 337-41.

Sergueef N, Nelson KE, Glonek T., Palpatory diagnosis of plagiocephaly. Complement Ther Clin Pract. 2006 May;12(2):101-10. Epub 2006 Mar 29.

Lancaster DG, Crow WT. Osteopathic Manipulative Treatment of a 26-Year-Old Woman With Bell's Palsy J Am Osteopath Assoc May 2006; 106(5):285-89.

Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complement Ther Clin Pract. 2006 May;12(2):83-90. Epub 2006 Feb 8.

Cuthbert S., Blum C Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment J Manipulative Physiol Ther. 2005 May;28(4):e1-6.

McPartland JM, Giuffrida A, King J, Skinner E, Scotter J, Musty RE. Cannabimimetic effects of osteopathic manipulative treatment. J Am Osteopath Assoc. 2005 Jun;105(6):283-91.

Cutler,M.J.Holland, B.S.; Stupski, B.A.; Gamber, R.G.; Smith, M.L. Cranial manipulation can alter sleep latency and sympathetic nerve activity inhumans: a pilot study. Journal of Alternative and Complementary Medicine 2005;11(1):103-8.

Pederick F. Cranial and Other Chiropractic Adjustments in the Conservative Treatment of Chronic Trigeminal Neuralgia: A Case Report Chiro J Aust, 2005; 35:9-15.

Cook, A. The mechanics of cranial motion—the sphenobasilar synchondrosis (SBS) revisited Journal of Bodywork and Movement Therapies 2005;9(3):177-188.

Sabini RC, Elkowitz DE. Patency and Obliteration of the Cranial Sutures: Is There a Clinical Significance? J Am Osteopath Assoc, Jan 2005;105(1):25.

Quezada D Chiropractic care of an infant with plagiocephaly Journal of Clinical Chiropractic Pediatrics, 2004;6(1):342-8.

Vallone S. Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction in Infants Demonstrating Difficulty Breastfeeding Journal of Clinical Chiropractic Pediatrics, 2004; 6(1):349-61.

Nelson, K.E.; Sergueef, N.; Glonek, T. Cranial Manipulation Induces Sequential Changes in Blood Flow Velocity on Demand The American Academy of Osteopathy Journal 2004;14(3):15-7.

Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H. The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation Cranio. 2003 Jul;21(3):202-8.

King HH, Tettambel MA, Lockwood MD, Johnson KH, Arsenault DA, Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design J Am Osteopath Assoc. 2005 Jun;105(6):283-91.

Cuthbert S. Applied Kinesiology and Down Syndrome: a Study of Fifteen Cases The International Journal of Applied Kinesiology and Kinesiologic Medicine, 2003;16:16-21.

Sergueef, N.; Nelson, K.E.; Glonek, T. Cranial manipulation induces sequential changes in blood-flow velocity, on demand Journal of the American Osteopathic Association 2003;103(8):380.

Blum, C.L. Chiropractic Treatment of Mild Head Trauma: A Case History Proceedings of the 2002 International Conference on Spinal Manipulation. 2002.

Rivera-Martinez, S., Wells, M., Capobianco, J. A retrospective study of cranial strain patterns in patients with idiopathic Parkinson’s disease Journal of the American Osteopathic Association, August 2002;102(8):417-422.

Oleski, S, Smith G, Crow W Radiographic Evidence of Cranial Bone Mobility Cranio: The Journal of Craniomandibular Practice; Jan 2002;20(1):34-8.

Cuthbert S. An applied Kinesiology evaluation of facial neuralgia: A case history of Bell’s palsy The International Journal of Applied Kinesiology and Kinesiologic Medicine Summer 2001:42-45.

Sergueef, N.; Nelson, KE.; Glonek, T. Changes in the Traube-Herring Wave Following Cranial Manipulation The American Academy of Osteopathy Journal 2001;11(1):17.

Farasyn, A.; Vanderschueren, F. The Decrease of the Cranial Rhythmic Impulse During Maximal Physical Exertion: an Argument for the Hypothesis of Venomotion? Journal of Bodywork and Movement Therapies 2001;5(1):56-69.

Holtrop DP. Resolution of suckling intolerance in a 6-month-old chiropractic patient J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):615-8.

Funk, SL. Osteopathic Manipulative Treatment and Down Syndrome The American Academy of Osteopathy Journal 2000;10(2):36-7.

Miller RI, Clarren SK. Long-term developmental outcomes in patients with deformational plagiocephaly Pediatrics, 2000 Feb;105(2):E26.

Hewitt EG. Chiropractic Care For Infants with Dysfunctional Nursing: A Case Series Journal of Clinical Chiropractic Pediatrics. 1999 May ; 4(1): 241-4.

Blum CL. Cranial Therapeutic Treatment of Down’s Syndrome Chiropractic Technique, May 1999; 11(2): 66-76.

Moskalenko YE, Kravchenko TI, Gaidar BV, Vainshtein GB, Semernia VN, Maiorova NF, Mitrofanov VF The periodic mobility of the cranial bones in man Fiziol Cheloveka, 1999 Jan-Feb;25(1):62-70.

Drengler KE, King HH Inter-examiner reliability of palpatory diagnosis of the cranium Journal of the American Osteopathic Association 1998;98(7): 387.

Blum CL. Spinal/Cranial Manipulative Therapy and Tinnitus: A Case History Chiropractic Technique, Nov 1998;10(4):163-8.

Pick MG Spinal-cranial morphology and physiology: A review of the relationships between osseous, meningeal and neuronal structures and their role in the cranio-sacral respiratory rhythms Association of Swiss Chiropractors Conference: BŸrgenstock Hotels and Resorts : September 18, 1998.

Pick MG Anatomy & physiology of cranial motion: A look into the various intercranial rhythmic motions and their effects upon the brain, meninges and cranial bones Association of Swiss Chiropractors Conference: BŸrgenstock Hotels and Resorts : September 18, 1998.

Pick MG Cranial palpation: Hand utilization techniques & cranial rhythmic identification Association of Swiss Chiropractors Conference: BŸrgenstock Hotels and Resorts : September 18, 1998.

Pick MG Morphology of the cranial vault sutures: A comprehensive description of the vault sutures interarticular unions and developing a working knowledge toward their manipulative strategies Association of Swiss Chiropractors Conference: BŸrgenstock Hotels and Resorts : September 18, 1998.

