Accepting Cranial

[DropkickMurphy]

*edit- Double Post*

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[DropkickMurphy]

And people wonder why DO's can't lose that ill perception in the press as being quacks or loonies.....drop the BS and stick with real manipulations that actually do something like treating musculoskeletal issues. This manipulating the skull crap is making you all look bad.

 

[Krazykritter]

Praetorian,

What we really don't need is someone from an allopathic school telling us what we already know. I would say that more than 95% of our class snickers and laughs about cranial just as much as you would, but we still have to understand parts of it for boards. It is no different than learning some mundane pathway for boards that you will never have to recall in your future pathway.

You are sure to make a lot of friends on the DO forums w/ posts like that. Congrats.

 

[DropkickMurphy]

Actually I'm not attending a MD school- I'm a premed planning on becoming a DO.

I understand it is something you must have for the boards- but that doesn't mean that something that should not be fought against by those practicing DO's who realize the impact of this blemish on osteopathy. Not only does it negatively affect peoples perceptions of DO's in general but it does hinder the acceptance of useful aspects of OMT. That is the point I want to make, not that I look down my nose at my future colleagues.

 

[DrMnemonic]

The above is good advice. It IS on the boards, and like some of the more random stuff you had to swallow in A&P, Neuro and Immuno - you gotta hold it in your head long enough to dump it out on the boards.

Where I am, we like to refer to all of the subjective things in OMM as "voodoo". Cranio-sacral motion is at the top of the voodoo list for sure. Nobody is more skeptical of these (non EBM) techniques than me. That said, I have felt the PRM, and it makes a huge difference if you have a person with good rate/amplitude.

Do I think it is an amazing cure all? Not just no, but hell no. It's kind of weird and my personal opinion is that movements THAT subtle while clinically significant in SOME way can't possibly be PRIMARY mechanisms in overall health.

Relieving torsions, and strains in the skull bones is a totally different story and should be approached like any other somatic disfunction: restore physiologic motion (insofar as the patient is able to respond).

Lastly, venous sinus technique is easy, effective and very powerful for its limited applications. Go ahead and buy into this one.

The bottom line is: you have to differentiate between the voodoo that works and the voodoo that doesn't. Should you fight against Cranio-Sacral because it is a blemish on Osteopathy? Maybe so. I think the bottom line for ALL MEDICINE is EBM. Lets see the RCT's and THEN fight! Or... if an RCT can't be designed, maybe that IS proof that it needs to be seriously re-thought.

 

[CatsandCradles]

The bottom line is: you have to differentiate between the voodoo that works and the voodoo that doesn't.

That reminds me of an old military saying: "When planning for war, there are some plans that won't work - and some plans that might work"

 

[dee1971]

I find almost all of these posts narrow minded. You cant see an xray, but you can see the results.

If you have a cranial treatment or see the results of it yourself then it isn't hard to make that leap of faith.

America is the most religious nation in the world. I can't see God, I can't explain it. So shall I just say its all bull****.

 

[homeboy]

I find almost all of these posts narrow minded. You cant see an xray, but you can see the results.

If you have a cranial treatment or see the results of it yourself then it isn't hard to make that leap of faith.

America is the most religious nation in the world. I can't see God, I can't explain it. So shall I just say its all bull****.

Yea, but you don't get charged $56 every time you go to church. And an x-ray isn't even on the same level as cranial...gimme a break.
Not only does cranial have no proven indication for use, it has no proven or consistent results. Physicians require a certian amount of reliabilty for diagnoses and treatment; there is absolutely no reliability to cranial therapy.
The whole "how dare you doubt cranial" line is not a strong argument for using it; it's a mere emotional plea and holds no weight whatsoever.

As was summed up in a 1999 systematic review by the University of British Columbia:

The literature suggests that the adult cranium does not obliterate, fuse or ossify its sutures until well into late life. There is also some evidence (albeit of variable research quality) that there is potential movement at these suture sites in earlier life. Questions remain as to whether such “movement” is detectable by human palpation or whether mobility has any influence on health or disease. The authors of this review also note that, in accord with a basic tenet of craniosacral therapy, there is evidence for a craniosacral rhythm, impulse or “primary respiration” independent of other measurable body rhythms. However, [the] studies do not provide any valid evidence that such a craniosacral “rhythm” or “pulse” can be reliably perceived by an examiner. Our review does not suggest any reasonable data that would allow such a conclusion. The influence of this craniosacral rhythm on health or disease states is completely unknown. Clinicians require a reliable means of assessment for decision making. Craniosacral assessment has not been shown to be reliable. The literature on craniosacral therapy does not include any high grade evidence, such as random controlled trials, of its effects on health outcomes. The evidence that is available is of poor methodological quality, is highly variable, lacks consistency and does not allow any logical “positive” conclusions regarding craniosacral therapy.

 

[homeboy]

More recently (Scientific Review of Alternative Medicine 6(1):23-34, 2002.), two professors at the University of New England College of Osteopathic Medicine concluded:
Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. 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.

 

[homeboy]

Actually I'm not attending a MD school- I'm a premed planning on becoming a DO.

I understand it is something you must have for the boards- but that doesn't mean that something that should not be fought against by those practicing DO's who realize the impact of this blemish on osteopathy. Not only does it negatively affect peoples perceptions of DO's in general but it does hinder the acceptance of useful aspects of OMT. That is the point I want to make, not that I look down my nose at my future colleagues.

Well said, Murphy. I think 'blemish' is a very accurate statement. It's hard to gain acceptance from mainstream medicine when there is a percentage of very verbal DOs clinging to cranial as if OMM must be taken in its entirety or not at all. The attitude of "if you don't believe in it, don't practice it and leave us cranial people alone" does nothing to validate it, or osteopathy in general for that matter.
In the end, we're utilizing a technique on the basis of tradition and heresay while the whole of medicine is laughing it off as proposterous. Who is right here...the entirety of allopathic medicine and the bulk of DOs that don't do it?...or the handful of DOs that do? My vote is for the former.

