Accepting Cranial

[deeq]

I've felt the mystical, elusive CRI. I became 'one' with it during 1st and 2nd years. And I thought to myself, "Darn! That's pretty cool!" But I never revisited it during third year or this year. And I would NEVER, NEVER admit to my allopathic counterparts that it is something I even learned. Still cool though....

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[InductionAgent]

I would propose doing some animal studies to examine the situation:

Completely anesthetize some sort of mammal. Place them on a ventilator.

Place an intraventricular catheter into the cranium of said animal, connected to a transducer to measure CSF pressure.

Place an arterial BP line and a CVP monitor.

Measure fluctuations in CSF pressure and see whether any appreciable cyclic variations exist. If so, compare them to the fluctuations of arterial and venous BP as well as the ventilator cycle to see what interactions exist. The ventilator rate could be changed, including periods of apnea.

This would provide purely objective evidence for or against the whole CRI concept.

 

[Karmajunkie]

I would propose doing some animal studies to examine the situation:

Completely anesthetize some sort of mammal. Place them on a ventilator.

Place an intraventricular catheter into the cranium of said animal, connected to a transducer to measure CSF pressure.

Place an arterial BP line and a CVP monitor.

Measure fluctuations in CSF pressure and see whether any appreciable cyclic variations exist. If so, compare them to the fluctuations of arterial and venous BP as well as the ventilator cycle to see what interactions exist. The ventilator rate could be changed, including periods of apnea.

This would provide purely objective evidence for or against the whole CRI concept.

It's funny that osteopathic students are debating stuff like this. Then again, perhaps the biggest problem with garnering wide respect for any OMM tx is the fact that the field sucks at developing research or referencing it when appropriate. Case in point, this type of research has already been done. Though you wouldn't know it by reading the debate between osteopathic students on this thread, I don't think the existence of skull movement is really debatable any more. That being the case, the efficacy of any treatments to this movement is where the heart of the debate lies. Do these treatments actually do anything? Who knows?

Don't hate the player. Hate the game.

1. Parietal Bone Mobility in the Anesthetized Cat
Thomas Adams, Ph.D., et al.

Journal of the American Osteopathic Association, Volume 92, Number 5, May 1992

Dr. Thomas applied strain gauges across the surgically exposed sagittal sutures in living cats. He recorded rhythmic motion across the sutures with the cats at rest that differed from cardiovascular and respiratory activity. Externally applied stimuli did not significantly change the sutural activity. The rates of sutural movement averaged 11 cycles per minute.

2. Ultrasonic Measurement of Intra-Cranial Pulsations at 9 Cycles Per Minute
Wallace, Avant, McKinney and Thurstone at Winston-Salem, North Carolina

Journal of Neurology, 1975

The investigators reported an apparently independent 9-cycle-per-minute intracranial pulsation observed by ultrasound in the brain and membrane tissues of a human subject.

 

[LukeWhite]

Read the metastudy, Karma. A few 30-year old neuro studies or cat anesthetizations do not make for compelling evidence. We've mentioned several substantive challenges that proponents of cranial therapy should be able to answer fairly easily since any sound theory would have answered these already. So far, the silence has been notable. Lots of calls for new research, but why haven't all the major critiques of the theory been addressed by the old? It's a conclusion seeking justification, and that's not science.

 

[cooldreams]

Read the metastudy, Karma. A few 30-year old neuro studies or cat anesthetizations do not make for compelling evidence. We've mentioned several substantive challenges that proponents of cranial therapy should be able to answer fairly easily since any sound theory would have answered these already. So far, the silence has been notable. Lots of calls for new research, but why haven't all the major critiques of the theory been addressed by the old? It's a conclusion seeking justification, and that's not science.

and likewise justifyable arguements against your "metastudy"... anyways karma was not saying that omm works in cranial... he was just giving already published studies (not metastudies) showing with reproducable results that the "immovable bones" do infact move with some rhythm.

 

[Karmajunkie]

Read the metastudy, Karma. A few 30-year old neuro studies or cat anesthetizations do not make for compelling evidence. . . . .

Are you really putting so much stake in that metastudy? Someone picks apart some aparantly poorly done studies and this disproves cranial mobility all together? You may note that the "metastudy" does not make mention of the either of the 2 studies I mentioned above or either of these:

1. Milicien Tettambel, DO, coauthored an article in the Journal of the American Osteopathic Association (vol. 78, October, 1978, p. 149) titled "Recording of the Cranial Rhythmic Impulse", in which she reported using force transducers taped across the frontal bone and the two mastoid processes of the temporal bones on 30 subjects. She successfully recorded three separate rhythms on all the subjects. The cardiac pulses and respiratory rhythms were clearly recorded, as was a third pulse at an average of 8 cycles per minute. She presumed the third rhythm to represent the cranial rhythmic impulse.

2. Jenkins, Campbell & White authored "Modulation Resembling Traube-Hering Waves Recorded in Human Brain" in European Neurology (Vol. 5:1-6, 1971), in which they reported that using ultrasound echo pulsations were observed at 7 cycles per minute in a human subject. The pulsations did not change when the subject held his breath. Traube-Hering pulsations are usually measured on the ear. When they observed the Traube-Hering pulsations, they differed significantly from the 7-per-minute pulsations of the brain. Therefore, they concluded that the 7-per-minute pulsations were autonomous and not related to either cardiac, respiratory, and/or Traube-Hering pulsations.


If you do much searching at all you will realize that these studies are often cited by proponents of the therapy. The metastudy was very thorough and one has to wonder why the author would neglect to even mention these works. Perhaps it's because they were well done and reported in journals that don't exactly let in trash (i.e. Neurology and European Neurology). In other words, they disproved the authors purpose so he chose to ignore them.

Am I completely sold on craniosacral therapy? No. Will I refuse to allow for the possibility that a pulsation of fluid around the CNS could prove to affect health? Obviously not.

 

[LukeWhite]

and likewise justifyable arguements against your "metastudy"... anyways karma was not saying that omm works in cranial... he was just giving already published studies (not metastudies) showing with reproducable results that the "immovable bones" do infact move with some rhythm.

Good to see you, cool! You owe us a...word doc, was it? that you promised some time ago. What happened to it?

 

[cooldreams]

Good to see you, cool! You owe us a...word doc, was it? that you promised some time ago. What happened to it?

i said on friday. i didnt say which friday.

i am at such a disadvantage not having the books and libraries you guys have. im not even in school yet... im still working on it... dont worry - BE HAPPY

honestly all of this talk has really inspired me... i really want to do research in this... i think either outcome would be fine, just learning this stuff is pretty cool to me...