Connelly DM, Rasmussen SA The effect of cranial adjusting on hypertension: a case report Chiropractic Technique, Aug 1998;10(2):75-78.

Blum CL, Curl DD The Relationship Between Sacro-Occipital Technique and Sphenobasilar Balance. Part Two: Sphenobasilar Strain Stacking Chiropractic Technique, Aug 1998; 10(3): 101-107.

Blum CL, Curl DD The Relationship Between Sacro-occipital Technique and Sphenobasilar Balance. Part One: the Key Continuities Chiropractic Technique, Aug 1998;10(3): 95-100.

Moskalenko YE The phenomenology and mechanisms of cranial bone fluctuations Paper Presented at Proceedings of 1st Russian Symposium St. Petersburg, Russia, May 27-29, 1998.

Lockwood MD. Cycle-to-cycle variability attributed to the primary respiratory mechanism. Journal of the American Osteopathic Association 1998;98(1):35-6 and 41-3.

Myers R. Measurement of small rhythmic motions around the human cranium in vivo Australian J of Osteopathy 1998;9(2):6-13.

Van Loon M. Colic With Projectile Vomiting: A Case Study Journal Of Clinical Chiropractic Pediatrics. 1998 Aug; 3(1): 207-10.

Drangler, KE.; King, HH. Interexaminer Reliability of Palpatory Diagnosis of the Cranium J Am Osteo Assoc 1998;98(7):387.

Pederick FO A Kaminski-type evaluation of cranial adjusting Chiropractic Technique, Feb 1997;9(1): 1-15.

Chaitow L. Review of aspects of cranio-sacral theory. British Osteopathic Journal 1997:14-22

Sanders GE, Unger JF Cranial Distortion and Category II Pelvic Blocking – A Pilot Study: Poster Presentation (Diagnostic Sciences) Proceedings of the Scientific Symposium - 1997 World Chiropractic Congress: Tokyo, Japan Jun 6-8, 1997: 252.

Ulrich, RG. Osteopathic Manipulative Treatment of Bell's Palsy The American Academy of Osteopathy Journal 1997; 7(3):28-9.

Greenman PE, Mein EA, Andary M Craniosacral manipulation Physical Medicine and Rehabilitation Clinics of North America 1996;7(4):877-96.

Zanakis MF, Zaza W, Zhao H, Morgan R, Schatzer M Objective measurements of the cranial rhythmic impulse in children [abstract] The American Academy of Osteopathy Journal 1996;96(9) 552.

Zanakis MF, Zhao H, Schatzer M, etal, Studies of the cranial rhythmic impulse in man using a tilt table [abstract] The American Academy of Osteopathy Journal 1996;96(9)552.

Zanakis MF, Dimeo J, Madonna S, Morgan M, Drasby E. Objective measurement of the CRI with manipulation and palpation of the sacrum Journal of the American Osteopathic Association 1996;96(9):551.

Zanakis MF, Marmora M, Morgan M, Lewandoski MA Application of the CV4 technique during objective measurement of the CRI Journal of the American Osteopathic Association 1996;96(9):552.

Lewandoski MA, Drasby E, Morgan M, Zanakis M Kinematic system demonstrates cranial bone movement about the cranial sutures J Am Osteopath Assoc, 1996;96(9):551.

Zanakis MF, Morgan M, Storch I, et al. Detailed study of cranial bone motion in man J Am Osteo Assoc. 1996;96(9):552.

Opperman LA, Passarelli RW, Morgan EP, Reintjes M, Ogle RC. Cranial sutures require tissue interactions with dura mater to resist osseous obliteration in vitro J Bone Miner Res, 1995 Dec;10(12):1978-87.

Madeline LA, Elster AD. Suture closure in the human chondrocranium: CT assessment. Radiology 1995;196:747-56

Upledger J. Research and observations support the existence of a craniosacral system. Alternative Medicine Journal 1995;2(5):31-43.

Moskalenko YE, Kravchenko T, Chervotok A, Sharapov K. Bioengineering support of the cranial osteopathy treatment Med Biol Eng Comput. 1995;34:185-186.

Phillips CJ, Meyer JJ, Chiropractic Care, Including Craniosacral Therapy, During Pregnancy: A Static-Group Comparison of Obstetric Interventions during Labor and Delivery Journal of Manipulative and Physiological Therapy 1995 Oct ;18(8): 525-9.

Chinappi AS, Getzoff H. The Dental-Chiropractic Cotreatment of Structural Disorders of the Jaw and Temporomandibular Joint Dysfunction Journal of Manipulative and Physiological Therapeutics, Sep 1995; 18(7): 476-81.

Folweiler DS, Lynch OT. Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches J Manipulative Physiol Ther. 1995 Jan;18(1):38-41.

Pick M. A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain J Manipulative Physiol Ther. 1994;17(3).

Phillips CJ, Chiropractic and Pediatrics Cranial Compression and Distraction: a Possible Implication in Otitis Media Proceedings of the 1994 International conference on Spinal Manipulation: Palm Springs, California Jun 10-11, 1994: 136-39.

Degenhardt BF, Kuchera ML. The prevalence of cranial dysfunction in children with a history of otitis media from kindergarten to third grade. Journal of the American Osteopathic Association 1994;94:754.

Manley P. Cranial osteopathy and the infantile craniopathies. Journal of Naturopathic Medicine 1994;5(1):80-1.

Zanakis MF, Cebelenski RM, Dowling D, Lewandoski MA, Lauder CT, Kircher BA, Hallas BH. The cranial kinetogram: objective quantification of cranial mobility in man. Journal of the American Osteopathic Association 1994;94(9):761.

Pick M. A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain J Manipulative Physiol Ther. 1994;17(3)

Miyasaka-Hiraga J, Tanne K, Nakamura S. Finite element analysis for stresses in the craniofacial sutures produced by maxillary protraction forces applied at the upper canines Br J Orthod. 1994 Nov;21(4):343-8.

Heisey, SR, Adams, T. Role of cranial bone mobility in cranial compliance Neurosurgery, 1993;33(5):869-876.