 

[DrMnemonic]

In my original post, I noted that I had in-fact felt cranial sacral motion, but at the same time, I also said that EBM insists we get some decent RCT's for the benefits of Cranial-Sacral Tx and if they can't be found or an RCT can't even be devised then the Tx has to go.

I can freely admit that I hadn't given much thought to the idea that keeping this 'voodoo' a peripheral part of our profession does infact tarnish the entire lot of us, but after a conversation with an MD colleague, I am convinced that it does.

Being an MS-I (who is headed nto finals), I don't have much time to do a journal search, but does anyone know off-hand if RCT's have been attempted for Cranial Sacral Treatment and where the results might be published?

 

[homeboy]

In my original post, I noted that I had in-fact felt cranial sacral motion, but at the same time, I also said that EBM insists we get some decent RCT's for the benefits of Cranial-Sacral Tx and if they can't be found or an RCT can't even be devised then the Tx has to go.

I can freely admit that I hadn't given much thought to the idea that keeping this 'voodoo' a peripheral part of our profession does infact tarnish the entire lot of us, but after a conversation with an MD colleague, I am convinced that it does.

Being an MS-I (who is headed nto finals), I don't have much time to do a journal search, but does anyone know off-hand if RCT's have been attempted for Cranial Sacral Treatment and where the results might be published?

The two previous posts I had listed some data; one was a systemmatic review analyzing all the current cranial data (up to 1999). The thing is, cranial is unimportant, no one is going to waste the time or resources to do an RCT on something that doesn't matter.

 

[DrMnemonic]

Very good. Thank you. Even though I do believe I have felt it, I am going to have to firmly plant myself in the anti-CS rythm camp until I can see some RCT's. (So basically - permanently against)

One huge problem with any anti-Cranial movement, however, is going to be the fact that the term 'cranial' encompasses many different techniques, not all of which involve palpating and/or resetting movement of the skull bones or the Reciprocal Tension Membrane.

Venous sinus release, various facial nerve releases, and TMJ treatments all fall under the auspices of 'cranial' in most texts and curricula.

We have to be careful that when fighting against those things that are clearly only anecdotally supported (like balancing the RTM) we don't discard truly useful OMT (like TMJ release) or worse, have evidence of effictive 'cranial' OMT (ie - TMJ) used as support for the so-called 'voodoo' of RTM.

I wonder if some of the pro-cranial camp isn't seeing it as an all-or-nothing proposition. Just a thought.

 

[homeboy]

Very good. Thank you. Even though I do believe I have felt it, I am going to have to firmly plant myself in the anti-CS rythm camp until I can see some RCT's. (So basically - permanently against)

One huge problem with any anti-Cranial movement, however, is going to be the fact that the term 'cranial' encompasses many different techniques, not all of which involve palpating and/or resetting movement of the skull bones or the Reciprocal Tension Membrane.

Venous sinus release, various facial nerve releases, and TMJ treatments all fall under the auspices of 'cranial' in most texts and curricula.

We have to be careful that when fighting against those things that are clearly only anecdotally supported (like balancing the RTM) we don't discard truly useful OMT (like TMJ release) or worse, have evidence of effictive 'cranial' OMT (ie - TMJ) used as support for the so-called 'voodoo' of RTM.

I wonder if some of the pro-cranial camp isn't seeing it as an all-or-nothing proposition. Just a thought.

Well, read the literature. The review confirms there is legit scientific data that there IS a rhythm, but the ability to manually detect it is absolutely zero, as is the consistency of feeling this rhythm, and there are absolutely no proven therapeutic benefits. It's not a matter of feeling it: it's a matter of 'what valuable diagnostic and therapeutic value can I extract from this procedure,' and the answer is "none." Rather than have the attitude of "let's not be haste and discard something that might have true value," let's look pragmatically at the issue: 1.) how many DOs do OMT?, 2.) of those DOs, how many do cranial?, 3.) is embracing craniosacral therapy helping or hurting the acceptance of our profession not only in the United States, but world wide?, 4.) if we rejected cranial and dropped it from board exams, is there going to be an detrimental impact on our profession?, and finally 5.) in 21st Century medicine, is it wise to remain steadfast and embrace a treatment that the VAST majority of DOs (and MDs for that matter) reject as invalid, ie. is the interprofessional tension created worth pleasing the few who wish to use it? Take a good hard look at those questions and tell me honestly why cranial is something we should keep in the curriculum.

 

[bones]

I find almost all of these posts narrow minded. You cant see an xray, but you can see the results.

If you have a cranial treatment or see the results of it yourself then it isn't hard to make that leap of faith.

America is the most religious nation in the world. I can't see God, I can't explain it. So shall I just say its all bull****.

To answer your question: most have not.

Not only that- I'm willing to bet you that 90% of the people railing against cranial on this board have not had it done to them by a skilled practitioner, nor have they had it used on their children- and probably wouldnt even if their child had severe cholic and were offered free treatment... even if not giving their child cranial would cost them 4+ hours of sleep every night for the next 6 months.

Some people would rather believe they are right than be happy. You cant convince them all, nor should you try to.

To be fair though- I think they are right that very important components about the mechanism for cranial are not understood, even if it does produce such wonderful results at times. And... the cranial mechanism taught at most schools has the potential to be either grossly incomplete or blatantly false. This is bad for a required course or something covered on boards


One of the biggest challenges in an intellectual environment is keeping a healthy balance of skepticism and open-mindedness.

 

[homeboy]

To answer your question: most have not.

Not only that- I'm willing to bet you that 90% of the people railing against cranial on this board have not had it done to them by a skilled practitioner, nor have they had it used on their children- and probably wouldnt even if their child had severe cholic and were offered free treatment... even if not giving their child cranial would cost them 4+ hours of sleep every night for the next 6 months.

Some people would rather believe they are right than be happy. You cant convince them all, nor should you try to.