 

[Dr JPH]

Am I completely sold on craniosacral therapy? No. Will I refuse to allow for the possibility that a pulsation of fluid around the CNS could prove to affect health? Obviously not.

Best comment on this entire thread so far.

 

[Karmajunkie]

It's a conclusion seeking justification, and that's not science.

Are you saying that we shouldn't start with a hypothesis? I thought that this is exactly how scientific method worked. Maybe I just learned it incorrectly.

Courtesy of dictionary.com:

hy·poth·e·sis ( P ) Pronunciation Key (h-pth-ss)
n. pl. hy·poth·e·ses (-sz)

1. A tentative explanation for an observation, phenomenon, or scientific problem that can be tested by further investigation.
2. Something taken to be true for the purpose of argument or investigation; an assumption.

 

[jhug]

for the purpose of argument or investigation; an assumption.

NOT to be taught as truth nor a proper mode of treatment for sick patients...

here is another word straight from the dictionary...(just in case you don't believe me...http://dictionary.reference.com/search?q=quackery)

quackery

n 1: medical practice and advice based on observation and experience in ignorance of scientific findings

 

[tkim]

I will say this - after completing my 40 hour cranial course.

I've never had so many headaches in a week.

CN IV decompression - stat!

 

[cooldreams]

NOT to be taught as truth nor a proper mode of treatment for sick patients...

here is another word straight from the dictionary...(just in case you don't believe me...http://dictionary.reference.com/search?q=quackery)

quackery

n 1: medical practice and advice based on observation and experience in ignorance of scientific findings

hmm dont you need the scientific findings in direct conflict with the practice and advice for that definition to fit?

futher, you would need scientific findings.....

 

[jhug]

i believe the definition states that a quack (one who practices quackery) is someone giving medical advice/treatment in IGNORANCE of scientific findings, that is, treatment without any science to back it up...

cranial may be legitimate...but until it is, i feel it should be taught as any other investigational therapy...
And even then, i think cranial should be taught to the level to do well on the boards (two weeks max) and any extra should be offered as an elective.

 

[cooldreams]

i believe the definition states that a quack (one who practices quackery) is someone giving medical advice/treatment in IGNORANCE of scientific findings, that is, treatment without any science to back it up...

cranial may be legitimate...but until it is, i feel it should be taught as any other investigational therapy...
And even then, i think cranial should be taught to the level to do well on the boards (two weeks max) and any extra should be offered as an elective.

these two are not equal. you are wrong in your interpretation.

how does
"treatment in IGNORANCE of scientific findings"
=
"treatment without any science to back it up"

seems that the first is where scientific findings stand in direct conflict,

whereas the second there is no scientific findings to back it up, but also not nessesarily any to say otherwise either.



if you wish to argue that scientific findings say that csr is wrong fine, use real evidence.. not meta studies. this is what has started the whole arguement. seems both arguements (for and against) are really lacking any evidence on the actual usefulness of this.

metastudy = opinionated regurgitation of bits and pieces of other studies without any original studies of the author'(s) own.

 

[LukeWhite]

cool,

Your quote a little ways back about not having the advantages of literature and experience that current students do was prescient. Hold that thought for awhile, and read up on the scientific method, because you're brutally mangling it with the equivalent of a rusty knife and it's starting to hurt.

I'll make the point everyone else has made one more time: There *are* plenty of studies that invalidate core tenets of cranial (see: the preponderance showing an absurdly low interexaminer reliability) but even without these there would be no basis for the thing. The burden of proof is on the claimant, and the studies that purport to demonstrate tenets of CSI are invariably poorly constructed, obscure, and unreplicated.

I really do hate to bring up this point again, but maybe you should wait to learn a bit more about the modality before getting into these pit fights. I can't help but question your motivation for the defense, as you've brought up martial arts and perhaps even mysticism as rationale for your gravitation towards cranial. These may be fine and good things, and I hope that there's a place for cranial in their hallowed halls. But medicine, even osteopathic (despite what so many of its students seem to believe) is not some big-tent free-for-all that lets every bit of quackery through the door if it's chaperoned by a 1970s anesthetized cat study. There are hurdles that cranial has not surmounted. If you're determined, though, to defend this fair damsel cranial whose face you've never seen, you might be well served to get a bit better grasp on the rather large dragon of inconvenient facts you're facing.

 

[jhug]

Luke...as always, eloquently perfect!!!

cool:
ignorance=the lack of knowledge or education (http://dictionary.reference.com/search?q=ignorance)

People are teaching/treating with cranial..."in the lack of knowledge or education" via scientific evidence that it works...ie: teaching/treating medicine "in ignorance" of scientific findings (see quakery above)

They can tell me it works, they can promise me it works, they can bet their practices on it working, they can even claim to feel angstroms of motion beneath various layers of tissue, fat, and even bone!!! But until they prove its efficacy through legit studies i don't think it should hold a substantial place in our education.

 

[bigmuny]

these two are not equal. you are wrong in your interpretation.

how does
"treatment in IGNORANCE of scientific findings"
=
"treatment without any science to back it up"

seems that the first is where scientific findings stand in direct conflict,

whereas the second there is no scientific findings to back it up, but also not nessesarily any to say otherwise either.



if you wish to argue that scientific findings say that csr is wrong fine, use real evidence.. not meta studies. this is what has started the whole arguement. seems both arguements (for and against) are really lacking any evidence on the actual usefulness of this.

metastudy = opinionated regurgitation of bits and pieces of other studies without any original studies of the author'(s) own.

A meta-analysis is a study of all the published literarture on a particular subject(within certain defined parameters for the analysis, ie all double-blind randomised studies, ect..). In evedince-based medicine it is considered the ultimate authority and best evidence for or against a particular treament. There is something called the ebm pyramid(there are dozens of websites to look this up on, and help you become more informed), and at the top of that pyramid is the meta-analysis. It is above all other studies because it uses all other studies for it's data. You really need to know and understand this before you make a fool out of yourself later in your career.

 

[cooldreams]

begining and end analysis...

"Since no properly randomized, blinded,
and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed
from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations."

hmm. so they say that since in their "opinion" and in their fact finding effort, that there is "no properly randomized, blinded, and placebo-controlled outcome studies have been published" that the entire study should be removed from the program. and you agree with this, i assume.


