Accepting Cranial

[phd2b]

Student Osteopaths,

Let's try some literature first:
1.) Parietal bone mobility in the anesthesized cat; JAOA 92, (5), May 1992, 599 - 622, (editorial on 589 also), Adams, et al.
2.) Craniosacral Manipulation, Physical Medicine and Rehabilitation Clinics of North America, Vol 7 (4), Nov 1996, p 877 - 896, Greenman, et al

I think that these two are 'must-read' articles before one quickly endorses or dismisses craniosacral therapy. The Greenman paper has some nice references (upledger's .87 inter-rater reliability study, etc) and is not a terribly boring read.

I'm really curious about how other schools teach the subject also. At PCSOM, as an example, we don't attempt to learn cranial until after our palpatory skills are sufficient to appreciate the CRI, at a minimum. Our practical was last week and we were forced to count the number of sphenobasilar 'revolutions' via the occipital hold, the spheno-occipital hold, the vault hold, or direct sacral palpation, while the testers monitored at the same time. You can sometimes get lucky (if you assume that most patients run 10-14/minute), but if Dr. Stiles ever suspected you were faking it, he'd simply grab an arm, leg, etc and stop the motion (if you were faking it, you'd keep right on counting!)! I have found that after we have learned ME, Functional, Jones S/CS, and HVLA, that even mediocre OMT students are able to pick up the CRI. I'd have to assume that if you are thrown into cranial without significant palpatory skills, you'd find nothing but futility and frustration (my opinion - please correct me, of course). There is a method to Dr. Stiles' madness, it seems.

Having said that, I can put my hand on a forearm or leg and can detect the rhythmic interal and external rotations that are associated with the CRI. You just have to know how deep to palpate and be in a quiet enough environment. When we were practicing for our exam, we'd take turns palpating skulls while a 3rd person (often a fellow) would verify if we were feeling s/b flexion vs. extension and then confirm the rate. Those in my class who came to osteopathy with pre-existing palpatory skills (chiropractors, athletic trainers, PTs, etc) are even better at it. Still, I had *NO* skills to speak of less than 2 years ago, but I really put extra time in to gain some skills, b/c I believe that OMT works (I was the biggest skeptic until Dr. Stiles treated me a couple of times and help resolve some chronic back pain that no amount of injections, PT, or exercise could help). I've been able to help many people and I know that I have a lot to learn....(enough of my 'rah-rah OMT is good' chanting).

Now, onto the idea of conceiving, devising, and executing (and reporting and evaluating, of course) proper, robust, reproducible research. I've been exposed to 'real' research firsthand (cancer, not OMT), and I've been dismayed by the lack of reproducible evidence as to OMT's efficacy. The weight or preponderence of the literature is ambiguous at best, it seems. [The JAOA is not exactly Science or Nature (or even JAMA, NEJM, etc), but we are seeing more and more reputed medical schools (allopathic, like Harvard), explore it under the aegis of 'comparative and alternative medicine' (as if that brings it any legitimacy). To wit, the Cleveland Clinic teaches some OMT to its FP residents now (the chief resident is from PCSOM, as it happens).]

I think that we can devise trials that could explore the incremental effects (vs sham or no additional treatment) of standardized OMT protocols. Let's say, for example, that I think that rib raising improves pulmonary function in patients with COPD. A simple pilot could be devised that would measure spirometry results before and after treatment (vs. sham treatment) with patients on the same medications, matched for demographics and clinical factors. Few would argue that spirometry results aren't objectively measurable results (vs. pain scales and the like). I'm pretty sure that smart folks can figure out reasonable ways to test whether cranial therapy has an objective clinical improvement vs. sham therapy (phrenology! - hee, hee) or no therapy. A start would be to measure the CRI objectively (neurosurgeons and biomechanical engineers could figure that out) and then measure before vs. after. Take baby steps.

What I patently refuse to accept, however, is that people who have NOT attempted to scientifically refute a theory (disprove the null hypothesis) with an equally rigorous set of trials, have any more authority to judge the efficacy of a therapy. It just doesn't hold any water...

So, whereas I can not objectively measure the number of revolutions of CRI in a minute, I can at least corroborate others' claims that a CRI is not a random vibration (randomness doesn't come in reproducible cycles, by definition, does it?).

So, perhaps we can change this thread a little bit by suggesting some trial designs that the smart folks in TX, IL, IA, etc can pilot to publish to disprove the null (or fail to disprove, as the case may be) of no effect...

Keep on questioning the system. Dispel myths and produce some positive evidence if you can (I'll sleep better knowing the truth)...in the meantime, I've got to learn about myofascial release tomorrow.

---

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[cooldreams]

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.

hoped that it would not come to personal attacks.

while i am compiling actual facts (of which you have never posted any) i would like to ask in the mean time, for you to let us all know why you continue to be in attendance at azcom if this is such a horrendous ordeal for you. why do you force yourself to learn something that you already do not think is right? seems pretty dumb to me. perhaps you can expand on that for us?

have a great night....

 

[LukeWhite]

phd,

Have your read the article posted a few threads back reviewing all the existing cranial research? It's the most comprehensive (and so far only) meta-analysis I've seen on the topic, and the results are damning. As I've said, I may be missing something, and I certainly won't be irritated if someone points it out to me. As best as I can tell, though, there's absolutely no compelling reason to accept the mechanism of cranial osteopathy.

I would recommend that those reading this thread go back and read the article if they haven't already. It addresses most of the extant evidence.

 

[phd2b]

phd,

Have your read the article posted a few threads back reviewing all the existing cranial research? It's the most comprehensive (and so far only) meta-analysis I've seen on the topic, and the results are damning. As I've said, I may be missing something, and I certainly won't be irritated if someone points it out to me. As best as I can tell, though, there's absolutely no compelling reason to accept the mechanism of cranial osteopathy.

I would recommend that those reading this thread go back and read the article if they haven't already. It addresses most of the extant evidence.

shoot the link to me and I'll look at it. A meta-analysis is the one of the poorest research designs, btw, largely b/c of the difficulties in reconciling different research designs, sample sizes, statistical methods, and patient populations. One of my greatest gripes about OMT studies is the lack of proper power in detecting statistically significant differences (nevermind meaningful clinical differences)! I can't say whether it is a fundamental lack of rigor, a lack of funding, or short attention span by the authors (or, perhaps, that there isn't an actual measurable difference!). Typically, I'd want to follow a compelling pilot study with a larger study to confirm or refute the magnitude of the results, taking into consideration confounding, interaction, etc...

Anyway, no, I haven't reviewed it, but would like to...

 

[dkwyler94]

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

Here are two faculty members from the New England College of Ost Med who examined the intertester reliability of people palpating the "Cranial Rythmn"

Here is a quote about the scientific method(end of post). Some people, who expose a superior understanding of science then the rest of us, may find it helpful.

When researching a topic, we must be willing to accept the data for what it is. We cannot go in with a preconceived notion about what the outcome will be. Too often, people who accept certain tenants of Osteopathy (from my personal experience with classmates and professors) do so with more of a religious zeal than anything. No evidence will disprove what these people believe.