To be fair though- I think they are right that very important components about the mechanism for cranial are not understood, even if it does produce such wonderful results at times. And... the cranial mechanism taught at most schools has the potential to be either grossly incomplete or blatantly false. This is bad for a required course or something covered on boards


One of the biggest challenges in an intellectual environment is keeping a healthy balance of skepticism and open-mindedness.

If the cranial education, as you say, is grossly inadequate at most institutions, and not a priority of the university administration or the AOA to correct, coupled with the futility of it's use and low-yield diagnoses and results, it should be removed from the educational system until a time deemed appropriate through evidence based studies in which cranial is either embraced unabashedly by the AOA or banished from the profession altogether. You can cite personal experiences until the cows come home, but testimonials (which are few and far between) make for poor justification. I'll reiterate: is this the case of a handful of DOs with brilliant insight, up against stubborn and non-believing MDs and DOs unwilling to keep an open mind? Or is it a handful of DOs convinced of a practice based on individual experiences and personal feelings towards a practice the overwhelming majority of medicine rejects as non-useful diagnostically and therapeutically?

 

[DrMnemonic]

Rather than have the attitude of "let's not be haste and discard something that might have true value," let's look pragmatically at the issue:

I WASN'T saying let's not be hasty to jettison those things that aren't supported by EBM/RCT like SBS manipulation and balancing the RTM. Let's be hasty! Get that voodoo outta here, now!

What I WAS saying is that, historically useful OMT like TMJ and perhaps to a lesser extent venous sinus technique (which is basically brain lympnatics) is lumped together WITH THE VOODOO. Let's not throw out the baby with the bathwater. We can give RTM and SBS the boot without stomping on the good things that ACCIDENTALLY fall under the 'cranial' umbrella.

It is these few things that are totally unrelated to RTM/SBS cranial which supporters of 'cranial' are going to use to obfuscate the issue. I was just saying that we (the anti-RTM/SBS DO's) are going to have to be painfully aware of those minor distinctions. When we come out against 'cranial' we are going to have to force people to define what they mean by 'cranial' and when or if we find it is meant as "manipulating the RTM/SBS" then, by all means, we should attack it with all due ferocity.

 

[shelley2315]

And people wonder why DO's can't lose that ill perception in the press as being quacks or loonies.....drop the BS and stick with real manipulations that actually do something like treating musculoskeletal issues. This manipulating the skull crap is making you all look bad.

Sorry, i know this is a little off of the topic of what you are all debating. But I had to tell you that I love your screen name. Im from Boston and its not everyday you see someone from Indiana with a dropkick sn! Makes me proud of boston bands!
Smile,
Shelley

 

[veryvickyish]

If the cranial education, as you say, is grossly inadequate at most institutions, and not a priority of the university administration or the AOA to correct, coupled with the futility of it's use and low-yield diagnoses and results, it should be removed from the educational system until a time deemed appropriate through evidence based studies in which cranial is either embraced unabashedly by the AOA or banished from the profession altogether. You can cite personal experiences until the cows come home, but testimonials (which are few and far between) make for poor justification. I'll reiterate: is this the case of a handful of DOs with brilliant insight, up against stubborn and non-believing MDs and DOs unwilling to keep an open mind? Or is it a handful of DOs convinced of a practice based on individual experiences and personal feelings towards a practice the overwhelming majority of medicine rejects as non-useful diagnostically and therapeutically?

Many decisions are based on poor justifications and closed minds. I would not follow any leader I could not question. That does not mean a person is unable to recognize the truth when they experience the fact. However, a person's perception becomes their reality.

Perhaps I missed something in an earlier thread. Where is the scientific data used to refute the effectiveness of Cranial Therapy? How is your experience any more qualified to make justification? Is your perception truly scientifically substantiated, or do you base it upon your experience and how many people will support your stance?

Indeed, history has shown that even in research, bias taints results in the writing and the reading. If the research is osteopathically oriented, I imagine there will be bias. If it is allopathic, there, too, is bias. If I listed my scientific support of my beliefs, how easy would it be for you to counter? Would I be inclined to find flaws in the testing, if the data supported a theory I did not favor?

Many beliefs have been taught which have no scientific backing and people will continue to back the popular opinions, especially if they feel it will benefit them. You leave no room for argument if you discount personal experience.

Certainly, I cannot speak for all curriculum. However, my experience has been highly critical of Cranial Therapy. My personal research (of texts and references related to Cranial Therapy) shows that I am not willing to dismiss the life work of so many people, nor a therapy which may only help one of my patients, if only through touch. Neither do I dismiss biochemistry and genetics and other sciences which are intangible.

There is science in all arenas of medicine. However, Medicine is also an art. The dynamic aspect of any individual can never truly be quantified and evaluated, because the same moods and thoughts and biochemical influences are impossible to reproduce. My words, actions, and my interest may do more to affect the outcome of a patient than anything I learn in medicine. Likewise, the confidence a person has in their own ability to influence another life, does not lessen the potential impact.

Respectfully,
Veryvickyish

 

[homeboy]

Respectfully,
Veryvickyish

Look at my previous threads: i posted 2 articles from journals (1 a systematic review from U. of British Columbia, the other from a Journal examining CAM) analyzing all the cranial up to 1999. When I say "cranial is invalid," I'm saying it has no therapeutic and diagnostic value; I've stated several times that the PRM seems to have been proven scientifically.
In the end, the value that the whole of medicine would receive from cranial does NOT outweigh it's being a blemish on our profession.
Ie. if your position is right, the whole of allopathic medicine (in this country and world-wide) is in the wrong. I can't believe that's the case. I'm willing to side with the majority of world-wide medicine at the risk of trashing a handful of peoples' "Life long work." Just because you work your life to prove something doesn't mean it's going to hold validity.

 

[veryvickyish]

Look at my previous threads: i posted 2 articles from journals (1 a systematic review from U. of British Columbia, the other from a Journal examining CAM) analyzing all the cranial up to 1999. When I say "cranial is invalid," I'm saying it has no therapeutic and diagnostic value; I've stated several times that the PRM seems to have been proven scientifically.
In the end, the value that the whole of medicine would receive from cranial does NOT outweigh it's being a blemish on our profession.
Ie. if your position is right, the whole of allopathic medicine (in this country and world-wide) is in the wrong. I can't believe that's the case. I'm willing to side with the majority of world-wide medicine at the risk of trashing a handful of peoples' "Life long work." Just because you work your life to prove something doesn't mean it's going to hold validity.