"Until mechanistic claims associated with the PRM have been validated, until diagnostic reliability has been established, and until properly randomized and placebo-controlled outcome studies have demonstrated symptom improvement following manipulation of relevant parameters, we believe cranial osteopathy should be excluded... "

again they say that in their opinion this needs to fit their decided upon parameters to be allowed as part of the curriculum. and since they could find no evidence of any of those, they have decided in their opinion (note the wording "we believe") that it should be taken out of the curriculum.

i would like to move that this paper someone found is not even an acceptable form of a meta-analysis as per definition:


"met·a-a·nal·y·sis (mt--nl-ss)
n.
The process or technique of synthesizing research results by using various statistical methods to retrieve, select, and combine results from previous separate but related studies."



obviously this does not mean the study includes ALL literature as bigmuny attempted to suggest.

if one were to simply read this mind numbing paper with many groundless and poorly articulated claims, you would see that it quickly falls apart. case in point:

"...the brain and spinal cord cannot be capable of intrinsically derived movement as organs (see also Becker)ll because neurons and glial cells
lack the requisite microstructure (in particular, dense arrays of actin and myosin filaments). Claims of "a subtle, slow, wormlike movement,"7 "coiling and un- coiling of the cerebral hemispheres,"6(p165) "rhythmic expansion and contraction of the brain and spinal cord,"5 and "dilation and contraction of the [cerebral] ventricles"4(p52) are scientifically groundless."

so in their reasoning that since these organs contain insufficient amounts of actin and myosin, they cannot possibly move. hmm.. well i found the following to be quite interesting in light of their OPINION:

"The Inherent Motility of the Brain and Spinal Cord

Several studies have demonstrated the presence of movement of the brain and spinal cord in vivo. Greitz, et. al., (1992) utilizing magnetic resonance imaging (MRI) techniques demonstrated brain tissue movements characterized by a caudal, medial and posteriorly directed movement of the of the basal ganglia, and a caudad and anterior movement of the pons during cardiac systole. The resultant movement vectors occurred in a "funnel shaped" manner eliciting a remolding of the brain creating a "piston-like" action that the authors felt was the driving force responsible for compression of the ventricular system and thus the driving force for intraventricular flow of cerebrospinal fluid (CSF).

Figs. 1 & 2

Enzmann, and Pelc (1992), demonstrated brain motion during the cardiac cycle utilizing a similar magnetic resonance technique as Grietz. Peak displacement was in the range of 0.10.5 mm except for the cerebellar tonsils which had a greater degree of displacement of 0.4 mm. Poncelet, et. al, (1992) using an echo-planar magnetic resonance imaging technique, were able to show pulsatile motion of brain parenchyma. Brain motion appeared to consist of a single displacement in systole, followed by a slow return to the initial configuration during diastole. Feinberg and Mark, (1987) postulated that the pulsatile nature of CSF flow and brain motion was driven by the force of expansion of the choroid plexus. In their study, using MRI techniques, observations of pulsatile brain motion, ejection of CSF into the ventricles and simultaneous reversal of CSF flow in the basal cisterns to the spinal canal, suggested that a vascularly driven mechanism may serve as the pumping force of CSF circulation. Maier, et. al., (1994) demonstrated periodic brain and CSF motion associated with periodic squeezing of the ventricles. Mikulis, et. al, (1994), demonstrated movement of the cervical spinal cord in an oscillatory manner in a craniocaudal direction during cardiac systole."

http://www.osteohome.com/MainPages/research.html


i would finally like to thank all of you who ridiculed me, a premed, for my lack of understanding. true, i honestly do not understand much of this, but with some study time put in, it can be easily understood. it finally made me stop what i was doing and actually read what you have brought as your mainstay argument against what you are taught in the school of your own choosing. yes i only hit on a few cases, but i feel these are enough in the time being to question any future argument that relies upon this paper for questioning csi.

i would for a moment like to come back to the last statment giving 3 conditions:

1) Until mechanistic claims associated with the PRM have been validated
--->(this appears to be satisfied in light of the above arguement)

2) until diagnostic reliability has been established
--->(diagnostic monitoring of the csr has been established using reproducable methods. as shown in articles posted by karmajunkie, phd2b, drusso, and others)

3) until properly randomized and placebo-controlled outcome studies have demonstrated symptom improvement following manipulation of relevant parameters
--->(I found this to be an interesting article: http://www.garynull.com/Documents/JuneRussell/ConventionalMedicine.htm

"The U.S. Congress' Office of Technological Assessment reported that only 10 to 20 percent of the medical procedures done by conventional medicine has been proven to be effective. ("Prescription for Health," Thomas Moore, 1998) In Thomas Moore's 1995 book, "Deadly Medicine," he states that there are unproven drugs - which were suppose to be off the market by 1964 - still being sold thirty years later, despite lawsuits, court orders, critical government studies and congressional complaints.")

l8rs...............

 

[lama]

Cool

Dude, your'e not even a medical student yet... Don't you think you ought to wait until AFTER you have taken cranial to speak out about its merits/faults? Your'e naive and ignorant concerning the matter and have no place commenting on something you have neither experienced first-hand nor know anything about. Lay off.

 

[LukeWhite]

cool,

Nobody's ridiculing you, but you really should stop. You devoted a lot of time cutting-and-pasting to rebut the metastudy's point that the brain/spinal cord is incapable of inherent movement. Never mind that the studies you cite are far less persuasive, estabilshed, replicated than the knowledge the metastudy's relying on--they don't address the question of *inherent* movement at all. If you read the paragraphs you pasted, you'll see that neither one suggests evidence for an intrinsic capacity for movement.

I wonder what medical treatments you *would* reject. Given that you've embraced cranial therapy with no experience of it and in the face of what everyone agrees is some significant evidence against, it seems to me that your criterion for whether you'll embrace a therapy is whether it sounds good to you or not. You'll certainly have plenty of company in the medical field if you continue that route, but that doesn't make it medicine.

 

[cooldreams]

Luke - I have been repeatedly ridiculed in this thread for simply being open to the possibility that this may be beneficial. I suppose that is part of my motivation in continuing the argument. But even so, my argument all along has never been that this actually works. It has been that I do not see sufficient evidence to disclaim this 40-50 year old method that has a growing number of supportive research. You have produced a number of questionable points that I have actually read up on a number of and it just does not hold up to killing this off.

Inherent movement has already been addressed in this thread to my personal satisfaction. If you are not happy with it, well, I don’t really care. To me, the only question left is if the cranial techniques actually produce positive results. The articles and research I have read open up the possibility for movement to be real and rhythms to be real but with unknown proven benefit.

Lama – I have as much place as ANY person out there to COMMENT on this. If you can’t handle that, then quit reading. This is STUDENT doctor network. We are here (at least i am) to learn and gain insight that is not readily provided elsewhere.

crazy man... the first time i attack their main paper, all of the points i found get ignored and i am personally attacked for just being me.