Some things need not be researched. That is true. This was a comment made in regards to an earlier post I had made. It was asked if one needed research putting ones hand through a window when when already knows they will cut their hand if they do so. One could consider Immanuel Kant's learning theory and A priori knowledge. These things either can be completely intuitive that one could not possibly deny them(his claim on the existence of God or of self), or based on similation of various collections of evidence (window is made of glass, placing hand through object will break it, broken glass is sharp, I will cut myself if I place hand through window). All other things are post priori and require observations. The basis of the scientific method. (I know I did not do his work justice. I havent studied is works since undergrad some years back, but hopefully I explained it sufficiently.)
As I do not believe one would make the claim that the existence of a cranial rhythmn is completely intuitive, and as we can not bring it from a collection of outside knowledge to form a substantiated conclusion, it requires evidence.
The evidence in a hypothesis always comes from those who are trying to establish it or change an existing belief. One cannot simply make a claim of an idea being fact and challenge others to disprove it. By its nature of a scientific principle, it must be able to be disproved provided the appropriate data be found.
Unfortunatly, much science is corrupted (in general, not just Osteopathy), as people are too often motivated with publication or recognition than with establishing solid evidence. One could consider the University of Utah scientists and cold fusion. Fortunatly, as there data is provided, one can attempt to duplicate the research using the same methods and should come up with the same data. One can also examine the data itself and consider the validity of the conlcusions based on this data.
I know this is a long post, and many will not read to its end. Unfortunatly, as I said, some have claimed to have a superior understanding of science from the rest of us-most of whom also have strong science backgrounds.
To those individuals who do not hold to the rigores of science in medicine, our discipline is science. It is an applied science, but science nonetheless.
"
The Scientific Method
© Copyright 1999, Jim Loy

Science is the process of observing nature (and performing and observing experiments) and deducing natural laws. But there are traps, which lead to false deductions. And so a general method has evolved which more or less prevents scientists from falling into these traps. This general method is called the Scientific Method:

Information (data) is gathered by observation of the phenomenon being studied.
A hypothesis (preliminary generalization) is formed to perhaps explain the data.
Deductions and implications from the hypothesis suggest further observations and experiments to test the hypothesis.
Based on these tests, the hypothesis is either rejected or accepted.
This is an ongoing process. The results may suggest further observations and experiments, or they may suggest an alternative hypothesis. Along with this method, a scientific attitude is also important:

The scientist tries to be impartial.
Measurements are more reliable than subjective results.
Experiments are designed to test (disprove), not just confirm.
Data are recorded so they can be studied, and so the experiments can be replicated.
Certain common errors (like contamination or experimenter bias) are guarded against.
Statistical analysis is used to study the data.
The Scientific Method is not a checklist that scientists consciously follow. It is implied in the way they do science.

Sometimes it may seem that errors occur, as a false hypothesis survives for a long time. Sometimes there actually are errors, and even fraud. But mostly, the false paths are natural, and are corrected eventually, merely by further testing. Sometimes, this may involve looking at the situation from an entirely different perspective.

Richard Feynman simplified the definition of science like this: "Observation is the ultimate and final judge of the truth of an idea." The rest of science, the method (or methods) and attitude are designed to help you avoid mistakes when you observe."

David

 

[drusso]

Posters,

I've reposted the palpatory reliability studies of cranial motion under the osteopathic journal club forum for February. I think that it is productive to have discussions about how best to scientifically test key osteopathic principles and theories. The profession has been slow in generating the kind of data required to convince scientists and policymakers of the validity of uniquely osteopathic treatment modalities.

My question is this: While I've watched DO students debate, complain, resist and accept osteopathy in the cranial field and other forms of OMM for years, I've been amazed that despite the rancor and heated debates so few are actually stimulated to step up to the plate and scientifically investigate these issues. Why? NIH's National Center for Complementary and Alternative Medicine will accept scientifically rigorous proposals to study cranial osteopathy and other forms of manual medicine. The profession has created a research center and a course of graduate study in order to learn how to scientifically investiage these issues. A new research conference, that focuses this year on training osteopathic students and residents, is in its 6th year.

Would someone care to offer why, despite these new developments, do osteopathic students lag behind allopathic students in stepping up to the plate and learning how to do rigorous "bench to bedside" osteopathic research?

Resources:

SDN Osteopathic Journal Club

NCCAM Exploratory and Development Grant for CAM Clinical Trials

The Osteopathic Research Center at UNTHSC-FW

The Osteopathic Collaborative Clinical Trials Initiative Conference

 

[LukeWhite]

phd,

http://forums.studentdoctor.net/showpost.php?p=2221717&postcount=23

While I'll agree that meta-analyses and lit reviews are generally not the best sort of studies, there's one thing they're exceptionally good at: seeing whether a claimed treatment regiment works, or a claimed phenomenon exists.

While cranial may have some value in the former (as I've said before, I'm open to the idea that children may derive some benefit from it and that adults may get some peripheral benefit), it's not as a result of the mechanism cranial claims.

The idea that those who are unpersuaded of cranial's validity should do research to demonstrate that is a canard...if the current research either suggests that cranial's mechanism is bogus or consists of poorly crafted studies, there's no reason to take it seriously in the first place. It's not for the doubters to prove.

 

[LukeWhite]

let us all know why you continue to be in attendance at azcom if this is such a horrendous ordeal for you. why do you force yourself to learn something that you already do not think is right? seems pretty dumb to me. perhaps you can expand on that for us?

cool,

You seem to regard osteopathic education as a monolithic whole, some sort of seamless garment in which everything is perfectly integrated. Not the case. I'm sure you can understand that one might choose a discipline because it has its good points while not signing on to its more dubious aspects.

Personally, I'd be careful of attacking people for their choices and opinions on things you have little background in. One of osteopathy's principal flaws is that it tends to stifle any sort of criticism from within its ranks, defending its territory at the expense of intellectual integrity. You'll find a welcome environment for your brand of love-it-or-leave-it science when you start school; it might be good to get it out of your system before it's reinforced by what is, unfortunately, the dominant paradigm in osteopathy.

 

[LukeWhite]

Would someone care to offer why, despite these new developments, do osteopathic students lag behind allopathic students in stepping up to the plate and learning how to do rigorous "bench to bedside" osteopathic research?

drusso,

Thanks for the journal club post. Have you read the meta-analysis posted awhile back? Perhaps its most striking point is that inter-examiner reliability is less than intra-examiner reliability: ie, measurement of the CRI seems to depend more on the person measuring than the patient.

As for your question, I'll venture a guess: Right now cranial osteopathy has poor to no support in the body of respectable published research. Those who accept cranial osteopathy as valid generally do so in opposition to widely-accepted medical principles. There's no motivation for those who evaluate the claims on the basis of science to pursue it further; the motivation for those who do accept the claims is generally not scientific.

While there are exceptions, and I'm not about to suggest that everyone who accepts any part of cranial osteopathy is a prima facie poor researcher, it takes a lot of people to get a reasonably-sized research team together, particularly since the research itself has to be controlled for examiner reliability. Finding people who are excellent researchers, committed to unbiased scientific analysis, who understand the pitfalls in cranial osteopathy, and, perhaps hardest, think that there's even hpothetical merit in the proposed mechanism despite the mountain of evidence against it, is no small task.

 

[AwesomeO-DO]

Would someone care to offer why, despite these new developments, do osteopathic students lag behind allopathic students in stepping up to the plate and learning how to do rigorous "bench to bedside" osteopathic research?

I'd have to disagree with you that DO students do not engage in scientific research. They may be more interested in biochemical, biomedical, pharmacological, etc. research than OMM (cranial specifically) research because it is so difficult to set up reliable, reproducible, and adequate parameters to get data to prove/disprove the techniques utilized during cranial. How can you do a blind (or even a double blind) study? Without touching the patient, the patient will know no treatment was done. With touching the patient (say... phrenology), it is still possible to accidentally manipulate these so called movable cranial bones, and thus causing changes to the SBS pattern and such. There is obviously a great difference in manipuative technique between physician, so you can't really standardize the treatments when they area given . What student would want to deal with all of these barriers when they can easily pursue research in the many other sciences, and possible more lucrative areas. At DMU we have a great deal of research going on, and even some on OMM, but NONE on cranial. It's just not appealing to students, and obviously not to faculty either, since it is the faculty that usually spearheads most of the research on campus. So don't generalize that DO students don't do research, we just know the right pies to put our fingers in.