I have no bias against allopathic medicine. I have been clinically active in a predominantly allopathic area for several years. However, I obviously put much value in osteopathic medicine. I believe I have an open mind... but perhaps not one that is easily swayed when it is made up . I sense the same in you. So perhaps we can humor each other by sharing our views openly.

I have witnessed therapeutic and diagnostic value. I could give you the same research, which we have been directed to in our studies of Cranial Therapy. However, I would hope you've already researched those. But my decision to study Cranial Therapy as a valuable resource are not based beyond my experience. The sympathetic and parasympathetic effects on the CRI seemed bizarre the first time I felt the phenomenon. Feeling the CRI alone, was enough to catch me off guard. Noting the difference in individuals also amazed me. No amount of research could convince me more of what I understand.

While it is true that there is little research done on Cranial Therapy, there are studies being done. I am more concerned about the so-called "blemish" you have high-lighted and placed for display among people who have not been given a chance to find as a possible birth mark. Just because the studies aren't complete, doesn't mean that they won't prove valid.

Learning Cranial Therapy, or any OMT takes time and practice. Having a healthy dose of skepticism is not a bad idea. However, some of what I am reading seems to be more skepticism of people who don't want to spend the time to understand new ideas. I hear the complaints at my school and among people who find mastery of Osteopathic techniques challenging. I hear the clinicians, who are performing OSCEs, state their amazement at students who never touch their patient. Defining Osteopathic Medicine solely on manipulation doesn't fit my understanding Osteopathic principles. Deciding to remove a practice from medicine because the comfort level of the doctor seems more important than the patient's, is wrong. In my opinion, removing a curriculum because the technique is not easily learned, (and students tend to whine more when such is the case) is also a lame idea.

 

[homeboy]

Deciding to remove a practice from medicine because the comfort level of the doctor seems more important than the patient's, is wrong. In my opinion, removing a curriculum because the technique is not easily learned, (and students tend to whine more when such is the case) is also a lame idea.

So should medicine incorporate every complimenatry and alternative practice that is equally as efficacious (based on amount of reserach and the numbers of people that practice it)? Why is cranial acceptable to DOs while accupuncture, hyrdotherapy, herbals, etc, etc...are not? Removing cranial from 'the osteopathic books' would not prevent you from learning about it and doing it; you want to do it, go ahead, but the practice should not be ENDORSED by the osteopathic profession. Having cranial dose more harm to those who DON'T want it than it would to people such as you if we did not support cranial (ie. the only support you have is the official AOA stance, not the majority of the DOs and students that make UP the AOA). and by 'harm' I think blemish is an appropriate term. There is a difference between giving physicians the right to learn non-mainstream medicine modalitites and allowing them to incorporate them into their practice, and requiring every single student to learn that modality when 95% of them have no interest in using it in practice.
You may have your mind made up, as I'm sure you know I do, but that doesn't mean we're both right.

 

[veryvickyish]

You may have your mind made up, as I'm sure you know I do, but that doesn't mean we're both right.

First, I apologize for such a long post. However, seeing the opposition has had much more ink, I appreciate your consideration of my views.

I have had a class, in O.P. and P on accupuncture. In PBL, We study herbal medicines and their effects on our patients. Any doctor should study herbal medicines and understand the more popular ones, regardless of what we accept. Many people (patients) are involved in the practice of herbal medicine, and we have the responsibility to care about what that means. Several D.O. clinicians I know, advise some herbal medicine therapy. I have also worked in rehabilitation where many forms of therapy have been implemented by the D.O., including hydrotherapy. I find your assumption to be incorrect. You have lumped such therapies into your belief that they are not efficacious or common. Because these things are not specifically tested on comlex does not mean they are less important modalities of care, and if you are not learning about them, you will be ill-prepared for the real world.

I think the "harm" you are speaking about in learning Cranial Therapy, may be from the fear that your ability to pass a test is decreased. But you will not get a letter grade from your patients. Your patients will come to you because they have the same ideas. The clinicians practicing Cranial are very busy not because patients don't see the efficacy of Cranial Therapy. Because the majority of people don't want to incorporate Cranial into their practice, doesn't mean you shouldn't learn such therapy. Should we learn about the types of surgeries available? The majority will not practice them. Should we study so many types of disease? We surely will not see them all. Many of your patients will choose you merely by what you choose to practice.

I am intrigued that you believe two people cannot be right. The question should be "right for whom?" Perhaps the choice of how much to emphasize cranial therapy is too extreme. Like any specialty, cranial therapy does have its place among people who choose to use such a practice. However, I must still study the diseases and the types of surgeries and many modalities of care I will never use. All of them are sanctioned by both boards. They were not always mainstream therapies, and perhaps still aren't, but I will be tested on them anyway. Osteopathic Medicine, in general, has not been accepted for very long. But I am not an MD wanna-be.

Peace,
Vicky Mays, PBL, OMS I (almost II )

 

[homeboy]

However, I must still study the diseases and the types of surgeries and many modalities of care I will never use. )

To cut down on ink time, I'll merely address your ad hominem argument for the continuation of cranial: It seems that people such as yourself approach the argument via the rationale for learning it when compared to other "useless" aspects of education (albeit rather silly to compare cranial therapy to something as longstanding and proven as an appendectomy). Ie: "why shouldn't I learn cranial when I have to learn other stuff I'll never use?" I, on the other hand, am approaching cranial from the issue of efficacy / diagnostic & therapeutic value / ability to have consistent diagnoses & results. I find it difficult to compare learning something that has inherent value and efficacy, to something that has been discredited by several articles and proven by none, and when I say "discredited" I'm referring to the ability of cranial to provide accurate, consistent diagnostic information and have legitimate treatment options--of which there are absolutely none.