 

[jhug]

cool...
have you ever heard of an angstrom???
it's equal to one hundred-millionth (10-8) of a centimeter...
Cranial quacks claim to feel angstroms (one hundred-millionths of a centimeter) of movement in bones that are under layers of skin, facia, bone, and meninges!!!!
Cranial = quackery
quakery = bad
bad = not good
not good = evaluate why we are being taught this in medical school
The studies supporting cranial are bunk as is the idea behind it...as is the fact that i am required to be tested on it...

just wait till you are taught it...they turn down the lights, speak real soft, light a few incense, and you tap into the dust clouds circling the second moon of jupiter...
the best thing about cranial were the naps i took while some poor student wasted 45 min. holding my head with his thumbs!!!

 

[cooldreams]

cool...
have you ever heard of an angstrom???
it's equal to one hundred-millionth (10-8) of a centimeter...
Cranial quacks claim to feel angstroms (one hundred-millionths of a centimeter) of movement in bones that are under layers of skin, facia, bone, and meninges!!!!
Cranial = quackery
quakery = bad
bad = not good
not good = evaluate why we are being taught this in medical school
The studies supporting cranial are bunk as is the idea behind it...as is the fact that i am required to be tested on it...

just wait till you are taught it...they turn down the lights, speak real soft, light a few incense, and you tap into the dust clouds circling the second moon of jupiter...
the best thing about cranial were the naps i took while some poor student wasted 45 min. holding my head with his thumbs!!!

i understand that you are a highly stressed medical student with absolutely no freetime to read the whole thread, so to help,

http://forums.studentdoctor.net/showpost.php?p=2252289&postcount=70

i have already addressed this issue. it was one of Luke's first points that raised a red flag to me.... i know very well what an angstrom is. you use this to measure atoms. the documentation i have found talking about this is much more believeable however. can you provide documentation describing the exact range of depth required? the one i found said approx 1/2500 of an inch. this is much more than an angstrom, and within the range of human sensation.

if they were to say you are required to detect a delta on a scale of an angstrom that would have been a deal breaker. i cannot find anything ever talking about such a small scale. maybe they teach you guys out there in arizona something different. i see you both are in the same class.............

 

[jhug]

yea, they told us to "look for the angstroms of movement"...
even still, 1/2500 of an inch DEEP TO half of an inch of bone is pushing...no, it's long crossed, that fine line of even somewhat remotely believable and complete quackery...(and i don't use the "q" word lightly)

 

[cooldreams]

"look for the angstroms of movement" sounds like terminology that is used as a tradition of sorts. like, i dont think it means anything. how many angstroms? like one hydrogen atom is about one angstrom in diameter.

i dunno man... i know i feel grooves and mountains on things smaller than i can easily see like the depth of some typed/printed words, and im positive that if they were moving it would have been a hell of a lot easier to detect... at any rate, this size is within what is considered the limits of human sensation. if you dont believe that, fine... but for me, this is not enough to dismiss cranial. it does not at all confirm it, but neither does it dismiss it.

 

[Karmajunkie]

Luke - I have been repeatedly ridiculed in this thread for simply being open to the possibility that this may be beneficial. . . .

Lama – I have as much place as ANY person out there to COMMENT on this. If you can’t handle that, then quit reading. This is STUDENT doctor network. We are here (at least i am) to learn and gain insight that is not readily provided elsewhere.

Props for such diligence cool. I'm not sure how Luke could possibly say that no one is ridiculing you immediately after you were berated for not being in medical school yet. Apparently Lama (a gross misnomer) feels that now that he/she is in med school the opinions of all others are inferior even if their opinion is backed by stated research and his is backed by an obviously flawed meta-analysis. I feel sorry for his/her future patients.

Here is another prescient moment for you luke.

Lama's patient - but I'm telling you it hurts doc.
Lama - You're lying. I've seen hundreds of cases like this and your pain is not as bad as you say it is. You're just a drug seeker.
(nevermind the fact that neuropathic pain is probably present)

You might also note that any research addressing cranial movement or CSF fluctuation is immediately dismissed as being flawed without any reason. Never mind the fact that these studies were performed with ultrasound, MRI's, and stress transducers. If the studies prove something inconvenient to their argument then they must be flawed.

This thread is getting boring. Numerous pieces of evidence that there is movement and one horribly inadequate piece of evidence against.

As for the angstrom thing, I can relate to you on that point Luke. I'm not sure who your instructor is but it would probably be hard for me to believe any statements coming from that person as well. This doesn't change the fact that the cranium moves though. You really wouldn't need the studies we've provided (which are substantive) if you just felt for the movement with genuine concentration.

Unless someone starts giving substantive retorts rather than just making fun of cool for being a subhuman premed I'm out. It has been fun chatting with ya'all.

And just to summarize: I'm not totally sold on the therapy but rather retaining an open mind to a treatment modality with loads of anecdotal evidence and some scientific research that is yet in its infancy.

"You must first be the change you wish to see in your world." - Gandhi

 

[AwesomeO-DO]

Props for such diligence cool. I'm not sure how Luke could possibly say that no one is ridiculing you immediately after you were berated for not being in medical school yet. Apparently Lama (a gross misnomer) feels that now that he/she is in med school the opinions of all others are inferior even if their opinion is backed by stated research and his is backed by an obviously flawed meta-analysis. I feel sorry for his/her future patients.

Here is another prescient moment for you luke.

Lama's patient - but I'm telling you it hurts doc.
Lama - You're lying. I've seen hundreds of cases like this and your pain is not as bad as you say it is. You're just a drug seeker.
(nevermind the fact that neuropathic pain is probably present)

You might also note that any research addressing cranial movement or CSF fluctuation is immediately dismissed as being flawed without any reason. Never mind the fact that these studies were performed with ultrasound, MRI's, and stress transducers. If the studies prove something inconvenient to their argument then they must be flawed.

This thread is getting boring. Numerous pieces of evidence that there is movement and one horribly inadequate piece of evidence against.

As for the angstrom thing, I can relate to you on that point Luke. I'm not sure who your instructor is but it would probably be hard for me to believe any statements coming from that person as well. This doesn't change the fact that the cranium moves though. You really wouldn't need the studies we've provided (which are substantive) if you just felt for the movement with genuine concentration.

Unless someone starts giving substantive retorts rather than just making fun of cool for being a subhuman premed I'm out. It has been fun chatting with ya'all.

And just to summarize: I'm not totally sold on the therapy but rather retaining an open mind to a treatment modality with loads of anecdotal evidence and some scientific research that is yet in its infancy.

"You must first be the change you wish to see in your world." - Gandhi

"nevermind the fact that neuropathic pain is probably present)".... hmmmmm... somebody just had a neurology exam.....