 

[DORoe]

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




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.




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.



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??

I am all for a truce. I sent you a PM by the way. Just please do not question my desire to be an osteopathic physician. You do not know me or my reasons for going to a DO school. If you really want to know I would be happy to tell you, but not in this thread. And for everyone else reading this thread I should not have used the word master in my post. That was incorrect wording on my part. All I was trying to point out was that if you practice something enough you will get good at it (at least that is what they tell us about OMM here).

 

[phd2b]

phd,

http://forums.studentdoctor.net/showpost.php?p=2221717&postcount=23

While I'll agree that meta-analyses and lit reviews are generally not the best sort of studies, there's one thing they're exceptionally good at: seeing whether a claimed treatment regiment works, or a claimed phenomenon exists.

While cranial may have some value in the former (as I've said before, I'm open to the idea that children may derive some benefit from it and that adults may get some peripheral benefit), it's not as a result of the mechanism cranial claims.

The idea that those who are unpersuaded of cranial's validity should do research to demonstrate that is a canard...if the current research either suggests that cranial's mechanism is bogus or consists of poorly crafted studies, there's no reason to take it seriously in the first place. It's not for the doubters to prove.

Thanks for the link. I believe that one would be correct in concluding that there has not been much convincing evidence *published* to support the clinical efficacy of CS therapy. [Note that I did not say that I don't think that it works, however.] I agree that the research is lacking to provide a convincing conclusion. I still think that properly designed trials would help refine that part of OMT by disproving or supporting its clinical effects. I'll think on this a little more over the next few weeks. [btw, thanks for introducing 'canard' to my vocabulary: "a false or unfounded report or story", had to look that one up on webster.com ]

I'm still curious about how cranial is presented in other schools. It is presented as a nature extension of FRT here, so we pick it up pretty quickly. Now, I've never used the 'V-Spread' technique successfully, but treated an occipital-petrous dysfunction indirectly in lab just today...I found the dysfunction by palpating in the vault hold, but the CRI was normal before and a little faster after the treatment...I don't know if what I was doing was a 'sham' or not, but the sutural dysfunction was normalized when I was finished (so it was specific enough to change that one problem). Don't throw out the baby with the bath water just yet.

 

[LukeWhite]

I still think that properly designed trials would help refine that part of OMT by disproving or supporting its clinical effectset.

I agree entirely, and do hope that more research is done in areas that have merit. It seems to me that it's going to be impossible to prove anything resembling a CRI, nor do I think it would be terribly helpful. There's certainly nothing wrong with a treatment experimentally proven to work that doesn't have a mechanism; no mechanism at all is, I'd say, absolutely preferable to one that's incorrect.

That study is helpful in noting the various ages at which sutures fuse...I do think that there's a lot of potential for some elements of cranial osteopathy in pediatric care, particularly otitis media. One of my major gripes with cranial research so far isn't just the shoddiness of the setup--it's that it's been done to prove a point rather than to establish valid treatments. I think that when good researchers (hopefully you among them!) start to focus on proving treatment efficacy rather than dubious mechanisms that don't necessarily have direct relevance to care, respectability and broader acceptance will quickly follow.

 

[drusso]

I agree entirely, and do hope that more research is done in areas that have merit. It seems to me that it's going to be impossible to prove anything resembling a CRI, nor do I think it would be terribly helpful.

Look, we can put a man on the moon, we can sequence the human genome, we can split atoms, but we can't substantiate the physiologic basis for the CRI??? Please.

Believe me, one day, likely at 3AM while cramming for the dreaded cranial questions on the COMLEX, the answer will come to an overworked DO/PhD student who hasn't eaten all day or changed his underwear for a week. And, all I've got to say is, "God bless him or her..."

 

[LukeWhite]

Look, we can put a man on the moon, we can sequence the human genome, we can split atoms, but we can't substantiate the physiologic basis for the CRI??? Please.

Believe me, one day, likely at 3AM while cramming for the dreaded cranial questions on the COMLEX, the answer will come to an overworked DO/PhD student who hasn't eaten all day or changed his underwear for a week. And, all I've got to say is, "God bless him or her..."

An often overlooked prerequisite to putting a man on the moon is the moon's existence.

 

[AwesomeO-DO]

even if we all agree that there needs to be more research to prove/disprove cranial as a whole, I still don't think that DO students should be forced to learn cranial just because it is on the boards. What percentage of graduating DO's are going to utilize cranial? Maybe 0.01% (just guessing). That's like putting neurosurgery techniques on the boards and forcing every student to take a neurosurgery course for a month. Not everyone is going to use it. (Might be a bad analogy since there is obviously more evidence in the usefulness of neurosurgery)

 

[cooldreams]

even if we all agree that there needs to be more research to prove/disprove cranial as a whole, I still don't think that DO students should be forced to learn cranial just because it is on the boards. What percentage of graduating DO's are going to utilize cranial? Maybe 0.01% (just guessing). That's like putting neurosurgery techniques on the boards and forcing every student to take a neurosurgery course for a month. Not everyone is going to use it. (Might be a bad analogy since there is obviously more evidence in the usefulness of neurosurgery)

?? if you dont want to learn it, dont go to a school that will force you to learn it. seems pretty simple to me. i for one want to learn it and potentially use it, and i know for a fact there are many others. if you want it out of the curriculum, get off your lazy butt and drum up some research that conclusively proves it wont work. submit to the AOA, and bamm... otherwise, quit being such a whiner ...

 

[Docgeorge]

He doesnt need to drum any research up. If you want to put forth something that goes against accepcted principles you're the one that needs to drum it up. Hell just go talk to your neighborhood anatomist or forensic anthropologist. Or even better yet just go look at the "proof" they've put foreward in the JAOA. (www.JAOA.com) It's free. And after you do that go look at some other papers againt cranial then we will have a basiss for discussion.

It's interesting that you cooldreams who has not even started Medical School and concequently have very little info the theory behind Crainal is such a vocal proponent of it. Is it based on indepent reading, personal experience, or just blind allegence to the Cranial Academy?

 

[AwesomeO-DO]

?? if you dont want to learn it, dont go to a school that will force you to learn it. seems pretty simple to me. i for one want to learn it and potentially use it, and i know for a fact there are many others. if you want it out of the curriculum, get off your lazy butt and drum up some research that conclusively proves it wont work. submit to the AOA, and bamm... otherwise, quit being such a whiner ...

I get it. Since I don't "believe" in cranial, I obviously don't belong in an Osteopathic school, right? Well i for one love doing manipulative techniques, I've personally benifeted from OMM treatments utilizing Muscle energy, strain/counterstrain, HVLA. I'm really into that aspect. Who knows, maybe I'll even get good at these aspects of OMM and use it in practice one day. But I don't accept cranial as legitimate. I'm not the only one obviosly. I'm also not saying get rid of it totally either. Make cranial an elective, remove it from the boards, and there will be tons of happy DO students that can spend their time on more important things like studying for boards. For you and others that are so psyched to learn cranial, it will still be there for you to "master" and go out there and keep fooling the rest of the nation that it is useful.