 

[veryvickyish]

when I say "discredited" I'm referring to the ability of cranial to provide accurate, consistent diagnostic information and ... legitimate treatment options--of which there are absolutely none.

No argument is worth petty assumptions and ill-based comparisons. I wonder, could you consistently and accurately diagnose any patient based on what you learn from research and books? Out of respect for you, I invite others to do their own research. Not all of these references support Cranial Therapy, as you might assume. However, the scope of SDN to influence readers who have never had exposure to the topic, presents potential bias which might not otherwise exist. Please consider keeping an open mind. Research takes time. Perhaps current research will prove or disprove the value of cranial therapy. But do not be hasty to condemn doctors, researchers, and patients who see the benefit of such therapy, regardless of science. Your perception is your reality, as is theirs.

pp. 660-62, pp. 988-89 Ward RC, Ed. Foundations for Osteopathic Medicine, 2nd Edition. Lippincott Williams &Wilkins, Philadelphia, 2003
Biondi DM. Physical treatments for headache: a structured review. Headache 45(6):738-46. 2005
Bronfort G, Nilsson N, Haas M et al. Non-invasive physical treatments for chronic/recurrent headache. In The Cochrane Library, Issue 3, John Wiley &Sons, Chichester, UK, 2004
LaResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 8(3): 291-305. 1997
Lenssinck ML, Damen L, Verhagen AP et al. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain 112(3): 381-88. 2004
Craniosacral Therapy, Upledger & Vredevoogd, 1983.
www.cranialacademy.org
William Garner Sutherland, D.O., Teachings in the Science of Osteopathy. 1990
Retzlaff, E., Mitchell, Jr., F., The Cranium and its Sutures. 1987
Degenhardt, BF, Kuchera, ML, The Prevalence of Cranial Dysfunction inChildren with a History of Otitis Media from Kindergarten to Third Grade, JAOA, V94, N9, Sept 1994, 754.
Sergueef N. Nelson KE, Glonek T. Palpatory Diagnosis of Plagiocephaly. JAOA 2004: 104(8): 339
Mills, MV Henley, CE, Barnes, LLB, Carreiro, JE, Degenhardt, BF, The use of Osteopathic Manipulative Treatment as Adjuvant Therapy in Children With Recurrent Acute Otitis Media, Arch Pediatr Adolesc Med. V157, Sept 2003, 861-866
Steele K, Kukulka G. Ikner C: Effect of Osteopathic Manipulative Treatment (OMT) on Childhood Otitis Media Outcomes, JAOA 1997; 97-484

http://www.do-online.osteotech.org/ has links to current research in many areas of osteopathy.

 

[homeboy]

No argument is worth petty assumptions and ill-based comparisons. I wonder, could you consistently and accurately diagnose any patient based on what you learn from research and books? Out of respect for you, I invite others to do their own research. Not all of these references support Cranial Therapy, as you might assume. However, the scope of SDN to influence readers who have never had exposure to the topic, presents potential bias which might not otherwise exist. Please consider keeping an open mind. Research takes time. Perhaps current research will prove or disprove the value of cranial therapy. But do not be hasty to condemn doctors, researchers, and patients who see the benefit of such therapy, regardless of science. Your perception is your reality, as is theirs.

pp. 660-62, pp. 988-89 Ward RC, Ed. Foundations for Osteopathic Medicine, 2nd Edition. Lippincott Williams &Wilkins, Philadelphia, 2003
Biondi DM. Physical treatments for headache: a structured review. Headache 45(6):738-46. 2005
Bronfort G, Nilsson N, Haas M et al. Non-invasive physical treatments for chronic/recurrent headache. In The Cochrane Library, Issue 3, John Wiley &Sons, Chichester, UK, 2004
LaResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 8(3): 291-305. 1997
Lenssinck ML, Damen L, Verhagen AP et al. The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Pain 112(3): 381-88. 2004
Craniosacral Therapy, Upledger & Vredevoogd, 1983.
www.cranialacademy.org
William Garner Sutherland, D.O., Teachings in the Science of Osteopathy. 1990
Retzlaff, E., Mitchell, Jr., F., The Cranium and its Sutures. 1987
Degenhardt, BF, Kuchera, ML, The Prevalence of Cranial Dysfunction inChildren with a History of Otitis Media from Kindergarten to Third Grade, JAOA, V94, N9, Sept 1994, 754.
Sergueef N. Nelson KE, Glonek T. Palpatory Diagnosis of Plagiocephaly. JAOA 2004: 104(8): 339
Mills, MV Henley, CE, Barnes, LLB, Carreiro, JE, Degenhardt, BF, The use of Osteopathic Manipulative Treatment as Adjuvant Therapy in Children With Recurrent Acute Otitis Media, Arch Pediatr Adolesc Med. V157, Sept 2003, 861-866
Steele K, Kukulka G. Ikner C: Effect of Osteopathic Manipulative Treatment (OMT) on Childhood Otitis Media Outcomes, JAOA 1997; 97-484

http://www.do-online.osteotech.org/ has links to current research in many areas of osteopathy.

Not a single one of those articles addresses the underlying efficacy of cranial, merely its use for various symptomotologies. Have you even had cranial yet?

And the fact that you cite an Upledger source amazes me. Upledger has been debunked entirely by the medical mainstream, and if he is the standard of your evidence, I'd start searching elsewhere.
Look, I can do a PubMed search on every cranial article out there, but that doesn't prove anything, and most them will be SMALL studies done by a handful of DO students and faculty at one of the DO schools. That hardly counts for "evidence."

Bottom line: you're in the camp that believes something that an overwhelming majority of our profession (as well as the majority of mainstream medicine world wide) has deemed ludicrous. Grasping on to the thinning strings of as controversial of a practice as craniosacral therapy is at BEST, stubborn...more accurately, ignorant.

"...could you consistently and accurately diagnose any patient based on what you learn from research and books?"
YES!!!! Because the tenets of medicine that are found in books have been proven effective again and again and again. If you couldn't, what's the point in reading Harrisons or Cecils?