 

[LukeWhite]

Karma,

I'm not sure where you get the idea that there's one piece of evidence against. I keep referring to the metastudy for two reasons: for one, it invalidates the bulk of the most solid cranial evidence. Secondly, it would take a very long time to list the very many reasons cranial osteopathy is logically flawed.

I'm not going to spend too much time rehashing old territory, but those who accept cranial seem to think that suggesting CSF movement settles it. I have no opinion on whether the CSF pulses or not. Frankly, I don't care, because the bones are sutured, feeling that CSF pulse is therefore going to be all but impossible, and study after study has shown that interexaminer reliability in determining the rhythm is abysmal. Those tenets of cranial osteopathy are there for a reason--the treatment's built on a mountain of suppositions, the invalidity any one of which trashes the whole thing. The standard way to get past inconvenient assumptions has always been to state them as axioms, and cranial does that very effectively.

 

[newyorkcougar]

Does anyone know about cranial at PCOM? How do they teach it? How "out there" is it at PCOM? How much time is spent on it? How much do most schools spend? A whole semester? More?

 

[DOSouthpaw]

We spend 2 months on it in the second year at PCSOM. We are not taught the Sutherland model in lab, just in theory in class for boards. In lab we are taught a cranial modality A.T. Still's grandson, George A. Laughlin used. We don't spend all of our time in a dark room trying to palpate the CRI or anything like that. The cranial we use is very simple and quite effective. It's so simple that I've demonstrated it to many PhDs and MDs and totally blown their socks off because they could feel what I was feeling.

A friend and I actually put together a research protocol for interexaminar reliability when comparing traditional cranial (Sutherland) to Laughlin cranial, but our school rejected the funding. Now we're just waiting for internship so we can tap into hospital funding, IRB, etc to get it done because we have found pretty good reliability amoung us casually when Dxing our way as opposed to the Sutherland model.

That being said, I still respect the Sutherland model. It's like any other model, it was decent for the time, but still has its downfalls. I mean you have to give the guy some credit. He sat around for 20 years with a closet full of skulls and numerous anatomy texts and tried to disprove what he was feeling to himself. When he could no longer in his mind come to the conclusion that the bones didn't move, he thought otherwise. A little obcessive? Maybe, but certainly more noble than going to one lab, getting pissed cuz the professor is a fruitcake with the lights off and dismissing the whole thing with no personal investigation. Flame on...

 

[bones]

Hey guys,

Lots of anti-cranial sentiment here without a whole lot of experience. However, some very good points.

1) many people who use and teach cranial are fruitcakes.

2) a lot of chiros and PT's are taught 'cranial sacral therapy' (CST) with little medical background via the upledger courses- and on occasion say some questionable things about 'cranial'. and there is some confusion about the differences between CST and cranial osteopathy.

3) there are HUGE variations in the skill levels of active practitioners, and it is very difficult to enforce competency in the art in practitioners prior to seeing patients.

4) there are only a few good studies to support the use of cranial osteopathy in the literature, and none i know of are in top journals (just JAOA and the like).

5) mobility of the cranial bones is certainly minimal in a dried out cadaver.



So why bother studying it?

In babies, the theory is more acceptable and the outcomes more obvious. Their heads feel like baloons- and you can physically see a change in the shape of their heads. it is actually quite easy to reshape a deformed head shortly after birth, and quite common to get babies with colic and feeding difficulty to begin feeding and acting normally immediately after thier first treatment (simply releasing strains in fascia around CN X and XII may be responsible for that- but occipital strain is often a factor). In class, unfortuntely, you dont get many babies to work on (and they are afraid to let most DO students near them in peds and OB rotations for competency reasons). Does the cranial rhythm have anything to do with the efficacy of cranial on babies? you can't prove it. Maybe all you are doing is pushing things back to normal anatomy- just be careful how it is done- (the cranial approach appears to work very well in this regard).


on adults?
In good hands, it just works. When flakey docs make up reasons it works, the reasons very well could be wrong- but this is not proof cranial is bunk. You have no reason to believe in the efficacy of cranial though until you cut a classmates horrible migrane in seconds with your own hands. I still remember my first- very surprising at the time because i wasn't expecting it to do anything. Now if it doesn't work immediately i laugh and tell the patient that this cranial stuff is probably just bunk (then I change handholds- and then it often finally releases). Sinus headaches seem to respond consistently as well.

Of course, you cant actually do this until you study cranial (extensively). So we have a catch-22. The healthy skeptics among you have no reason to study it- except that they make you (and perhaps curiosity from all this heresay).


I'm not convinced it should be on boards- and i might suggest to make the entirety of the cranial training an optional course (for that matter, all OMM should be optional- perhaps you could accomplish this by making applications to DO schools optional...

BUT- since you have to study cranial ANYWAY-
ignore your flakey profs and all their angstrom theories. learn it for the babies. both they and their mothers will thank you for it. If you find it works on your adults maybe you can use it as needed there as well.

and dont forget to have fun. Sounds like some of you are taking life a little too seriously...

michael

P.S. watch out who your partner is in cranial class. afterword we usually have to fix several people who are nauseated or dizzy (which of course must be placebo side effects since we all know cranial bones dont move...).

 

[heech]

On a similar (but slightly different) note... I noted with some surprise/interest the amount of research going into traditional Chinese medicine. Here's one link from this week's Medscape:

http://www.medscape.com/viewarticle/501973_2

Especially surprising is the diverse range of possible hypothesis which researchers list for explaining the proven, positive clinical results seen from pushing little metal pins into nerve centers in various areas of the body. Physical (vascular flow), neurological (nerve conduction)... even quantum mechanics and wave phenomenon were mentioned as a possible mechanism.

So, that said... a couple of cents:

- the theories of clinical practictioners of "the art" might not be scientifically reasonable (few clinical scientists believe the traditional Chinese elements, nor the existence of 'Qi' energy throughout the body, nor yin/yang)... but that doesn't automatically mean there's no science behind it. Clinical practictioners might just be wrong. (This is in reference to the debate about whether 'angstroms' are actually being felt/manipulated.)

- clinical research in medicine is *all* about proving/detecting positive results first, and then trying to understand the mechanism. The fact that we can't explain the mechanism doesn't mean it's not happening... not in medicine.

- that said, wishful thinking and plausible explanations is no replacement for solid clinical research.

 

[LukeWhite]

The problem is not that we've got a great, clinically useful technique without an articulated mechanism. It's that we've got a pretty mechanism without useful clinical results to accompany it. While proponents of cranial can point to all sorts of success, so can the homeopaths, who maybe-not-so-ironically have at least as much, if not more, clinical evidence to back up their claims. This is the Achilles heel of osteopathy and alternative medicine in general: well-meaning practitioners (often just one) get a Theory and elaborate it far beyond what the data support. It's an unfortunate artifact of America's wholesale acceptance of osteopathy that we've allowed this shoddy science to worm its way into boards and osteo labs.