Fredrick DR, Mulliken JB, Robb RM. Ocular manifestations of deformational frontal plagiocephaly J Pediatr Ophthalmol Strabismus. 1993 Mar-Apr;30(2):92-5.

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

Opperman LA, Sweeney TM, Redmon J, Persing JA, Ogle RC. Tissue interactions with underlying dura mater inhibit osseous obliteration of developing cranial sutures Developmental Dynamics 1993;1(98):312-322.

Gregory, TM Temporomandibular Disorder Associated with Sacroiliac Sprain, Journal of Manipulative and Physiological Therapeutics, May 1993; 16(4): 256-65.

Biedermann H. Kinematic imbalances due to suboccipital strain J Man Med, 1992;31:92-95.

Bilkey WJ Cranial suture manipulation in the treatment of torticollis J Man Med 1992;6:212-214.

Vail B, Evaluation and Cranial Treatment of the Pediatric Patient With Sagittal Suture Synostosis: A Case Report Proceedings Of The National Conference On Chiropractic 1993 Oct: 58-63.

Gitlin, R.; Wolf, D. Uterine Contractions Following Osteopathic Cranial Manipulation - A Pilot Study Journal of the American Osteopathic Association 1992;92(9):1183.

Kostopoulos, D., Keramidas, G. Changes in Magnitude of Relative Elongation of the Falx Cerebri During the Application of External Forces on the Frontal Bone of an Embalmed Cadaver Journal of Craniomandibular Practice, January 1992.

Adams T, Heisey RS, Smith MC, Briner BJ Parietal bone mobility in the anesthetized cat J Am Osteopath Assoc, 1992 May;92(5):599-600, 603-10, 615-22.

Patterson MM. Study demonstrates cranial bone mobility. Journal of the American Osteopathic Association 1992;92(5):589.

Braun BL. Postural differences between asymptomatic men and women and craniofacial pain patients Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.

Principato JJ. Upper airway obstruction and craniofacial morphology Otolaryngol Head Neck Surg. 1991 Jun;104(6):881-90.

Blum C. Cranial therapeutic approach to cranial nerve entrapment Part II: Cranial nerve VII. ACA J Chiropract 1990;27(7):108.

Carruthers R. An integrated approach to children with Down’s Syndrome - a conference report. British Osteopathic Journal 1990. IV. 18-21.

The unanimous ruling of the Appellate Court in favor of W.M. Raemer, D.D.S., States that cranial therapy is an effective form of treatment for TMJ dysfunction. As such, it was ruled that dentists in Colorado are allowed to use cranial therapy for treatment in the scope of their practice. The Colorado Board of Medical Examiners vs. W.M. Raemer, D.D.S. Court of Appeals, State of Colorado, Case No. 87CA1589, March 22, 1990.

Jaslow CR Mechanical properties of cranial sutures J Biomech 1990;23(4):313-321.

Retzlaff E Cranial bones and their sutures in primates, including humans- research report. Journal of the American Osteopathion Association 1987;87(10):699-700.

Flanagan, M. The Relationship Between CSF and Fluid Dynamics in the Neural Canal J Manipulative Physiol Ther, Dec 1988;11(6):489-92.

Blum C. Cranial therapeutic approach to cranial nerve entrapment Part I: Cranial nerves III, IV, and VI. ACA J Chiropract 1988;22(7):63-67.

Blum C Spinal/cranial manipulative therapy and tinnitus: a case history Chiropractic Technique 1988;10(4):163-167.

Weiner LB, Grant LA, Grant AH. Monitoring ocular changes that may accompany use of dental appliances and/or osteopathic craniosacral manipulations in the treatment of TMJ and related problems. Cranio. 1987 Jul;5(3):278-85.

Whineray G. An investigation into the efficacy of cranial manipulation for cephalgia. Journal of the New Zealand Register of Osteopaths 1987;1(1):10-11.

Blum C. The effect of movement, stress and mechanoelectric activity within the cranial matrix Int J Orthodontics 1987;25(1-2): 1-8.

Blood SD The craniosacral mechanism and the temporomandibular joint Journal of the American Osteopathic Association 1986;86:512-9.

Gillespie B. Dental Considerations of Craniosacral Mechanism J. Craniomandibular Pract. December 1985;3:381-84.

Blum CL Biodynamics of the Cranium: A Survey The Journal of Craniomandibular Practice, Mar/May 1985: 3(2):164-71.

Carlson GE. Long term effects of treatment of craniomandibular disorders Craniomandibular Pract. Sept 1985;3(4):337-42.

Hussar CJ, Retzlaff EW, Mitchell FL Jr, Kalbfell JJ, Briner BJ Combined osteopathic and dental treatment of cephalgia Journal of the American Osteopathic Association 1985;85:605-6.

White WK, White JE, Baldt G. The relation of the craniofacial bones to specific somatic dysfunctions: a clinical study of the effects of manipulation Journal of the American Osteopathic Association 1985;85:603-604.

Retzlaff EW, Mitchell FL Jr, Walsh J, Wendecker A. The role of cranial ligaments in primates Anat Rec 1985;211:159-60.

Retzlaff EW, Mitchell FL Jr, Hussar C, Walsh J. The role of the Vth cranial nerve in the TMJ syndrome Anat Rec 1983;205:161A.

Frymann VM. Cranial osteopathy and its role in disorders of the temporomandibular joint. Dent Clin North Am. 1983 Jul;27(3):595-611.

Karni Z, Upledger JE, Mizrahi J, Heller L, Becker E, Najenson T Examination of the cranial rhythm in long-standing coma and chronic neurological cases In Text: Upledger JE, Vredevoogd JD, Craniosacral Therapy, Eastland Press, Seattle, WA, 1983:275-81.

Upledger JE, Vredevoogd JD. Examination of the cranial rhythm in long-standing coma and chronic neurologic cases In Craniosacral Therapy. Eastland Press, Seattle. 1983:275-281.

Cope M Calibration of a device for the measurement of the cranial rhythmic impulse - research report. Journal of the American Osteopathic Association, 1983;8(3):1-69.

Jones L, Retzlaff E, Mitchell FL Jr., Upledger J, Walsh J. Significance of nerve fibers interconnecting cranial suture vasculature, the superior sagittal sinus, and the third ventricle. Journal of the American Osteopathic Association 1982;82:113.