 

[cooldreams]

He doesnt need to drum any research up. If you want to put forth something that goes against accepcted principles you're the one that needs to drum it up. Hell just go talk to your neighborhood anatomist or forensic anthropologist. Or even better yet just go look at the "proof" they've put foreward in the JAOA. (www.JAOA.com) It's free. And after you do that go look at some other papers againt cranial then we will have a basiss for discussion.

you know, you guys keep saying to look at all of the evidence, but never show any. even the papers ive read against cst say there is not really enough research to conclusively say one way or another.

It's interesting that you cooldreams who has not even started Medical School and concequently have very little info the theory behind Crainal is such a vocal proponent of it. Is it based on indepent reading, personal experience, or just blind allegence to the Cranial Academy?

a little of all of that:

Independent reading :
the one thing ive seen anyone say so far was about detecting a depth difference on the order of an angstrom in size. if this is the case this raises serious questions. from what i have read however, the depth needed to perform this proceduce is on the order of .0010 to .0005 of an inch. it is "common" knowledge that people can normally detect a depth difference of around 1/2500 of an inch. that puts the noted depth detection parameters clearly within the realm of "possible" and not at all what you claim to be "impossible"

personal experience:
as i have already stated i am very much into martial arts, specifically kyusho-jitsu. i am almost certain you have not heard of it however, because it is relatively new, and does not involve any competitions. this is a style based on pressure point striking. you are taught to control someone, stop an attack, even knock someone out - and do all of that while inflicting the smallest amount of damage on your aggressor. this is such an amazing style, i have personally seen it work, and it worked for me, yet all other styles say this could never work, you have to smash things against peoples heads to knock them out, etc. my personal experience has shown me a lot of potential in the human body that is still largely rejected in the "mainstream" science and martial arts realms. i would suppose that it is this that leads me to dismiss anything you would say negative about crainial because you also give no proof, but rather only your personal experience and speculation. you tell me to go read articles, articles many of which i have actually already read and state that more is needed to be researched to clearly state a positive or negative effect here.

im really just restating what i have already stated, and so are you and everyone else. no definitive progress has been made.

 

[LukeWhite]

you tell me to go read articles, articles many of which i have actually already read and state that more is needed to be researched to clearly state a positive or negative effect here.

So which part of the lit review that's been posted twice and the abstracts drusso posted suggesting little interexaminer reliability did you not find compelling? I'm not sure where you get the idea that we're posting speculation. The literature doesn't support it. If you disagree, you might be better served writing up that word doc for us than regaling us with tales of your martial arts prowess.

When you do write up this treatise, be sure to address all the points made in the lit review, particularly the lack of interexaminer reliability, the *presence* of unacceptable intraexaminer consistency, and the bulk of scientific evidence that goes against the basic tenets of cranial. I'm sure you'll be forgiving if we're more persuaded by specific rebuttals to scientific analysis than by the mysteries of kyusho-jitsu.

 

[jonb12997]

unless I'm missing something, and please explain if I am, what's the connection between martial arts and osteopathy? If you wanna use cranial that's wonderful, more power to you, i'm sure you're going to find other parts of osteopathy that you don't like (pretty much everyone does) and if it's something that I like and use, I'm not going to fault you for not being a "true osteopath." There needs to be a certain amount of experience before you can come in here and tell us we're all so called "bad osteopaths". If you were a 3rd year NMM resident, I might listen a little more, but honestly, you're not even a medical student yet.... sorry to be so blunt, but seriously!

 

[cooldreams]

unless I'm missing something, and please explain if I am, what's the connection between martial arts and osteopathy? If you wanna use cranial that's wonderful, more power to you, i'm sure you're going to find other parts of osteopathy that you don't like (pretty much everyone does) and if it's something that I like and use, I'm not going to fault you for not being a "true osteopath." There needs to be a certain amount of experience before you can come in here and tell us we're all so called "bad osteopaths". If you were a 3rd year NMM resident, I might listen a little more, but honestly, you're not even a medical student yet.... sorry to be so blunt, but seriously!

as far as an example with martial arts it was two fold, and i shall RESTATE again, just for your convience.

1) shows that there is a great deal to anatomy that people do not understand, but has been repeatedly shown to work, and work by many different people.

2) even so it is regarded nearly as myth and rarely even considered in "main stream" martial arts with no "facts" to show it could not possiblly work.

i am not sure what you cannot understand here?


"bad osteopath" was never stated by myself. all i did was ask why someone wanted to go to an osteopathic school if you hate the curriculim? maybe you didnt know you would hate it until you got there... i dunno.. just asking. sure, im not in medical school yet, but proof is proof whether you are living the proof or not

- otherwise you are trying to argue that "proof is in the eye of the beholder".

now, if you would like to continue to put words in my mouth go ahead...

 

[cooldreams]

So which part of the lit review that's been posted twice and the abstracts drusso posted suggesting little interexaminer reliability did you not find compelling? I'm not sure where you get the idea that we're posting speculation. The literature doesn't support it. If you disagree, you might be better served writing up that word doc for us than regaling us with tales of your martial arts prowess.

When you do write up this treatise, be sure to address all the points made in the lit review, particularly the lack of interexaminer reliability, the *presence* of unacceptable intraexaminer consistency, and the bulk of scientific evidence that goes against the basic tenets of cranial. I'm sure you'll be forgiving if we're more persuaded by specific rebuttals to scientific analysis than by the mysteries of kyusho-jitsu.

idea of speculation? EVERYTHING thus far posted is speculation on various observations. NOTHING is double blind, NOTHING is conclusive. depending on YOUR BIAS you will see each paper as your reason that is does or does not work.

facts?? you have none, except that you continue to learn this stuff, and pay thousands of dollars a year to do so.

 

[jonb12997]

"bad osteopath" was never stated by myself. all i did was ask why someone wanted to go to an osteopathic school if you hate the curriculim? maybe you didnt know you would hate it until you got there... i dunno.. just asking. sure, im not in medical school yet, but proof is proof whether you are living the proof or not

I know you never said that exactly, it was just the feeling I got from your above posts... was I wrong? maybe so...

I also don't think that we hate the curriculim. didn't someone say above that they enjoyed certain parts, and were even treated and got relief? I would definetly hesitate to say that people "hate the curriculim". There are some things we don't like, (hence the point of the thread)... but I can almost guarentee that there is something that you'll find next year in your OPP classes that you don't like, but yet you're not in school yet so we don't know that now do we.

 

[AwesomeO-DO]

Reasons why I'm "learning" cranial:
1. it's on the boards
2. it's a required class
3. ummmmm dang, ran out of reasons

Reasons I wish i didn't have to learn cranial:
1. it sucks donkey balls
2. i'm never going toi use cranial specifically
3. the teachers use vague analogies to describe what cranial does to the CNS
4. I CAN'T FEEL ANYTHING
5. it's all in my head, not the pt's
6. I'd rather study for boards
7. It's not proven via scientific studies
8. Promoting it's usefulness gives Osteopaths a bad name
9. It seems like outright "quackery"
10. I pay way too much money to have to put up with this crap

 

[cooldreams]

I know you never said that exactly, it was just the feeling I got from your above posts... was I wrong? maybe so...

I also don't think that we hate the curriculim. didn't someone say above that they enjoyed certain parts, and were even treated and got relief? I would definetly hesitate to say that people "hate the curriculim". There are some things we don't like, (hence the point of the thread)... but I can almost guarentee that there is something that you'll find next year in your OPP classes that you don't like, but yet you're not in school yet so we don't know that now do we.

you are right we dont know if i will like it or not. but i didnt think that was much of any concern to anyone in this thread...

i guess i thought the point to this thread was this:

cst is false, and should therefore be dropped from all of osteopathy.

that is basically the premise that i have been argueing against all along.