At least HALF of our 2nd-year OMM labs have had something to do with cranial osteopathy: While useful skills remain undeveloped or atrophy, we're being indoctrinated in techniques the smallest proportion of practitioners will use. It's the classic triumph of orthodoxy over practicality, exactly the sort of thing that osteopathy so strenuously claims to work against.

 

[bones]

The problem is not that we've got a great, clinically useful technique without an articulated mechanism. It's that we've got a pretty mechanism without useful clinical results to accompany it. While proponents of cranial can point to all sorts of success, so can the homeopaths, who maybe-not-so-ironically have at least as much, if not more, clinical evidence to back up their claims. This is the Achilles heel of osteopathy and alternative medicine in general: well-meaning practitioners (often just one) get a Theory and elaborate it far beyond what the data support. It's an unfortunate artifact of America's wholesale acceptance of osteopathy that we've allowed this shoddy science to worm its way into boards and osteo labs.

At least HALF of our 2nd-year OMM labs have had something to do with cranial osteopathy: While useful skills remain undeveloped or atrophy, we're being indoctrinated in techniques the smallest proportion of practitioners will use. It's the classic triumph of orthodoxy over practicality, exactly the sort of thing that osteopathy so strenuously claims to work against.

Now, i could be wrong, but it doesnt sound like you have the clinical experience in pediatrics or in cranial osteopathy to back up your claims that cranial doesn't have clinically useful results. Question whatever you like, but dont say cranial works or doesnt work if you have no basis to make this claim.

Shadow a skilled OMM specialist that works a neonatal unit sometime- i think you'll find that their success rate (using mostly cranial) for colic and feeding problems is near 100% on the first treatment- and these are problems that can persist for weeks and months and sometimes seriously impact the health of the child if left untreated (other times its more of a pain in the butt to the parents who dont seem to sleep until its fixed). Infants dont lie about how they feel. Either they scream day and night or they dont. Either they feed or they dont.

If you can verify this is true (even if you can only verify it in infants)- cranial would be placed in your category of "a great, clinically useful technique without an articulated mechanism" even with all other applications and patient groups aside.

 

[LukeWhite]

I don't have the clinical experience to say that homeopathy doesn't work either, and so I rely on the studies to form an opinion.

If you hadn't jumped so quickly to fling your banner to the wind, you'd perhaps have noted that I only said we didn't have clinically useful results to accompany the proposed mechanism. As I've noted repeatedly on this thread, certain techniques that fall under the cranial rubric might very well have some validity, and I've in fact mentioned children as one group that might in fact benefit from something possibly and very tangentially related to the proposed orthodox mechanism.

Though I hate repeat the same points every post, perhaps it's necessary: The fact that you get results doesn't justify the mechanism you propose for those results. I could just as easily propose magic goblins as the force behind the placebo effect--unless I can come up with clinically significant, replicable evidence for the claim, it's not science. While I've no doubt that certain (though not all) techniques we call cranial may have some use, I certainly do doubt that it's according to the mechanisms attached to them.

As for this whole "don't question cranial unless you have the experience," really, let's give this a rest. This is the perpetual refuge of cultists everywhere, and it's why we have the scientific method. You'll forever be able to claim that doubters just haven't seen the amazing anecdotal results you've obtained: One of Viola Frymann's disciples lectured our OMM class and told us that she converted a true Down Syndrome to a mosaic. Absolute gibberish, but hey, *she was there*. I think there's plenty of room to discuss this stuff without being confrontational, but there comes a point at which appeals to authority become a refuge for religion rather than medicine, and those don't deserve much countenancing.

 

[bones]

P.S. It isnt your job to verify this stuff if you don't want it to be- but before you take sides in the debate- you should. Watching dozens of patients with great (and instant) clinical outcomes is no substitute for clinical research involving thousands, but it is more than nothing. Probably not enough to require it being taught to all students- but certainly enough to keep the topic of whether there is any value to it open for debate.

 

[LukeWhite]

I don't think anyone doubts it has potential value, and it's a given that innovations in medicine will often outpace evidence for them. But as you say, perhaps it's best suited to those who are interested in that particular frontier. Building an entire second-year OMM curriculum is either an act of extraordinary naivete or cold cynicism designed to protect the identify of the profession at the expense of actual utility to patients.

 

[bones]

Luke- sorry bout that- I thought when you said "clinical results" you meant "clinical results" and not "clinical studies".

 

[bones]

I don't think anyone doubts it has potential value, and it's a given that innovations in medicine will often outpace evidence for them. But as you say, perhaps it's best suited to those who are interested in that particular frontier. Building an entire second-year OMM curriculum is either an act of extraordinary naivete or cold cynicism designed to protect the identify of the profession at the expense of actual utility to patients.

I think we agree on the points that matter. I would be surprised if the entire second year at your school was built around cranial- at KCOM it is just another modality presented (of many). Because of its great clinical value in children I dont mind that they teach it to second years- though there certainly is reason for pause- i don't think they should put it on boards. Just my 2 cents.

seriously though- if you want to chime in about how something works (especially) or doesnt work, please spend some time educating yourself clinically. I can't guess how you guys learn it in class, but i suspect the method itself might be what turns you off.

 

[MGoBlueDO]

I wish I could feel taht CRI that everyone talks about...although my school didn't spend much time on this subject we just learned enought for board exams...even Dr. Simmons, DO gave a review on it to us and it took only 1 hour...but the doctors spent more time trying to prove to us how real it was instead of showing us more in lab...

 

[dcratamt]

I wish I could feel taht CRI that everyone talks about...although my school didn't spend much time on this subject we just learned enought for board exams...even Dr. Simmons, DO gave a review on it to us and it took only 1 hour...but the doctors spent more time trying to prove to us how real it was instead of showing us more in lab...

Try just feeling the joint play between the sutures first. Treat it and compare the feel before and after. Then you can worry about the CRI.

 

[bones]

I wish I could feel taht CRI that everyone talks about...although my school didn't spend much time on this subject we just learned enought for board exams...even Dr. Simmons, DO gave a review on it to us and it took only 1 hour...but the doctors spent more time trying to prove to us how real it was instead of showing us more in lab...

I believe that KCOM is the only DO school that offers a full free 40 hour credited cranial academy course to all students (one of the faculty told me this, but they may have been mistaken). I took it myself as a first year and have now table trained the course during my fellowship for class of 2007 and 2008. The first 20 hours are mechanistic, taught to all students, and geared towards boards. The second 20 hours are optional and designed to refine diagnostic and treatment skill with close faculty supervision.