Libin B. Occlusal Changes Related to Cranial Bone Mobility International Journal of Orthodontics, 20(1), March 1982

Harakal JH Dissection offers proof of Sutherland’s concept JAOA. Oct 1982;82:87.

Retzlaff EW, Mitchell FL Jr, Upledger J Efficacy of cranial sacral manipulationL the physiological mechanism of the cranial sutures J Soc Osteopath 1982-83;12:8-12.

Retzlaff EW, Mitchell FL Jr, Upledger JE, Efficacy of cranial sacral manipulation: the physiological mechanism of the cranial sutures. Journal of the Society of Osteopaths 1982-83;12:8-13.

Peterson, K A Review of Cranial Mobility, Sacral Mobility, and Cerebrospinal Fluid Journal of the Australian Chiropractic Association. 1982 Apr ; 12(3): 7-14.

Younoszai R, Frymann VM, Bordell BE, et al. Effects of temporal manipulation on respiration JAOA. Jul 1981;80:751-RES.

Mitchell FL Jr, Brooks HD, Bunnel WB. You can help children with scoliosis Patient Care Apr 1981; 30.

Heifitz, MD, Weiss M. Detection of skull expansion with increased cranial pressure J Neurosurg, 1981;55:811-812.

Retzlaff EW, Mitchell FL Jr, Upledger J Nerve fibers present within the parietal cranial bones of primates. Journal of the American Osteopathic Association 1981;80:753-754.

Retzlaff EW, Mitchell FL Jr., Upledger J, Vredevoogd J, Walsh J. Light and scanning microscopy of nerve fibers within the parietal bones of primates. Anat Rec 1981;199:21.

Retzlaff EW, Mitchell FL Jr, Upldeger JE, Vredevoogd J, Walsh J, Neurovascular mechanisms in cranial sutures - research report. Journal of the American Osteopathic Association 1980;80(3):218-9.

Upledger J, Vredevoogd JD, Retzlaff EW, Raynesford AK, Howeard TF Autistic children: preliminary physiologic, structural and craniosacral evaluations - research report. Journal of the American Osteopathic Association 1979;79(2):123.

Upledger JE, Karni S Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment Journal of the American Osteopathic Association 1979;78:782-91.

Retzlaff EW, Upledger J, Michell FL Jr, Walsh J, Aging of cranial sutures in humans Anat Rec 1979;193:663

Retzlaff EW, Upldeger JE, Mitchell FL Jr, Walsh J, Vredevoogd J, Age-related changes in human cranial sutures - research report. Journal of the American Osteopathic Association 1979;79(1):60-1.

Kokich VG, Shapiro PA, Moffett BC, Retzlaff EW. Craniofacial sutures. Aging in nonhuman primates New York: Van Nostrand Reinhold: 356-368, 1979.

Retzlaff EW, Mitchell FL jr, Upledger J, Biggert T Nerve fibers and endings in cranial sutures - research report. Journal of the American Osteopathic Association 1978;77(6):474-5.

Roppel RM, St Pierre N, Mitchell FL Jr, Measurement of accuracy in bimanual perception of motion Journal of the American Osteopathic Association 1978;77:475.

Tettambel M, Cicora RA, Lay EM Recording of the cranial rhythmic impulse - research report. Journal of the American Osteopathic Association 1978;78(2):149.

Upledger J. Mechano-electrically recorded physiological patterns which relate to subjectively reported craniosacral mechanism phenomena - research report. Journal of the American Osteopathic Association 1978;78(4):297.

Upledger JE The Relationship of Craniosacral Examination Findings in Grade School Children with Developmental Problems Journal of the American Osteopathic Association, June 1978; 77: 760/69 - 776/85.

Morey LW Jr Uses of cranial manipulative therapy Osteopath Med 1978;3:43-52.

Upledger JE, Retzlaff EW Cranial suture pain Second World Congress on Pain: Int Assoc Study Pain 1978;1:120.

Upledger JE Bioelectric and strain measurements during cranial manipulation. Journal of the Society of Osteopaths 1978;5:24.

Upledger JE. The relationship between craniosacral examination findings and the problems of special education students. Am Osteopath Assoc Res Conf, 1978.

Upledger JE The Reproducibility of Craniosacral Examination Findings: A Statistical Analysis Journal of the American Osteopathic Association, Aug 1977; 76: 890/67 - 899/76.

Lavitan S The whiplash syndrome in the light of the craniosacral mechanism J Clin Chiropract 1977;2:28.

Mitchell FL Jr. Voluntary and involuntary respiration and the craniosacral mechanism Osteopath Annals 1977;5:52-59.

Frymann VM. Learning Difficulties of Children Viewed in the Light of the Osteopathic Concept Journal of the American Osteopathic Association, Sept 1976; 76: 46-61.

Frymann VM The trauma of birth Osteopath Ann 1976;4:22-31.

Kokich VG Age changes in the human frontozygomatic suture from 20 to 95 years Am J Orthod, 1976 Apr;69(4):411-30.

Popevec JP, Biggert TP, Retzlaff EW, Histological techniques for cranial bone studies - research report. Journal of the American Osteopathic Association 1976;75(6):606-7.

St Pierre N, Roopel R, Retzlaff EW, The detection of relative movements of cranial bones Journal of the American Osteopathic Association 1976; 76:289.

Retzlaff EW, Michael DK, Roppel RM. Cranial bone mobility. J Am Osteopath Assoc, 1975 May;74(9):869-73.

Michael DK, Retzlaff EW A preliminary study of cranial bone movement in the squirrel monkey. Journal of the American Osteopathic Association 1975;74:866-880.

Magoun, HI Trauma – A neglected cause of cephalgia JAOA. Jan 1975;74:400-10.

Gelb H, Tarte J Two-year clinical dental evaluation of 200 cases of chronic headaches: The craniocervical –mandibular syndrome J Am Dent Assoc. Dec 1975;91(6):1230-6.

Lay EM. Osteopathic Management of Trigeminal Neuralgia JAOA. January 1975;74:373-89.

Brookes, D Indications for cranial therapy in general osteopathic practice. British Osteopathic Journal. 1973.6.2.25-8

Woods, R. Structural Normalization in Infants and Children with Particular Reference to Disturbances of the Central Nervous System Journal of the American Osteopathic Association, May 1973; 72: 903-908.