You can believe what you want to believe, but why should the majority of physicians in our profession be forced to endorse something that is on the absolute fringes of medical practice simply because a handful of DOs (as well as chiropractors, and other low level providers) believe it? Moreover, you are taught in school to buy into cranial based solely on the non-fused theory of the cranial bones and the instructor's personal experiences...no studies, no clinical trials, just theory and personal experience.

Regardless of how much YOU don't care how 98% of physicians view our profession, the rest of us do, and it doesn't validate our profession one bit simply on the argument of, "Just keep an open mind."

 

[veryvickyish]

Are you an Osteopathic student? What clinical experience do you have? I do not hide behind a screen name in basing my views. Neither am I naive. Neither do I understand a patient from a textbook which doesn't consider body, mind and spirit, nor the idiosyncracies and comorbidity of any given patient.

This forum has become nothing but the rantings of someone who is capable of much venom in complaint, but little in action toward communication or resolution. Your statistics and percentages have changed to suit your argument. Your argument is not making changes or accurately supporting your stance. How do you propose to transition toward your perfect view of medicine which has listed D.O.s, in your words, "on the absolute fringes of medical practice" among "chiropractors, and other low level providers?"

If your views are so strong, your logical next step would be to find a way to prove your point to the AOA, rather than attacking opinions of colleagues who are willing to listen, research, and contemplate their own position. Why bother preaching conformity to people who choose to practice Osteopathy because the conformity of the allopathic approach is not fully-encompassing? The loudest often make the majority rule. Sadly, they also place fences where gates might be more appropriate. Compromise is not weakness. Complaining does not advance research. Complaining in this fashion only undermines the overall medical profession.

Peace,
Vicky Mays, PBL, OMS I

 

[homeboy]

The loudest often make the majority rule. Sadly, they also place fences where gates might be more appropriate. Compromise is not weakness. Complaining does not advance research. Complaining in this fashion only undermines the overall medical profession.

Peace,
Vicky Mays, PBL, OMS I

"Neither do I understand a patient from a textbook which doesn't consider body, mind and spirit, nor the idiosyncracies and comorbidity of any given patient."
--Well, you're in for a shocker, Ms. First Year, because the rest of medicine does, and if you don't believe in such texts (Harrison's, Cecil's, et al...) you're in the wrong profession.
Yes, I am an osteopathic student, but don't be so quick to dismiss my "rantings" as "venemous complaints." I have spent time and effort to elaborate my position, and it is only in encountering people such as yourself that my frustration gets the best of me; you argue for compromise: how is the efficacy of cranial a compromise? it's either legit or it isn't, and with the current lack of evidence and overall acceptance by the medical community, it should not be required as a tenet of osteopathy, but an optional rotation in 3rd or 4th year because of it's obviously controversial applicaiton, minimal usage, low therapeutic yield...did you read the systemmatic review I referenced?

The fact is, I care about how people (patients and physicians) view this profession, and it disturbs me that people such as yourself are more concerned with maintaining a steadfast position on something that the rest of professional medicine deems useless. Don't give me the garbage, "I care about my patients and what works for them"...because that implies the majority of us don't, being we don't employ cranial; caring for your patients doesn't mean you're going to employ every single treatment / diagnostic modality under the sun, but it does mean that you will have standards of efficacy. Cranial has no evidence of efficacy in either diagnosis or therapy, and I challenge you to provide me a study...other than a small sample size study where patients were 'treated' with cranial versus other modalities...I'm talking a study that proves the CONSISTENT diagnostic and therapeutic value of cranial. Until then, I will rely on 2 things:

1.) a comprehensive systematic review analyzing ALL the cranial research from it's origin up to 1999, that provides results / conclusions of said studies, that concludes cranial therapy has no consistently reproducible results and essentially zero manual detectablilty, as well as no therapeutic value; and

2.) the fact that OVERWHELMINGLY, DOs, MDs, students of both, and patient consumer advocates have dismissed cranial, and it has been left to the likes of Dr. Upledger and Mr. Trudeau for advertisement.

As with others I have discussed this issue with, you have fallen back on the rationale that my argument is a personal attack on you and the cranial crowd, and any attempt to critically analyze cranial therapy (or any aspect of our profession) is viewed as an attempt to sever our roots and turn allopathic.

Complaining undermines research and the overall medical profession? It is quite unfair to label "critical dissent" as mere complaining. Yes, fences are often in place of gates, and currently the AOA has a fence surrounding cranial (and all of OMT) and anyone who thinks otherwise is viewed as a whiney, unexperienced heretic rather than a concerned student or physician that truly believes endorsing things such as cranial only hurts our profession.

I'll say this again, and ask you to address this if you reply: how would dropping cranial from the officially endorsed practices of osteopathic medicine hurt the minority of those who wish to employ it (as they could still do so as an elective...any physician can do cranial...an MD could if he/she wanted to), versus the current situation, which is a majority of physicians and students feel cranial has no benefit and does more harm to our profession than good...

 

[veryvickyish]

how would dropping cranial from the officially endorsed practices of osteopathic medicine hurt the minority of those who wish to employ it (as they could still do so as an elective...any physician can do cranial...an MD could if he/she wanted to), versus the current situation, which is a majority of physicians and students feel cranial has no benefit and does more harm to our profession than good...

The texts your refer to do not emphasize the individual considerations of patient care. Mr. second year, Homeboy, with no emphasized clinical experience other than Medical School. Take the time to realize that no text book or research can replace human contact with the interplay of emotion, respect and faith. You can never reconcile all of the intricacies of patient care through the "textbook" presented model of care. I honestly hope you do not believe you can learn all you need to know from a textbook... why bother going to clinicals? You should have learned it all by now.