What i have noticed is that many students (probably most) dont feel anything during the first 20 hours. Partially due to poor student faculty ratio, partially due to the emphasis of board prep over palpatory experience. At the end of the second 20 hours with a doc for every 4 students and much more lab time- all of the students claimed they were feeling what was going on (and most seemed to actually get accurate diagnoses and have some ability to apply treatment). Of course, in the course we finished last week, a third of the students were also getting mild to serious side effects- mostly headaches, dizziness and nausea (those not corrected by a table trainer were coming to me days later with persistent headache). Consider these your initiation rites. Cranial is the one area of OMM i've found where significant side effects from misapplied or partially-applied treatment are common. Try to have docs around that can help if you go experimenting. Have faith that if you can cause a headache you can also take one away. Also realize that your training will not be complete until you treat quite a few newborns.

What i notice is that most people who cant feel it are either not trying, or they try too hard (you see a lot of people with their heads down and their hands firmly pressing...). You need to sit back and keep yourself relaxed as you learn or you're more likely to screw up your patient without feeling a thing.


If you dont feel confident at the end of what your school offers, and you really want to learn it- I'd recommend laying down a chunk of change and going to a basic course (either SCTF or cranial academy). It's expensive, but if you plan to see any peds in your practice or would like more options to treat headaches you'll be happy you did. The PINS technique taught by Dr. Dowling is also a very effective OMM approach to headaches, and a LOT easier for most people with undeveloped palpatory skills- so you might consider learning this if you are just looking for tools to treat headaches.

michael

 

[jhug]

One of Viola Frymann's disciples lectured our OMM class and told us that she converted a true Down Syndrome to a mosaic. Absolute gibberish, but hey, *she was there*.

what a quack!!! That was almost as good as one of our professors claiming to diagnose a brain tumor via cranial!!!

 

[bones]

what a quack!!! That was almost as good as one of our professors claiming to diagnose a brain tumor via cranial!!!

I suspect she was misquoted (or maybe she had no idea what Dr Frymann was doing...). I worked with a past president of the cranial academy who learned from Dr Frymann, and she has had a lot of success with cranial on downs syndrome patients over the last 20 years of her practice. She talks about normalizing the position of boney structures of the skull during development to minimize the characteristic downs features and decrease the chronic hypoxic state they usually experience. I cant verify that this is exactly what occurs- but i have seen some of her downs patients and pictures of their progression- one of which was very impressive (going from classic mongoliod features and developmental delays at 3-4 years to normal looking at 7-9 years with low-average intelligence for a child of that age). Most were not quite this dramatic (especially if not seen until later in development), but the downs parents i talked to reported very noticeable improvements in their childs intelligence and behavior with cranial treatment.

This treatment process is clearly not the shifting of a whole-body non-disjunction mutation to a mosaicism (which would make no sense), but rather just an improved phenotype for trisomy 21. However, i can see how some docs might assume mosaicism of trisomy 21 seeing a downs child that looks normal and has minimal ******ation.

here is an article i just found on the topic for those interested:
http://www.altonweb.com/cs/downsyndrome/index.htm?page=handoll.html
He makes it sound as if hypoxia is the only cause of mental decline, and obviously A-beta plaques and neurofibrillary tangles play a role as well (much as they do in Alzheimer's). The improvements in health and intelligence noted via cranial treatment could be explained by reversal of this hypoxic process, however.


As far as the brain tumor quip- a few docs i know have referred patients for head CT's secondary to persistent headache not responsive to cranial treatment (wouldnt you?). This is the standard of care. The only suprise is if they are consistently accurate in pointing to the exact location of the mass- which some docs claim to do. If the cranial concept is correct though, this should be no surprise either- the dural strain secondary to a 1cm mass is significant.

 

[sfjohn]

this discussion is boring. no one says you have to "accept," buy, believe, or practice anything. maybe you can't feel anything. maybe you believe that the cranial bones are completely fused and can not move an angstrom. but does that give you the right to trash manipulations that DO's have been sucessfully performing for 10's of years longer than any of you have been exposed to manipulation (or have been alive, for that matter)? most of you come across as incredibly arrogant -since you can't figure something out in your first or 2nd year of medical school it should be nullified and voided? c'mon young doctors - humble yourselves just a tiny bit.
another thing to think about -the service of cranial therapy, like any other service, would not remain on the market if people did not demand it. as hard as it might be for you to believe, healthy, 20-something medical students are not the only people in the world. there are people with true, debilitating pain and other valid health problems who benefit from cranial manipulation. if those who practice cranial therapy provide any relief to their patients, who are 1st year osteopathic students to revolt against the profession and have it removed from the curriculum? grow up. spend some time focusing on your skills instead of bi*ching to make yourself feel better for what you can't understand or can't perform.

 

[Old_Mil]

You might also note that any research addressing cranial movement or CSF fluctuation is immediately dismissed as being flawed without any reason. Never mind the fact that these studies were performed with ultrasound, MRI's, and stress transducers. If the studies prove something inconvenient to their argument then they must be flawed.

It's one thing to say that CSF fluctuates. It's quite another thing to say that the bones of the cranium fluctate because CSF fluctuates. That's pretty much the difference between buying a ticket and winning the powerball.

This doesn't change the fact that the cranium moves though. You really wouldn't need the studies we've provided (which are substantive) if you just felt for the movement with genuine concentration.

Luke, I believe Obi Wan just told you to use the force.

 

[jhug]

so i thought i'd throw this out there and see what some of the cranial supporters had to say...
i just had the amazing experience of being able to perform my first LP...it was on an obese guy so i was extra impressed (and grateful for my omm training) that i could actually feel/get between his L4-L5 vertebra. After i got the flash of csf we tested his initial pressure...sure enough, it was mildly high at 32...and as i'm watching this tube fill with fluid i couldn't help but wonder why, 15 times a minute (and i was there for a good 10 minutes), i didn't see any pulsating pressure. If i can "feel it" through hair, skin, fat, fascia, and bone...wouldn't i surely see it as i'm taking the fluid out through an 18 gauge needle?

 

[bones]

so i thought i'd throw this out there and see what some of the cranial supporters had to say...
i just had the amazing experience of being able to perform my first LP...it was on an obese guy so i was extra impressed (and grateful for my omm training) that i could actually feel/get between his L4-L5 vertebra. After i got the flash of csf we tested his initial pressure...sure enough, it was mildly high at 32...and as i'm watching this tube fill with fluid i couldn't help but wonder why, 15 times a minute (and i was there for a good 10 minutes), i didn't see any pulsating pressure. If i can "feel it" through hair, skin, fat, fascia, and bone...wouldn't i surely see it as i'm taking the fluid out through an 18 gauge needle?