Retzlaff EW, Jones L, Mitchell FL Jr., Upledger J. Possible autonomic innervation of cranial sutures of primates and other mammals. Brain Research 1973;58:470-477.

Gelb H Review correlating the Medical-Dental Relationship in the Craniomandibular Syndrome NY J. Dent. 1971;41(5):163-75.

Magoun H. Pertinent Approach to Pituitary Pathology D.O. Magazine. July 1971;11(11):133-141.

Frymann VM A study of the rhythmic motions of the living cranium Journal of the American Osteopathic Association 1971;70:1-18.

Baker E. Alteration in Width of Maxillary Arch and its Relation to Sutural Movement of Cranial Bones Journal of the American Osteopathic Association, Feb 1971;70:559-564

Greenman PE. Roentgen Findings in the Craniosacral Mechanism Journal of the American Osteopathic Association, 1970;70:24-35.

Mitchell FL Jr, Pruzzo NA Investigation of voluntary and primary respiration mechanisms Journal of the American Osteopathic Association 1970:70:179-153.

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Magoun H. Entrapment neuropathy of the central nervous system. Part II. Cranial nerves I-IV, VI-VIII, XII. Journal of the American Osteopathic Association 1968;67(7);779-87.

Magoun H. Entrapment neuropathy of the central nervous system. Part III. Cranial nerves V, IX, X, XI. Journal of the American Osteopathic Association 1968;67(8):889-99.

Latham RA The sliding of cranial bones at sutural surfaces during growth. J Anat 1968;103:593.

Frymann VM. Relation of Disturbances of Craniosacral Mechanisms to Symptomatology of the Newborn, Study of 1,250 Infants Journal of the American Osteopathic Association, June 1966; 65: 1059-1075.

Frymann VM, Carney RE, Springall P. Effect of osteopathic medical management on neurological development in children. Journal of the American Osteopathic Association 1966;65: 1059-1075.

Woods JM, Woods RM Physical findings related to psychiatric disorders Journal of the American Osteopathic Association, Aug 1961;60.

Moss ML The pathogenesis of premature cranial synostosis in man. Acta Anat 1959;37:51-370.

Arbuckle B. Subclinical Signs of Trauma JAOA. November 1958; 58:160-66.

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Let me be clear that I am posting commentary and opinion when I say that doctors who practice cranial are more likely to provide flawed healthcare. I don't think there are any peer reviewed studies to validate this statement, nor do I know why one would invest time into devising such a study. I am speaking, as both a healthcare provider and consumer, that I would not want my family being treated by a craniosacral proponent. My opinion is bolstered, in part, by the clown in this very thread who claimed alcohol is a safer alternative therapy for atrial fibrillation than antiaarythmics or cardioversion.

I think your presumption that I am not well read on the subject is flawed. How would you possibly know the extent to which I have researched the subject? I am a fairly recent grad from DO school (2003), and certainly was exposed to the same basic principles of cranial osteopathy as you. And there is literature out there that exposes the scientific implausibility of these basic tenets. Not as much as (in quantity) as you have provided in argument for cranial, but then again the onus of proof is placed on those who claim the phenomenon exists.

I would direct you to:

Hartman SE and Norton JM Interexaminer Reliability and Cranial Osteopathy Scientific Review of Alternative Medicine 6(1):23-34, 2002.

This pretty much says it all. There was also a fairly comprehensive review published by the British Columbia Office of Health Technology Assessment (BCOHTA) in 1999 which concluded that the theory was invalid.

Furthermore, I think the biomedical implausibility of cranial osteopathy puts it into a different category than other mainstream treatment modalities that may also not technically be considered "evidence based". This is where you are comparing apples to oranges. It was scientifically plausible that prescribing statins to lower LDL cholesterol would lead to reductions in secondary events for patients with coronary disease, hence this was routinely done even before the evidence to back up this strategy came to fruition. The same scientific plausibility does not apply to cranial, not when so much peer reviewed evidence exists regarding the ossification and fusion of cranial bones in the medical literature.

I do respect your academic approach to cranial, NoBarsHeld, even though I don't agree with your conclusions. I would be interested in knowing for which specific conditions you think cranial is a valid therapeutic procedure. I'd also like to know if you think cranial should be marketed as strictly therapeutic, or preventative, or both, for said conditions. I know you have listed alot of varied case studies, but I'd like to know what you think, as an individual, regarding which diseases are best treated with cranial.

McDoctor said:

Let me be clear that I am posting commentary and opinion when I say that doctors who practice cranial are more likely to provide flawed healthcare. I don't think there are any peer reviewed studies to validate this statement, nor do I know why one would invest time into devising such a study. I am speaking, as both a healthcare provider and consumer, that I would not want my family being treated by a craniosacral proponent.

Click to expand...

I completely disagree, it is the duty of caring and responsible researchers to investigate any healthcare modality that has been used for decades and yet both is ineffective and causes harm through exhibiting "flawed" and delayed proper healthcare. At this time if there are no studies I would be circumspect with what I claimed.

McDoctor said:

My opinion is bolstered, in part, by the clown in this very thread who claimed alcohol is a safer alternative therapy for atrial fibrillation than antiaarythmics or cardioversion.

Click to expand...

I don't see how your opinion is bolstered in any way. Because there are pracitioners who make claims that may be irresponsible or based on wild unsubstantiated conclusions cannot be extrapolated to relate to any practitioner that uses cranial manipulation as a modality.

McDoctor said:

I think your presumption that I am not well read on the subject is flawed. How would you possibly know the extent to which I have researched the subject? I am a fairly recent grad from DO school (2003), and certainly was exposed to the same basic principles of cranial osteopathy as you. And there is literature out there that exposes the scientific implausibility of these basic tenets. Not as much as (in quantity) as you have provided in argument for cranial, but then again the onus of proof is placed on those who claim the phenomenon exists.

Click to expand...