 

[cremaster2007]

Reasons why I'm "learning" cranial:
1. it's on the boards
2. it's a required class
3. ummmmm dang, ran out of reasons

Reasons I wish i didn't have to learn cranial:
1. it sucks donkey balls
2. i'm never going toi use cranial specifically
3. the teachers use vague analogies to describe what cranial does to the CNS
4. I CAN'T FEEL ANYTHING
5. it's all in my head, not the pt's
6. I'd rather study for boards
7. It's not proven via scientific studies
8. Promoting it's usefulness gives Osteopaths a bad name
9. It seems like outright "quackery"
10. I pay way too much money to have to put up with this crap

I agree totally...............I loved first year OMM it was great learning all the those techniques. I just think cranial has really turned me off to it..........You can't even do it unless you are board certified in it so why is it asked so heavily on boards............that really isn't fair to the people who don't want to do that sort of thing.......I'm a big fan of integrating OMM into your practice when you can, but how many times have you had a headache and your back rubbed and all you feel better. People like to be touched, so when you can prove to me that you are making people better by doing a technique and not by just touching someone's head for 15 minutes then I'll start to take it more seriously. But hey at least lab time is great for napping now when I am the patient...........I'll apologize to anyone in my lab who has heard me snoring

 

[WillowRose]

Reasons why I'm "learning" cranial:
1. it's on the boards
2. it's a required class
3. ummmmm dang, ran out of reasons

Reasons I wish i didn't have to learn cranial:
1. it sucks donkey balls
2. i'm never going toi use cranial specifically
3. the teachers use vague analogies to describe what cranial does to the CNS
4. I CAN'T FEEL ANYTHING
5. it's all in my head, not the pt's
6. I'd rather study for boards
7. It's not proven via scientific studies
8. Promoting it's usefulness gives Osteopaths a bad name
9. It seems like outright "quackery"
10. I pay way too much money to have to put up with this crap

Can I just add an AMEN? There are aspects of OMM *other* than cranial (which we have not studied yet) that I find a bit dubious. I can already see there are techniques which I will never use in practice because I see no benefit.

I noticed in OMM lab this morning that there was a HUGE picture of AT Still where the clock used to be. All I could think was "Oh, look...it's like a little altar." Some days you get instructed in techniques with a sound physiologic basis and obvious usefulness. Other days, it just feels like you're sitting in the church of OMM and if you don't believe, you won't achieve. Those are the days (like today) when I just think "there's something to be said for the relaxing power of touch....and maybe that's all there is to this."

I just hope I can bite my tongue and not create a riot when they start preaching the cranial stuff next fall. So why am I in an osteopathic school if I don't "believe" in what they're doing? Well, I like most of it...but that doesn't mean there aren't improvements to be made. I can't escape the irony of the new push for evidence-based medicine in our courses while down the hall, they're practicing cranial on each other. It's like including homeopathic remedies in the pharmacology course. Most of the class is useful. Some of it is just wishful thinking.

Willow

 

[WillowRose]

But hey at least lab time is great for napping now when I am the patient...........I'll apologize to anyone in my lab who has heard me snoring

I did the "falling asleep twitch" on the OMM table one morning. I nearly twitched myself right off into the floor. There's nothing quite like soft tissue massage to make a person feel better.

 

[bla_3x]

I noticed in OMM lab this morning that there was a HUGE picture of AT Still where the clock used to be. All I could think was "Oh, look...it's like a little altar."

Willow

I very much agree with this sentiment. Through my thus far short-lived journey through school I have seen this sort of this sort of thing several times. To say ole’ Still is revered is an understatement…in fact he is wholly deified to a number of people, and I have seen fellow students and practicing physicians that appear to be zealots of this OMT religion. There are times in OM class when I wonder if I am in school or watching the evangelical channel.
I dunno, I my mind this sort of thing just looks bad and does give and aura of quackery to it all
You just don’t go to John Q MD school and see alters of DeBakey or Oxner, and hear quotes and personal stories repeatedly in class

This is just a benign observation that have made over the past months. Again,I am not meaning to insult, just stating observations. I personally love OMT and know personally that there is benefit. I AM NOT a believer of cranial however…at least not yet. I think that Luke has brought up some great points that demand attention.

 

[drusso]

Hopefully, some of you students can attend this year's Osteopathic Collaborative Clinic Trials Initiative Conferece to bring up and discuss the lack scientific data supporting cranial. I've heard this year's Key Note speaker fron NIH's National Center for Complementary and Alternative Medicine at other events. He's an incredible scientifist. And, if you think that cranial osteopathy is hard to swallow, you should see the research being done and some of the largest and most respected allopathic schools on "energy healing." Again, if scientists can muster the methods to rigorously things like "energy healing" then it seems like cranial osteopathy should be a slam dunk.



OCCTIC/RAD info

This year's keynote speaker will be Shan S. Wong, Ph.D. Dr. Wong who is a Program Officer of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). He oversees a research portfolio in cardiovascular, lung, and blood diseases, asthma, allergy, immunology, and small business innovation research (SBIR/STTR) program. His expertise is in the area of clinical chemistry, biochemistry, and biophysics. Prior to joining NCCAM, he served as a Scientific Review Administrator at the National Institute of Diabetes and Digestive and Kidney Diseases. Before joining NIH, he was Chief of Assay Laboratory at Loma Linda University in California, Director of Clinical Chemistry Laboratory at Herman Hospital in Houston, Texas, Associate Professor of Laboratory Medicine at the University of Texas Health Sciences Center at Houston, and Professor of Biochemistry at the University of Massachusetts at Lowell.

Dr. Wong received a Ph.D. in Biochemistry from the Ohio State University and completed postdoctoral training at Temple University School of Medicine. He has conducted research in enzymology, protein chemistry, and biophysics and has developed diagnostic tests for cardiovascular, liver, lung, kidney, and bone diseases. His interest in complementary and alternative medicine is in the modality of energy healing.


Some NIH funded projects in things stranger than cranial:

Center for Frontier Medicine in Biofield Science
Specialty: Biofield
Principal Investigator: Gary E. Schwartz, Ph.D.

Address:
Department of Psychology
University of Arizona
PO Box 210068
Tucson, AZ 85721-0068

Description:
This Center facilitates and integrates research on the effects of low energy fields. The research is focused on developing standardized bioassays (cellular biology) and psychophysiological and biophysical markers of biofield effects, and on the application of the markers developed to measure outcomes in the recovery of surgical patients.

Center of Excellence for the Neuroimaging of Acupuncture Effects on Human Brain Activity
Specialty: Acupuncture
Principal Investigator: Bruce Rosen, M.D., Ph.D.

Address:
Massachusetts General Hospital
Department of NMR/Radiology
149 13th St., Bldg 149 #2301
Charlestown, MA 02129

Description: This Center aims to increase understanding of the neural basis for the effects of acupuncture through the use of functional magnetic resonance imaging. The Center will test the hypothesis that acupuncture generates a widespread response in the brain, and that the brain's limbic system plays a central role in this response. This Center will also explore the neural basis of deqi, a unique acupuncture sensation that is considered essential to clinical efficacy in traditional Chinese acupuncture.


Exploratory Program Grant for Frontier Medicine
Specialty: Touch
Principal Investigator: Karen Prestwood, M.D.