I have been a licensed professional in Health care for 16 years. I have no doubt about my choice in profession. I do not look for ways to promote dissention, nor do I side with the majority because I want to spend time complaining about how things should change but never effectively address a means of affecting the change. I explore and learn new understandings every day. However, My choice to pursue practice as a D.O. was not based upon statistics or a desire to pursue research. If your only goal is to shred the perspectives of those who directly question your reasoning through the only experience you have as a book scholar, I question your preparedness for the real world and your ability to deal with people directly.

You have failed to see that I would be willing to listen to valid opposition to promoting cranial therapy as a specialty. However, if the AOA is made up of a majority of people who feel that endorsing cranial therapy is bogus, it should not be difficult to reconcile. The time and effort you have spent to elaborate your position, has done as much to affect my position, as your closed mind has allowed mine to affect yours.

Your argument for the amount of research is valid. However, your approach is whining. Being in the majority doesn't decide the lack of research, and what will you do if you are proven wrong along with the majority? (Do not presume I am posing such a question as if I know the answer). Will you ever allow a study to influence your bias? Indeed, the flaw of all research is bias, whether by the reviewer or the researcher. The acceptable, traditional modalities have little to prove, and yet the Earth is not flat!

If cranial therapy is to become a specialty, the implications in specification of providers, as well as the qualifying treatments in cranial, should be clearly defined. Your advocacy for all or none is wrong! You are correct in noting that any doctor can perform cranial, but not all of them can bill for Cranial. Likewise, Somatic Dysfunction as a billable diagnosis, with implicated treatment, is reserved for D.O.s and not M.D.s. Careful consideration of what is defined as Cranial Therapy should be given. The implications of what may constitute malpractice should also be considered if Cranial Therapy is not an officially endorsed practice. Specialization may actually benefit those who are certified and place more difficulty on others who practice forms of Cranial Therapy outside of specialization.

Osteopathy has only been endorsed by All fifty states in unlimited practice for 16 years. Every endorsement has been a fight. Yet, Osteopathy has been around since the early 1900s. In sixteen years, much has changed. Overall acceptance, with change, takes longer.

Respectfully,
Vicky Mays, PBL, OMS I

 

[homeboy]

Osteopathy has only been endorsed by All fifty states in unlimited practice for 16 years. Every endorsement has been a fight. Yet, Osteopathy has been around since the early 1900s. In sixteen years, much has changed. Overall acceptance, with change, takes longer.

Respectfully,
Vicky Mays, PBL, OMS I

The text I referred to doesn't emphasize patient intricacies? It's a systemmatic review! Do you know what a systemmatic review is? Great rationale--

Gimme a break: I'm not arguing for the mere textbook practice of medicine; how many times do we hear that clinical medicine is different than textbook medicine... But the truisms those clinical practices are based on are extrapolated and defined in textbooks, and we cannot throw away texts and research in the desire to focus on "intricacies." When you're on rotations, and the attending asks you something, do you say, "I'm sorry, I don't know, but maybe if I spend more time thinking about all the intricacies of this patient, maybe the answer will spontaneously come to me...", or do you say, "I'm sorry, I don't know, but I'll look it up in the Washington manual tonight and report back to you tomorrow." Those texts are not the primary learning tool of clinicals, but they are solid references that are absolutely essential.

"...but not all of them can bill for Cranial."
--Unfortunately, you are entirely wrong. MDs can take a few hundred hours of courses and CAN indeed bill (using the EXACT same billing codes we use) for OMT--though I believe cranial requires a 40 hour certification. If you were unaware of this, I'll have to beg another question: since MDs can learn and consequently bill for OMT (using the EXACT SAME CODES), what realistically sets us apart??

"If your only goal is to shred the perspectives of those who directly question your reasoning through the only experience you have as a book scholar, I question your preparedness for the real world and your ability to deal with people directly."
--My goal is to be a physician in the osteopathic profession; therefore, I am concernd about dubious practices in my profession and complacent students such as yourself. How about 8 years in the military...is that enough real world experience to convince you I'm not a 'book scholar'?

Correct me if I'm wrong, but have you even had cranial yet?

 

[veryvickyish]

Correct me if I'm wrong, but have you even had cranial yet?

Yes, I have studied cranial and endured the lab practicals and been in student clinic. As a PBL student, I have also done additional study in Cranial, and various other topics, because I tend to be a skeptical allopathically influenced person.

I have also been in grand rounds and been team leader where patient care was directed under me. I have given report with the understanding that real people never present as a systematic review and books do not hold all the answers. Your response to my last entry is mere anger. Your experience is vague, using the blanket of Military to sound as if you somehow are more qualified. Your rebuttal is unnecessarily looking for debate. You are unable to be rational, looking for ways of personal attack.

Complacent??? Me??? You don't know me. You haven't really read what I have been saying. Why should I seek to better myself and take on the responsibility of a Doctor if I favor complacency? Why should I care about your viewpoint being unopposed?

"What sets us apart?" Why should we be set apart? I was not "unaware" of an MD's ability to bill for OMT, if certified. But really, Why would an MD want to stoop to such an unlikely therapy as Cranial if it is a harmful practice? I am amazed that you acknowledge that such a thing happens. Such an occurrence is not standard, after all.

Once again, how is your approach to arguing the efficacy of Cranial Therapy based on the popularity of opinion on this forum going to effect any difference? What do you propose?

Respectfully,
Vicky Mays, PBL, OMS I

 

[homeboy]

"... using the blanket of Military to sound as if you somehow are more qualified."
--that comment was only added in an attempt to suggest I'm not some book-driven 'nerd' out of touch with the 'real world', being that you seem to be so much more 'experienced' than those of us who would dare to use texts and journals as references. As an OMS I, you seem to present yourself as a guru of osteopathic medicine...PBL this, grand rounds that...experience doesn't amount to a hill of beans when we're arguing the efficacy of cranial: it either works or it doesn't (clinically speaking), and if there is no proven diagnostic or therapeutic value for its application, I have a hard time charging patients for it.

Complacent??? Me??? You don't know me. You haven't really read what I have been saying.
--I've read exactly what you've been saying, word for word, and it seems to fit you quite well.