The field of manipulation is fraught with poor reliabilitiy and validity yet still many claim clinical success. Some of this difficulty is based on the challenge of finding a sham procedure that has no effect, since often after the fact we later find that the sham does have some effect. You are completely correct that onus is upon those who make claim, and particularly extraordinary claims, to support those claims with proof. I would say what I presented offers preliminary studies that show that the field of cranial manipulation has some degree of evidence and is worthy of further study. I agree that at this time what I have offered is not conclusive "proof."

McDoctor said:

I would direct you to:

Hartman SE and Norton JM Interexaminer Reliability and Cranial Osteopathy Scientific Review of Alternative Medicine 6(1):23-34, 2002.

Click to expand...

If you follow their trends of publication you will see that being an open and investigative clinician does not seem to be in their current agenda.

Norton JM. Questioning of OCF should rouse osteopathic response. J Am Osteopath Assoc. 2000 Dec; 100(12):763-4.

Hartman SE. Cranial osteopathy: its fate seems clear. Chiropr Osteopat. 2006 Jun 8;14:10.

Hartman SE, Norton JM. Craniosacral therapy is not medicine. Phys Ther. 2002 Nov;82(11):1146-7.

Both Norton and Hartman have specific agendas and much of that is to "rouse an osteopathic response." To do so they had to pick and choose what studies to focus upon and then which studies to ignore. While there have been more then just their studies that question cranial manipulation [1-6] the big issue is what is the "truth?"

While in healthcare we often want black and white, the reality is that there are so many aspects of the healthcare doctor patient intervention that ultimately we are left in a gray arena. In my experience I find that when I talk to researchers I have to present various studies on cranial and its plausibility -- some then become open, while others have made up their mind regardless of the research. On the other hand when I speak to clinicians in practice I need to caution them against blindly accepting dogma and remain open to questioning everything they hear and use as a treatment modality.

McDoctor said:

There was also a fairly comprehensive review published by the British Columbia Office of Health Technology Assessment (BCOHTA) in 1999 which concluded that the theory was invalid.

Furthermore, I think the biomedical implausibility of cranial osteopathy puts it into a different category than other mainstream treatment modalities that may also not technically be considered "evidence based". This is where you are comparing apples to oranges. It was scientifically plausible that prescribing statins to lower LDL cholesterol would lead to reductions in secondary events for patients with coronary disease, hence this was routinely done even before the evidence to back up this strategy came to fruition. The same scientific plausibility does not apply to cranial, not when so much peer reviewed evidence exists regarding the ossification and fusion of cranial bones in the medical literature.

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The BCOHTA study (you mentioned) clearly did not come out as a positive one for cranial manipulation. Some of this had to do with the bias of those doing the study and some of this had to do with the lack of sufficient studies to support cranial manipulation. The issue of bias is a huge one in the field of research, if those investigating clinical research have had little to no clinical experience. This has created an important responsibility for the clinical practitioner to become active in the field of research and share their case reports in the scientific literature using appropriate outcome measurement tools to lend credibility to any findings.

However, it is interesting that you question cranial manipulation's scientific plausibility because there is, "so much peer reviewed evidence exists regarding the ossification and fusion of cranial bones in the medical literature."

On page xiii of the same BCOHTA study they state:


While there have no been any conclusive studies they did seem to ignore one [13] and since that study another has also emerged[14]

McDoctor said:

I do respect your academic approach to cranial, NoBarsHeld, even though I don't agree with your conclusions.

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Without any sarcasm on my part I truely do respect your questions and position. We need to carry on a discussion that is research based and not get lost in being charged-up over a treatment modality. You have done that well.

McDoctor said:

II would be interested in knowing for which specific conditions you think cranial is a valid therapeutic procedure. I'd also like to know if you think cranial should be marketed as strictly therapeutic, or preventative, or both, for said conditions. I know you have listed alot of varied case studies, but I'd like to know what you think, as an individual, regarding which diseases are best treated with cranial.

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This is a great question and one that I could write pages on. However the quick answer would be that I do not prefer to treat diseases with cranial since I am not clear on what subset of patients will respond to specific applications. Therefore I mostly use it as a treatment regardless of the patient's presentation and evaluate sutural motion, dural flexibility and CSF pulsation balance. I do realize that these palpatory diagnostic protocols have questionable reliability, so I tend to be open to combining multiple indications for treatment.

I have used cranial in my practice reliably for treatment of TMD/CMD conditions, headaches and generally to stimulate parasympathetic activity. I do not use it exclusively and while I am a proponent for cranial, I am constantly questioning myself. However at some point I close my eyes, feel what I think I feel, and move my hands and fingers in a way that seems to help patients. I often am not even telling the patient I doing cranial manipulations or what they should expect, which makes it interesting when their report of what they feel or how they felt during and after care was consistent with mine.

Our world is very mysterious and we have many things to discover and explore. My greatest teachers were ones who did not close their minds and remained open while still challenging and questioning.

1. Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Phys Ther. 1994 Oct;74(10):908-16.

2. Rogers JS, Witt PL. The controversy of cranial bone motion. J Orthop Sports Phys Ther. 1997 Aug;26(2):95-103.

3. Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T. Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. J Orthop Sports Phys Ther. 1998 Mar;27(3):213-8.

4. Rogers JS, Witt PL, Gross MT, Hacke JD, Genova PA. Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons. Phys Ther. 1998 Nov;78(11):1175-85.

5. 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 Dec;7(4):201-7.

6. Moran RW, Gibbons P. Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):183-90.

7. Greenman PE. Roentgen findings in the craniosacral mechanism. J Am Osteopath Assoc 1970 Sep;70(1):60-71.

8. Frymann VM. A study of the rhythmic motions of the living cranium. J Am Osteopath Assoc 1971 May;70(9):928-45.

9. Hubbard RP, Melvin JW, Barodawala IT. Flexure of cranial sutures. J Biomech 1971 Dec;4(6):491-96.

10. Heifetz MD, Weiss M. Detection of skull expansion with increased intracranial pressure. J Neurosurg 1981 Nov;55(5):811-12.

11. Pitlyk PJ, Piantanida TP, Ploeger DW. Noninvasive intracranial pressure monitoring. Neurosurgery 1985 Oct;17(4):581-84.

12. Kostopoulos DC, Keramidas G. Changes in elongation of falx cerebri during craniosacral therapy techniques applied on the skull of an embalmed cadaver. Cranio 1992 Jan;10(1):9-12.