Address:
University of Connecticut Center on Aging, MC 5215
University of Connecticut Health Center
263 Farmington Avenue
Farmington, CT 06030-5215

Description:
This Center will evaluate the effects of Therapeutic Touch and healing touch on several human diseases and processes. The Center includes pre-clinical projects studying the effect of Therapeutic Touch on bone metabolism and on fibroblast biology, and two clinical projects, one investigating the effect of Therapeutic Touch on bone metabolism in postmenopausal women with wrist fractures and a second studying the effect of healing touch on immune function in advanced cervical cancer.

Alternative Therapies for Alcohol and Drug Abuse
Specialty: Traditional Chinese Medicine
Principal Investigator: Yue-Wei Lee, Ph.D.

Address:
McLean Hospital/Harvard Medcal School
Mailman Research Center
Bio-organic and Natural Product Laboratory
115 Mill Street
Belmont, MA 02478

Description: Center investigators will evaluate whether two traditional Chinese herbal remedies and an electrical acupuncture technique can be used to prevent addiction relapse and craving for alcohol and drugs of abuse. The four interactive projects will encompass the biochemical and biological standardization and characterization of the herbal remedies, test their effect in vitro and in animals, and perform a clinical evaluation of efficacy. In addition, the effectiveness of the electroacupuncture technique in animals and human participants will be evaluated.

Oregon Center for Complementary and Alternative Medicine Research in Craniofacial Disorders
Specialty: Craniofacial Disorders
Principal Investigator: B. Alexander White, D.D.S.

Address:
Center for Health Research
Kaiser Foundation Hospitals
3800 N. Interstate Avenue
Portland, OR 97227-1110

Description:
The Center will conduct research on potential efficacy, effectiveness, acceptability, effects on health care resource use, and psychosocial and other health outcomes associated with CAM practices for cranofacial disorders (CFDs) as well as the physiological and psychological mechanisms underlying some of these practices. Proposed Phase II clinical trials include CAM approaches to TMD pain management; alternative medicine approaches among women with TMD; and complementary naturopathic medicine for periodontitis.

 

[cooldreams]

Hopefully, some of you students can attend this year's Osteopathic Collaborative Clinic Trials Initiative Conferece to bring up and discuss the lack scientific data supporting cranial. I've heard this year's Key Note speaker fron NIH's National Center for Complementary and Alternative Medicine at other events. He's an incredible scientifist. And, if you think that cranial osteopathy is hard to swallow, you should see the research being done and some of the largest and most respected allopathic schools on "energy healing." Again, if scientists can muster the methods to rigorously things like "energy healing" then it seems like cranial osteopathy should be a slam dunk.



OCCTIC/RAD info

This year's keynote speaker will be Shan S. Wong, Ph.D. Dr. Wong who is a Program Officer of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). He oversees a research portfolio in cardiovascular, lung, and blood diseases, asthma, allergy, immunology, and small business innovation research (SBIR/STTR) program. His expertise is in the area of clinical chemistry, biochemistry, and biophysics. Prior to joining NCCAM, he served as a Scientific Review Administrator at the National Institute of Diabetes and Digestive and Kidney Diseases. Before joining NIH, he was Chief of Assay Laboratory at Loma Linda University in California, Director of Clinical Chemistry Laboratory at Herman Hospital in Houston, Texas, Associate Professor of Laboratory Medicine at the University of Texas Health Sciences Center at Houston, and Professor of Biochemistry at the University of Massachusetts at Lowell.

Dr. Wong received a Ph.D. in Biochemistry from the Ohio State University and completed postdoctoral training at Temple University School of Medicine. He has conducted research in enzymology, protein chemistry, and biophysics and has developed diagnostic tests for cardiovascular, liver, lung, kidney, and bone diseases. His interest in complementary and alternative medicine is in the modality of energy healing.


Some NIH funded projects in things stranger than cranial:

Center for Frontier Medicine in Biofield Science
Specialty: Biofield
Principal Investigator: Gary E. Schwartz, Ph.D.

Address:
Department of Psychology
University of Arizona
PO Box 210068
Tucson, AZ 85721-0068

Description:
This Center facilitates and integrates research on the effects of low energy fields. The research is focused on developing standardized bioassays (cellular biology) and psychophysiological and biophysical markers of biofield effects, and on the application of the markers developed to measure outcomes in the recovery of surgical patients.

Center of Excellence for the Neuroimaging of Acupuncture Effects on Human Brain Activity
Specialty: Acupuncture
Principal Investigator: Bruce Rosen, M.D., Ph.D.

Address:
Massachusetts General Hospital
Department of NMR/Radiology
149 13th St., Bldg 149 #2301
Charlestown, MA 02129

Description: This Center aims to increase understanding of the neural basis for the effects of acupuncture through the use of functional magnetic resonance imaging. The Center will test the hypothesis that acupuncture generates a widespread response in the brain, and that the brain's limbic system plays a central role in this response. This Center will also explore the neural basis of deqi, a unique acupuncture sensation that is considered essential to clinical efficacy in traditional Chinese acupuncture.


Exploratory Program Grant for Frontier Medicine
Specialty: Touch
Principal Investigator: Karen Prestwood, M.D.

Address:
University of Connecticut Center on Aging, MC 5215
University of Connecticut Health Center
263 Farmington Avenue
Farmington, CT 06030-5215

Description:
This Center will evaluate the effects of Therapeutic Touch and healing touch on several human diseases and processes. The Center includes pre-clinical projects studying the effect of Therapeutic Touch on bone metabolism and on fibroblast biology, and two clinical projects, one investigating the effect of Therapeutic Touch on bone metabolism in postmenopausal women with wrist fractures and a second studying the effect of healing touch on immune function in advanced cervical cancer.

Alternative Therapies for Alcohol and Drug Abuse
Specialty: Traditional Chinese Medicine
Principal Investigator: Yue-Wei Lee, Ph.D.

Address:
McLean Hospital/Harvard Medcal School
Mailman Research Center
Bio-organic and Natural Product Laboratory
115 Mill Street
Belmont, MA 02478

Description: Center investigators will evaluate whether two traditional Chinese herbal remedies and an electrical acupuncture technique can be used to prevent addiction relapse and craving for alcohol and drugs of abuse. The four interactive projects will encompass the biochemical and biological standardization and characterization of the herbal remedies, test their effect in vitro and in animals, and perform a clinical evaluation of efficacy. In addition, the effectiveness of the electroacupuncture technique in animals and human participants will be evaluated.

Oregon Center for Complementary and Alternative Medicine Research in Craniofacial Disorders
Specialty: Craniofacial Disorders
Principal Investigator: B. Alexander White, D.D.S.

Address:
Center for Health Research
Kaiser Foundation Hospitals
3800 N. Interstate Avenue
Portland, OR 97227-1110

Description:
The Center will conduct research on potential efficacy, effectiveness, acceptability, effects on health care resource use, and psychosocial and other health outcomes associated with CAM practices for cranofacial disorders (CFDs) as well as the physiological and psychological mechanisms underlying some of these practices. Proposed Phase II clinical trials include CAM approaches to TMD pain management; alternative medicine approaches among women with TMD; and complementary naturopathic medicine for periodontitis.

i know this may sound wierd to a large number of you, but i think this stuff is fascinating. Drusso, thanks for the link, i would love to goto something like that. i think this is something i would love to research more while in school. perhaps i will get some grant money or other help from somewhere with that endeavor??

how many of you have done research?? i have done some, but not published... this is something i think i would really enjoy learning more about...

thanks again drusso....

 

[Docgeorge]

ditto about the snoreing. I guess I was pretty bad a couple of weeks ago. But damn if it did'nt feel good take that 20 min nap.