Congrats on your first LP. First off- I'm no pro on the physics of liquid mechanics but in the LP's i've done I can honestly say I dont recall much of a flux either- although i wasn't looking for it and to be fair it may be somewhat subtle. I dont think we can argue this one way or the other on here- we need to take it to the research lab (and unfortunately i dont have the time at the moment).


BUT I suspect your point is that the mechanism as stated by most cranial practicioners appears to be outdated- and the dogma that supports it is unnecessary. I agree. Every bit of it should be given serious question. It is a mechanism they put together to explain what you can feel when you practice it, but it is mostly rooted in early 20th century theory rather than 21st century science. I am not convinced CSF moves around much, or that any such movement is particularly significant in cranial treatment. I do think there is some subtle movement between the sutures of the skull, however, both from what I've seen with patients and from animal studies that support sutural movement. Cranial facial surgeons know not to but braces across sutures because they break loose very quickly compared to those holding fractures together. interesting. but you're right this doesn't amount to proof. We all want unbiased research on the topic to understand and explain how it is we do what we do.



Four days ago I worked on a woman who's chief complaint was TMJ x30+ years with a very loud clicking every time she opened her mouth to talk or eat (audible across the room). Her husband had heard this ever since they were first married. Usually I treat the major jaw muscles for TMJ using muscle energy, but this was clearly ineffective in her case (continued popping after repeated attempts at localization and treatment). After struggling with it for about 5-10 minutes I checked cranial and found a dramatically internally rotated right temporal bone. The SCM were flaccid bilaterally, so i went straight to cranial treatment.

With the bilateral temoral hold i applied mild external rotation pressure on the right side, resisting a mild slow superior flux i was taught to be extension phase, and followed flexion. There was a fair amount of resistance to my pressure on the right until after a minute there was a subtle but very distinct give. i followed one push of mild superior and then inferior force (extension/flexion, as we were taught). The movement felt the same on both sides at this point. I had her open her mouth immediately. no click. It hasn't clicked once in the days since.

So what happened? I cant prove the temporal bone actually moved- though it certainly felt like it did. If it did move i dont really know by how much. It felt like whatever moved- shifted by maybe a millimeter, but maybe less. I wish i did know the mechanism. Maybe I was purely addressing fascial strain on the skull- and it was just the fascia that moved. maybe that slow pulse i was following had nothing to do with CNS contractility or CSF flux and it was something else entirely- and i dont really care, but it would be nice to know what it really was, and exactly how it allowed me to fix her TMJ.


What IS significant is that the method they taught me in class and that i have since taught to two years of students- however flawed it is- allowed me to fix this woman's 30+ years of clicking and grinding of her jaw in about 2 minutes of cranial treatment. I dont know how you placebo yourself into having a silent jaw.


Placebo MIGHT account for cranial's dramatic success on so many of my patients with vertigo, tinnitis, nausea, chronic and acute sinusitis, migraines, and tension headaches... maybe. much of those diagnoses are based on subjective feelings of the patient. Then again, it doesnt seem likely that the patient would know just which symptom should resolve and when based on their cranial anatomy or what im feeling- but the mechanisms I learned and what i feel seems to predict how they report their response and exactly when they report it.

Placebo seems unlikely to account for the mechanism for this case of TMJ. Probably it wouldnt account at all for the instant changes in feeding, colic, and spitting up in the babies I have treated either, nor otitis media responses in children. Still waiting for a serious bells palsy case- I haven't had the chance to try cranial yet for that, but I think success there may be outside the realm of placebo as well.


I dunno. I'm open to your theories as to cranial's mechanism of action- so long as they have some anatomical (or psychological) basis that makes sense. The only serious competitor i can see is the fascial/muscle theory- that the skull fascia is what causes the changes we see in cranial, and that it isnt the sutures moving at all. Fascia can pinch cranial nerves (and account for the cranial nerve findings associated with temporal bone treatment). The rhythm itself is so subtle and has rather poor interrater reliability if you take random people who say they know how to do cranial- so you can argue that is something of an imaginary response. The counter to this is that many cranial practicioners may be feeling different things (like respiration or pulses or maybe different rhythms that may exist) and due to the subtle nature of the cranial rhythm they may have just never calibrated to what they were supposed to be feeling for. There does seem to be SOME kind of regular palpable flux in the skull fascia/bones- slower than pulse and independent of and usually slower than respiration. Whatever it is, it seems to help speed treatment and can be used for localization of cranial/fascial strain. Oddly, when the patient relaxes enough, the rhythm seems to sync with respiration- and maybe its respiration in the end that ultimately drives cranial treatment for many practicioners.


Questions for debate:
1) Do sutures move? I strongly suspect so (without proof, only some supportive animal studies, clinical experience and heresay).
2) Is there a cranial rhythm independent of respiration and pulse? I think so from my clinical experience, but can't proove it, and it should be called into question until there is better research.
3) Is cranial mechanism taught in class effective for patient care? yes- or at least my patients and their families think so- and with great enthusiasm.
4) Is the cranial mechanism taught more dogma than science? yes- and this needs to change ASAP.
5) should the cranial MECHANISM be tested on boards? I'd say no, I'd rather they just tested on the cranial anatomy in a clinically significant way. leave the mechanisms to the theorists until the studies are done.
6) Should we learn OMM for the head? yes. focus on the fascia and direct/indirect balance with special attention to balanced membranous tension around the temporal bones and OA treatment. Less emphasis on the Sutherland cranial mechanism as it is traditionally taught- maybe just as a theoretical aside. The bulk of this information can be reserved for optional or advanced courses for those interested in further hands-on work in neurology and pediatrics (or OMM specialists) rather than for the general DO student body. We need serious help from the skeptics to keep ourselves honest and to provide a backbone for future research in this field.

 

[AwesomeO-DO]

it's been awhile since i started this thread, and I am very amazed it is still growing. I started it about 2 weeks into the cranial class we were forced to take last year (2nd year) (yes they did take attendance to make sure we were there). It was around January, when most 2nd year students want to skip boring classes and start their long board study prep. My main objections to cranial at that time were
1) damn this is boring stuff
2) the only reason I am putting up with this crap is so I can do better on boards
3) I'm never going to use these techniques no matter what field i end up in
4) THEY KNOW a lot of us don't "believe" in these techniques, but they still force us to make up our diagnosis in lab
5) the "professor" teaching us was so odd, she could be trying to tell me "the sky is blue" and I probably would not believe her
6) Trying to explain this to any of our MD counterparts (excluding those who have amazingly been cured by these techniques and are now believers themselves) is only going to make our degree look foolish, which is already a problem when it comes to getting interviews with MD PDs