13. Pick, MG, A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain," Journal of Manipulative and Physiological Therapeutics, Mar-Apr 1994; 17(3): 168-73.

14. Oleski SL Smith GH, Crow WT. Radiographic Evidence of Cranial Bone Mobility Cranio: The Journal of Craniomandibular Practice; Jan 2002; 20(1):34-8

NoBarsHeld said:

I understand your difficulty and that of most others.

Where I think the HUGE problem is, is the palpation of the PRM or CRI, which is extremely difficult, subtle, and for all intents and purposes, questionable at best, to someone attempting to learn this palpation skill. The issue is that there are subtle pulsations, which are even in dispute amongst those who purported saying they feel PRM or CRI.

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Real subtle pulsations.....Let's not forget that the 'Primary Respiratory Mechanism' is actually referring to CELLULAR respiration, not good ole'
pulmonary respiration.

So let me get this straight --- you're trying to tell me that you can sense 'inhalation' and 'exhalation' (or flexion and extension or external and internal rotation of paired bones --- yeah, I aced the practical for cranial that we just had -- I'm a neophyte but judged by my professors as knowing what the hell I'm doing or at least able to 'splain it to someone) of the ETC that's embedded in the membrane of a cellular organelle and, to my limited knowledge, doesn't have an 'inhalation/exhalation' cycle--- is that what I'm expected to believe?......

Coupled with that is the concept of 'physician intent'. Evidently some people feel physician intent is more important than what you're actually doing....so that leads me to believe I can club you over the head with a flashlight to 'treat' a vertical shear but as long as I have happy-happy/joy-joy feelings towards you and think good, positive thoughts, it'll treat shear appropriately....is that what I'm expected to believe?

PUHHHLEEAASSSEEE.....


When you believe in things that you dont understand,
Then you suffer,
Superstition aint the way

---- Stevie Wonder


I forgot to add a thought --- why doesn't the ORC take one afternoon and either prove or disprove cranial bone motion. I mean how hard would it be, in this day of laser surveying equipment, to set up and measure the diameter of the skull at the points of the skull that the cranial people say it moves? Yet according to the research I was shown, the cranial rhythm is based on the pulsations of a neuron in a petrie dish and the supposition that the rest of the brain parenchyma does the same thing......we're pouring our tax dollars into the ORC, it would only take an afternoon, maybe a week at the most......

Hi Just Plain Bill,

Part of the difficulty I see on this thread is that most of the students are asking good questions and have not been given good answers. So regretfully, instructors and doctors in the field prefer to either ignore the question or give a non sequitur response.

In life as we attempt to find the truth of things we all need to be aware of our "shadow" or flaws. In general, research-minded practitioners often have a flaw that involves being closed to ideas that expand their linear thought process whereas clinical minded practitioners tend to not question what they are told enough. My flaw is that I often can't take a side since I usually see both sides too clearly.

JustPlainBill said:

Real subtle pulsations.....Let's not forget that the 'Primary Respiratory Mechanism' is actually referring to CELLULAR respiration, not good ole' pulmonary respiration.

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The reality of which I can substantiate is that while there are CSF pulsations they have not yet been shown to be able to be palpated reliably. Of these pulsations the strongest would be pulmonary and then cardiovascular. The PRI is purported to be independent of pulmonary or cardiac influences and is the weakest of the pulses. Like an orchestra playing a symphony it would be challenging for an untrained ear to differentiate the PRI. To my palpation it is not as much a pulse, as a fluid wave.

JustPlainBill said:

Yet according to the research I was shown, the cranial rhythm is based on the pulsations of a neuron in a petrie dish and the supposition that the rest of the brain parenchyma does the same thing...

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Actually you are asking the same questions I have asked and as I studied the "studies" on glial cell pulsations I found out that not only were they studying glial cell pulsations in petrie dishes but the glial cells were not normal glial cells. If the glial cells do have a coordinated pulse so far the only plausible explanation I have found is that theorized by Frank Barr regarding neuromelanin and its relationship to the neuroglia. Also it is interesting that a peripheral weave of microfilaments in human glial cells have been found to contain actin and myosin.

For an interesting presentation of how glial cells may have an organized pulsation see: Blum CL, Non-Synaptic Messaging: Piezoelectricity, Bioelectric Fields, Neuromelanin and Dentocranial Implications. Journal of Vertebral Subluxation Research, Jan 2007: 1-6. [If you want I can send you the full text article if you contact me privately.]

Some studies that discuss the purported pulse wave associated with the PRI or PRM that you might find of interest are as follows:

Allen KL. Telemetry in the study of the intracranial pressure dynamics in man. South African Med J. 1972;46:776.

Hill DG, Allen KL. Improved instrument for the measurement of CSF pressures by passive telemetry. Med Bioi Eng Comput. 1977;15:666-72.

Allen KL, Bunt EA, Podlas H. Slow rhythmic ventricular oscillations and parenchymal density variations shown by sequential CT scanning. University of the Witwatersrand - Johannesburg, School of Mechanical Engineering, Research Report; 1983;83:1-36.

Feinberg DA. Mark AS. Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging. Radiology. 1987; 163: 793-9.

Enzmann DR, Pek NJ. Cerebrospinal fluid flow measured by phase Contrast cine MR, AlNR Am J Neuroradiol. 1993;14:1301-7.

Greitl 0, Wirestam R, Franck A, Nordell B, Thomsen C. Stahberg F. Pulsatile brain movement and associated hydrodynamics studies by magnetic resonance phase imaging, The Monro-Kellie doctrine revisited. Neuroradiology. 1992;34:370-80.

Podlas H, Allen KL, Bunt EA. Computed tomography studies of human brain movements, S Afr J Surg. 1984;22: 57-63.

Poncelet BP, Wedeen VJ, Weisskoff RM Cohen MS. Brain parenchyma motion: Measurement with cine echo-planar MR imaging. Radiology. 1992; 185:645-51.

JustPlainBill said:

So let me get this straight --- you're trying to tell me that you can sense 'inhalation' and 'exhalation' (or flexion and extension or external and internal rotation of paired bones --- ...) of the ETC that's embedded in the membrane of a cellular organelle and, to my limited knowledge, doesn't have an 'inhalation/exhalation' cycle--- is that what I'm expected to believe?......