 

[dcratamt]

I think the lack of research in the area of cranial osteopathy and the reason why cranial osteopathy is still being taught in schools is interrelated.

Nobody wants to do research on something they already believe to be non-existent; and the people who do feel the CSI and have a good feel for cranial are too busy and interested in treating pts to take the time for research. These clinicians don't feel the need to research something that they use everyday to diagnose and treat pts. These clinicians and the ones before them are also the reason why cranial still exists today; cause it works. Pt's have gotten results from cranial and that is the reason it is still being taught. It is the reason why we have two kinds of doctors DO's and the other ones.(can't think of the name right now). Problem is most schools do not teach it well and most students are not interested anyway.

I am an OMS1 at PCSOM and there are people here who thought all the OMM was crap when they first arrived, but i don't think there is one now who doesn't see it's value. I am not saying every student wants to do an OPP fellowship and an all OPP practice, but they all realize the power of the techniques as a diagnostic and treatment tool. They however, have seen results in lab either on them or right in front of their eyes. That credit has to be given to the OPP faculty here at PCSOM and i don't think this level of skill and logical progression of techs is taught at most schools.

 

[dochuffman]

cranial is voo doo. Just my opinion, some of the other OMM techniques I think are useful.

 

[Malph]

Hello Everyone,

I just want to drop a note here to get ALL D.O. Students to visit the current MATCH Survey thread--we only have a total of ten days from 4 feb 2005 to collect everyone's input.

http://forums.studentdoctor.net/sho...181#post2261181

We all talk about change on these threads, and now you have a chance to actually affect it. Please visit the thread and if you have not already done so, take 2 minutes and fill out the small 9 question survey. This is literally 2 min that can change the future of how we distribute students to programs.

Thanks so much for your time and I love reading the threads here on SDN.

 

[jhug]

and the people who do feel the CSI and have a good feel for cranial are too busy and interested in treating pts to take the time for research

i respectfully disagree with this...I don't think cranial is energy healing, i don't think cranial isn't researched because people are too busy...I think cranial at most should be taught as a sub-specialty of OMM and should be taught on an introductory level (enough to get us past the boards)...and those genuinely interested in cranial should be able to take a more in depth elective (much like emergency medicine)...

 

[LukeWhite]

Agreed.

Dcratamt, you argue that there's no need to research the stuff because those who practice it know it works. Presumably the only ones practicing cranial therapy are those who believe it works. It's logical, then, that there are lots of docs who don't practice cranial because they don't believe that it works.

Wouldn't it benefit those who practice cranial (and the patients they can't fit into their busy practices) to do research in order to convince the docs who are unpersuaded of its merits?

As it stands, cranial osteopathy's built up pretty impregnable defenses for itself. Low interexaminer reliability on the CRI? Must be because the CRI's so sensitive that even diagnostic touch can change it. Objective doc can't feel the CRI? Respond that their palpatory skills obviously need improvement through extensive additional cranial training (which, of course, only those predisposed to believing in the CRI will subject themselves to).

Cranial osteopathy reminds me of the complex mathematical models that popped up during the Renaissance to justify the idea that the earth was the center of the game. Brilliant models, totally self-consistent, able to predict the movement and position of heavenly bodies, dead wrong. Like those models, cranial osteopathy is an attempt to justify what's essentially a hypothesis of faith in the language of, but *in spite of*, well-established scientific principles. It looks pretty, seems consistent, and one might even make some observations that seem consistent with it, but in the end there are simpler, if less glamorous, explanations that fit far more closely with fact.

I can only speak for myself, but I've never questioned my choice of osteopathy as much as in these last several weeks when tested on these elaborate physiological orreries with little basis outside Sutherland's own cranial impulses. Can I in good faith recommend to premeds a discipline that makes room for such contortions in science with so little concern for rigor and proof? Yes, because osteopathy has a lot going for it. But the recommendation is in spite of this, and had I fully understood the extent of the cranial cartel's reach as a premed I would have gone into osteopathy far more warily.

 

[drusso]

Agreed.


Cranial osteopathy reminds me of the complex mathematical models that popped up during the Renaissance to justify the idea that the earth was the center of the game. Brilliant models, totally self-consistent, able to predict the movement and position of heavenly bodies, dead wrong. Like those models, cranial osteopathy is an attempt to justify what's essentially a hypothesis of faith in the language of, but *in spite of*, well-established scientific principles. It looks pretty, seems consistent, and one might even make some observations that seem consistent with it, but in the end there are simpler, if less glamorous, explanations that fit far more closely with fact.

This can be said to be true for all theories---scientific and otherwise. This is the way science works. Pre-Watson and Crick models of genetic replication were also like this. So, again, an inspiring DO/PhD student needs to tackle this problem with fresh eyes beginning with fundamental basic science investigations about CSF fluid hydrodynamics, cranial suture development and osteology, etc. This can be the only way to separate fact from fiction. But, for all of the complaining that goes on, no one steps up to the plate to do these sorts of studies despite the fact that doing so would attract great noteriety for such an individual.

I'd like to see dozens of posters at AOA conventions documenting basic science evidence for and against cranial theories. I'd like to see debates rage in the JAOA about the methods used. I'd like to see informed discussion about the whether or not conclusions drawn from data are actually correctly interpretted. I'd like to see investigators re-analyze and publish data from other studies. In short, I'd like to see the osteopathic profession develop a culture of research around these contentious issues.

 

[tom26]

Folks, I really enjoy this thread. As a practicing Doctor of Physical Therapy, I am well aware that the vast majority of practicing DO's have poor palpatory skills. Further, many despite their training have poor ability to make accurate musculoskeletal diagnoses. It's sad that many of you don't take the opportunity to embrace these effective techniques as these techniques are so important for the primary care physician. Much of this can be blamed on weak OMM teaching/programs but it also must be recognized that the OMS 1 likely has no previous palpatory experience. That being said it leaves you with two options. One give all your OMM training (yes including cranial) the full attention it deserves so that you can help your patients when they come to you for treatment. Or (and I would prefer you choose this one) blow off the classes and keep whining on the discussion threads, make a foolish diagnosis that isn't really the problem, give them a pill that won't work and send them to a PT so we can heal your patient. I know I have the palpatory skill and I am the expert at resolving musculoskeletal problems. I have studied osteopathic manual skills and while you debate them I will be busy healing your patients. So, I guess I will thank you because it's those of you who are 2nd rate MD's (DO's without OMM skills) that keep me very, very busy at work. Now as for the 1st class DO's who know their OMM, let me say I look forward to working with you and hopefully getting the opportunity to train with you in the future.

 

[AwesomeO-DO]

Folks, I really enjoy this thread. As a practicing Doctor of Physical Therapy, I am well aware that the vast majority of practicing DO's have poor palpatory skills. Further, many despite their training have poor ability to make accurate musculoskeletal diagnoses. It's sad that many of you don't take the opportunity to embrace these effective techniques as these techniques are so important for the primary care physician. Much of this can be blamed on weak OMM teaching/programs but it also must be recognized that the OMS 1 likely has no previous palpatory experience. That being said it leaves you with two options. One give all your OMM training (yes including cranial) the full attention it deserves so that you can help your patients when they come to you for treatment. Or (and I would prefer you choose this one) blow off the classes and keep whining on the discussion threads, make a foolish diagnosis that isn't really the problem, give them a pill that won't work and send them to a PT so we can heal your patient. I know I have the palpatory skill and I am the expert at resolving musculoskeletal problems. I have studied osteopathic manual skills and while you debate them I will be busy healing your patients. So, I guess I will thank you because it's those of you who are 2nd rate MD's (DO's without OMM skills) that keep me very, very busy at work. Now as for the 1st class DO's who know their OMM, let me say I look forward to working with you and hopefully getting the opportunity to train with you in the future.