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I think palpating cranial motion for me started with initiating the motion along suture bevels and evaluating dural membrane tensions. Then I would attempt to feel motion through the cranium as a patient moved their jaw, tongue, eyes, feet, and took deep breaths. From there I went to evaluating CSF pulsations or what feels like CSF pulsations associating with breathing and cardiac activity. After that I began to listen with my fingers for the PRI within all the other activities.

JustPlainBill said:

Coupled with that is the concept of 'physician intent'. Evidently some people feel physician intent is more important

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This will mean much more when you are in practice. Intent is not about hitting someone over the head with good intention. You have to have someone hold your head who is thinking of having an argument with someone, or have someone hold your head who is preoccupied with something else or someone who is intent on trying to help you with love in their heart. When you are on the receiving end it does make a difference, or at least to a subset of patients who think they can feel the doctors "touch."

My experience is that intent is only valuable when it is coupled with exceptional clinical expertise, and at that time only, will it make the big difference. Intent is not a substitute for doing things properly.

JustPlainBill said:

I forgot to add a thought --- why doesn't the ORC take one afternoon and either prove or disprove cranial bone motion. I mean how hard would it be, in this day of laser surveying equipment, to set up and measure the diameter of the skull at the points of the skull that the cranial people say it moves?

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I am sure if you think it is so easy that you could get a grant by the Cranial Academy to perform the study in one free afternoon that you might have.

Oleski SL Smith GH, Crow WT. Radiographic Evidence of Cranial Bone Mobility Cranio: The Journal of Craniomandibular Practice; Jan 2002; 20(1):34-8.

I think the key point I want to make is that language is often an inadequate manner of expressing abstract experiential concepts. Yet while this may be a fact it should not be an excuse to not attempt to properly explain and study a clinical phenomena. If a method of treatment is going to taught and students are expected to learn how to perform a questionable procedure, then an honest appraisal of its evidence should be shared by proponents of a method such as cranial manipulation.

Nothing is more of a "put off" then a poor answer to a good question. You have asked many good questions.

NoBarsHeld said:

You have to have someone hold your head who is thinking of having an argument with someone, or have someone hold your head who is preoccupied with something else or someone who is intent on trying to help you with love in their heart. When you are on the receiving end it does make a difference, or at least to a subset of patients who think they can feel the doctors "touch."

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Ok, so what's next --- 'healing' a patient by placing your finger on the point of 'subluxation' and allowing your 'correct' vibration to sync up with their 'incorrect' vibration and effect the healing? Or perhaps having the patient wear glasses with lenses that are different shades of the color spectrum because, as we all know, light vibrates at different frequencies and it is 'powerful, powerful' medicine to effect healing....or thumping someone in the chest while saying specific sentences to effect an 'emotional adjustment' or better yet, holding a catsup bottle against their stomach, pushing down on the extended arm and when the patient's strength is overcome, diagnosing an allergy to tomatoes? When practices like these occur, we normally call them 'quacks'. If it walks like a duck, quacks like a duck, it's a duck. I first learned about this mystical 'physician' intent while in such an office and left as quickly as I could with one hand on my wallet.....and this was the only practice where I heard it mentioned until it was taught in the cranial portion of our OMM course.....

That's why I'm a wee bit skeptical about physician itent and cranial.....they were mainstays in this particular office and could, and to my mind, have not been substantiated, period.

Wanted to add a link that may prove interesting....you'll have to scroll about halfway down the page for the part on cranial....

http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html

edited for misspelling

Hi Just Plaiin Bill:

JustPlainBill said:

That's why I'm a wee bit skeptical about physician itent and cranial.....they were mainstains in this particular office and could, and to my mind, have not been substantiated, period.

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I would be skeptical about you if you weren't skeptical about the issue of intent. Intent is commonly misused as a way of not adequately understanding the multitude of clinical indications and possible treatment applications. It is used to give the doctor a false sense of confidence at the patient's expense. It is a very abstract experiential concept that in questionable hands leads to questionable practice.

That is why I only recommend intent being an issue after every other avenue of study and investigation has been explored and that it is not a substitute for proper diagnosis or treatment. However, intent to me, is more like empathy and caring with conceptualizing what I am attempting to accomplish with treatment.

Any practitioner whether they are treating with cranial manipulation, surgery, or the spoken word can have a different clinical intervention if their intent varies. It is possible that a great surgeon can be preoccupied or not concentrating and yet have a good outcome, but I can't see where having impeccable intent cannot help.

NoBarsHeld said:

Hi Just Plaiin Bill:

I would be skeptical about you if you weren't skeptical about the issue of intent. Intent is commonly misused as a way of not adequately understanding the multitude of clinical indications and possible treatment applications. It is used to give the doctor a false sense of confidence at the patient's expense. It is a very abstract experiential concept that in questionable hands leads to questionable practice.

That is why I only recommend intent being an issue after every other avenue of study and investigation has been explored and that it is not a substitute for proper diagnosis or treatment. However, intent to me, is more like empathy and caring with conceptualizing what I am attempting to accomplish with treatment.

Any practitioner whether they are treating with cranial manipulation, surgery, or the spoken word can have a different clinical intervention if their intent varies. It is possible that a great surgeon can be preoccupied or not concentrating and yet have a good outcome, but I can't see where having impeccable intent cannot help.

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NoBarsHeld----

I've always believed that if you offend or are obnoxious or insulting to
someone for whatever reasons and realize it, you should apologize in
front of the same people that you committed the act/insult in front of....(does that make sense?).....

So ---- I was wrong. I was wrong and I apologize for it. I was unduly harsh about OMM in general and cranial in particular. I was speaking from a position of ignorance and recently had an experience with a preceptor that
really rekindled a fire for OMM. It motivated me to get up in the library and get ahold of the old, dusty books written by the early osteopaths to record their findings and learn and apply -- with modern scientific reasoning --- what they discovered.......

Please accept my apologies....sometimes I suffer from cranial-rectumitis and need the optosigmoidectomy (you know, where they clip the nerve that connects your eyes to your sigmoid colon to improve your outlook on life).....

Anyway, proceeding forward with much gusto....

.

I did not know abt this. I did a search and understood. I dont believe in this, and hence will not comment