I think you are confused as to the motivation behind the beginnings of this thread. I created it because I enjoy OMM greatly, but dislike cranial. I plan on utilizing the obviously benificial manipulative techniques I've learned in OMM, but cranial is just too weakly based for me to "believe in". It may seem like whining to you, but what is wrong with demanding a little more proof to the authenticity of the material we are paying an arm and a leg to learn.

 

[LukeWhite]

This can be said to be true for all theories---scientific and otherwise. This is the way science works. Pre-Watson and Crick models of genetic replication were also like this. So, again, an inspiring DO/PhD student needs to tackle this problem with fresh eyes beginning with fundamental basic science investigations about CSF fluid hydrodynamics, cranial suture development and osteology, etc. This can be the only way to separate fact from fiction. But, for all of the complaining that goes on, no one steps up to the plate to do these sorts of studies despite the fact that doing so would attract great noteriety for such an individual.

I'd like to see dozens of posters at AOA conventions documenting basic science evidence for and against cranial theories. I'd like to see debates rage in the JAOA about the methods used. I'd like to see informed discussion about the whether or not conclusions drawn from data are actually correctly interpretted. I'd like to see investigators re-analyze and publish data from other studies. In short, I'd like to see the osteopathic profession develop a culture of research around these contentious issues.

I wouldn't agree that most theories take that form. My problem with cranial is that belief precedes evidence, just as it did with the geocentrics.

That's not to say there's NO evidence...obviously people thought the earth was flat for a reason too. Nor are all theories born full-formed out of a huge body of evidence...Sutherland's dreams, or whatever, may have had intuitive value.

However, at some point an intuitive theory has to be backed up with compelling evidence. That evidence simply doesn't exist for cranial, and like we've mentioned before, there's no compelling reason for anyone but the believers to try to disprove it.

It's not on even footing with other respectable theories that present evidence in demand of refutation or confirmation...it is, as best as I can tell, a glorified hypothesis that gains adherents through indoctrination and anecdote rather than study. Until advocates of cranial respond to the very substantive criticisms that have been leveled against the field, why keep bothering?

I've still yet to hear a solid rebuttal to the meta article posted a few times here (either on the forum or in print). That article takes on pretty much the whole body of cranial research. If the advocates of the CRI are silent in face of the criticism, why keep piling it on? The ball's in the cranial osteopaths' court.

 

[dcratamt]

Agreed.

Dcratamt, you argue that there's no need to research the stuff because those who practice it know it works. Presumably the only ones practicing cranial therapy are those who believe it works. It's logical, then, that there are lots of docs who don't practice cranial because they don't believe that it works.

Wouldn't it benefit those who practice cranial (and the patients they can't fit into their busy practices) to do research in order to convince the docs who are unpersuaded of its merits?

As it stands, cranial osteopathy's built up pretty impregnable defenses for itself. Low interexaminer reliability on the CRI? Must be because the CRI's so sensitive that even diagnostic touch can change it. Objective doc can't feel the CRI? Respond that their palpatory skills obviously need improvement through extensive additional cranial training (which, of course, only those predisposed to believing in the CRI will subject themselves to).

Cranial osteopathy reminds me of the complex mathematical models that popped up during the Renaissance to justify the idea that the earth was the center of the game. Brilliant models, totally self-consistent, able to predict the movement and position of heavenly bodies, dead wrong. Like those models, cranial osteopathy is an attempt to justify what's essentially a hypothesis of faith in the language of, but *in spite of*, well-established scientific principles. It looks pretty, seems consistent, and one might even make some observations that seem consistent with it, but in the end there are simpler, if less glamorous, explanations that fit far more closely with fact.

I can only speak for myself, but I've never questioned my choice of osteopathy as much as in these last several weeks when tested on these elaborate physiological orreries with little basis outside Sutherland's own cranial impulses. Can I in good faith recommend to premeds a discipline that makes room for such contortions in science with so little concern for rigor and proof? Yes, because osteopathy has a lot going for it. But the recommendation is in spite of this, and had I fully understood the extent of the cranial cartel's reach as a premed I would have gone into osteopathy far more warily.

I never said there was no need for research i was simply stating why there is no good research.

 

[jhug]

But, for all of the complaining that goes on, no one steps up to the plate to do these sorts of studies despite the fact that doing so would attract great noteriety for such an individual.

Noteriety? if i may speak frankly, cranial is a thorn in the side of osteopathy and i wouldn't want my name associated with it either! It kills me to hear the defensive..."if you don't believe in cranial why don't you just become an MD..."
I didn't go into osteopathy because i felt i was lacking in religion...i don't have to *believe* anything...just teach me medicine...cranial is NOT medicine. Teach me how to treat the patient as a person...not fantasize about some mysterious CRI that i have to "tune into" like it's some midichlorian gift because the patient "needs something to be expelled from the body"
AND i don't need omm faculty posing as a pt trying to make me feel like i'm missing out on some great medical breakthrough (hint hint tom26) by not believing cranial of all things!!!

 

[AwesomeO-DO]

Noteriety? if i may speak frankly, cranial is a thorn in the side of osteopathy and i wouldn't want my name associated with it either! It kills me to hear the defensive..."if you don't believe in cranial why don't you just become an MD..."
I didn't go into osteopathy because i felt i was lacking in religion...i don't have to *believe* anything...just teach me medicine...cranial is NOT medicine. Teach me how to treat the patient as a person...not fantasize about some mysterious CRI that i have to "tune into" like it's some midichlorian gift because the patient "needs something to be expelled from the body"
AND i don't need omm faculty posing as a pt trying to make me feel like i'm missing out on some great medical breakthrough (hint hint tom26) by not believing cranial of all things!!!

jhug... use the force

 

[Ligament]

I have taken two basic 40hr and one advanced Cranial Academy course.

I am not convinced the CRI means anything at all. Yes I can generally palpate "it" whatever it is. I think that the CRI itself is a red herring.

I don't really care if the cranial bones are mobile. There are still people that don't believe the sacro-iliac joint is mobile!

One thing I can say, and I say this as a soon to be attending physician, is that my cranial training GREATLY helped my palpatory skills in general. Even things as standard as an abdominal exam improved because I learned to "listen" better with my hands, to "listen" for subtle motions and stresses in the myofacia that otherwise I would have neglected.

Point is, if you don't believe the basic tenents of cranial osteopathy, that is fine. Use your time with hands on the head to improve your palpatory skills in general and apply to areas of OMM you do agree with.

And I do agree cranial osteopathy should not be on the boards.

 

[phd2b]

One thing I can say, and I say this as a soon to be attending physician, is that my cranial training GREATLY helped my palpatory skills in general. Even things as standard as an abdominal exam improved because I learned to "listen" better with my hands, to "listen" for subtle motions and stresses in the myofacia that otherwise I would have neglected.

Point is, if you don't believe the basic tenents of cranial osteopathy, that is fine. Use your time with hands on the head to improve your palpatory skills in general and apply to areas of OMM you do agree with.

Ligament,
I couldn't agree more! I've learned that much better palpatory skills through OMT has led me to more confidence doing breast exams (is it a fibrous change or a nasty lump?) especially post-op, lymph node exams, and yes, adbominal exams...

Interesting observation...

 

[AwesomeO-DO]

dang, almost had 100 posts

 

[AwesomeO-DO]

that's better