"What sets us apart?" Why should we be set apart? I was not "unaware" of an MD's ability to bill for OMT. But really, Why would an MD want to stoop to such an unlikely therapy as Cranial if it is a harmful practice? I am amazed that you acknowledge that such a thing happens. Such an occurrence is not standard, after all."
--Never said it was; but the mere FACT than MDs can be certified in all the methods and modes of OMT speaks volumes about our supposed distinction. I didn't ask "WHY" should we be set apart, I asked--and this is a categorical imperative--what the difference between a DO and an MD is when the core of what we learn at DO school can be learned by any practicing physician. This is quite an important fact that you seem to be willing to overlook to fit your liking: what do we learn in DO school besides OMT that differentiates us from MDs? Is there a set, defined block of knowledge or treatment modality or theory that is emphasized in our education outside the realm of OMT? Being that MDs can learn OMT and legally bill for it, I posed this question to the AOA president when he came to our school. His response: "You all learn things you aren't even aware of yet. When you get to rotations, you'll see the difference. You learn quality patient care, how to interact with the patient, all kinds of things you don't even realize yet."
I find that hard to swallow, and I'm compelled to believe that if he posed this difference to a crowd of MDs, the response would be laughter.

Do you honestly buy in to the logic that on a whole, DOs are better physicians, more caring, treat the patient as a whole, whereas MDs are wholly deficient in that department? I think that's an insult to our future colleagues, and would argue it creates a false "we're better than you" mentality. Maybe you don't think you're better than any other physician simply because of your initials; I know I don't. But your governing body--the AOA--entirely puts forth that message, that we are superior physicians. Again, like I've said in numerous other posts, when I went to dinner with the AOA pres and his wife, I listened to them tell me over and over that "there really is a difference." It is quite disturbing that the people running my profession think because my initials are "DO" I can provide superior care.

Once again, how is your approach to arguing the efficacy of Cranial Therapy based on the popularity of opinion on this forum going to effect any difference? What do you propose?
--I've already stated what I propose: drop cranial from licensing exams and board testable material. Simple as that, and I believe I've stressed that suggestion in numerous other posts.

 

[veryvickyish]

"--I've read exactly what you've been saying, word for word, and it seems to fit you quite well. "

"--I've already stated what I propose: drop cranial from licensing exams and board testable material. Simple as that, and I believe I've stressed that suggestion in numerous other posts."

You have proven nothing. Are you prepared to approach the AOA with such a proposal? No. Because you have not gotten beyond what your suggestion means beyond complaining. Perhaps you put no credential in me, but if you are so sure of your stance, why do you not propose your opposition in a way it truly makes a difference... to the AOA?

This forum has become more than a reply about Cranial Therapy. You have assumed much, but not the responsibility of defending your position to anyone who will make a difference. The irony is, the minority doesn't bare the burden of justification in this case, even if you are right.

Peace,
Vicky Mays, PBL, OMS I

 

[Mad Frog]

HOMEBOY:
I have read this thread with a lot of interest and great amusement. As a pre-med student, I will readily admit that I have not studied Cranial Therapy. I cannot say that it is or is not effective. I do see flaws in your argument, however. Your own initial post on this thread counters your more recent posts. I quote "The influence of this craniosacral rhythm on health or disease states is completely unknown. Clinicians require a reliable means of assessment for decision making. Craniosacral assessment has not been shown to be reliable. The literature on craniosacral therapy does not include any high grade evidence, such as random controlled trials, of its effects on health outcomes." It is quite a large leap from this statement to declaring that cranial has no effect.

You say that you have "cited" journals and systematic reviews. I see no citations, simply brief mentions in your own words of what they say. No titles, no authors listed, nothing but your interperetation of what the "cited" items say. Post the links so that readers can look at the items for themselves, as veryvickyish and others have done.

You say that you have made proposals. I believe you misunderstand what was intended by asking you to make a proposal. Present a fromal , written proposal to the AOA stating your position and the evidence you believe justifies it! If, as you say, most DO's feel that cranial therapy is not of value, and these are after all the people who make up the AOA, your proposal should be well recieved and the action you suggest would be taken. However, I see no action, merely complaint and criticism.

As for what sets a DO apart from an MD, it is the approach to education and treatment. If you don't see a difference, why did you apply to an Osteopathic program? Yes, there are excellent, caring, involved MD's who view the patient as a whole and "treat the person, not the disease", as I continuously hear from DO's. But the fact is, the allopathic schools that I have looked into have a more disease-oriented focus, with more emphasis on research than patient care. Do I think all allopathic programs fall into that category? No, probably not. And do I believe all osteopathic programs are more patient-oriented than disease oriented? Probably not. But the schools I have looked into seem to fall neatly into these categories. I don't believe that the letters you place after your name make you who you are. Your education is only worth what you make of it. But if you don't believe in the general philosophy of the program you are in, you picked the wrong one. I am not saying you have to believe everything you are taught, but to succeed, you need to believe in the basic philosophy.

What does having dinner with the AOA president have to do with this? I'm sure it was an honor, but it is unrelated to this matter (unless cranial therapy happened to come up during the meal). The same is true of your military background. You should be proud of having served your country. You deserve to be honored for that. It is, however, irrelevant to what you are discussing, unless you were directly involved with patient care. You know what it means to work hard and be proud of a job well done. But do you know what it means to literally hold someone's life in your hands? If you don't now, you will soon enough. And I hope you can deal with that. For that matter, I hope I can.

Simply arguing about cranial therapy with other students doesn't accomplish anything. If you believe it should be removed from the curriculum, make the fromal proposal and present your evidence to the AOA, the people who can make a difference. Otherwise, all of your talk is pointless.

 

[homeboy]

Hey Frogger, how 'bout this...you apply to DO school...you go through all this stuff than get back to me. Until then, your post is nothing more than irrelevant rambling from some naive (and rather self righteous) pre-med'er completely removed from the subject matter.
(btw--that quote you attributed to me was from a systematic review...like I said it was...done by the University of British Columbia...google it and you'll find it.)

And the following goes for you, vicky, and all the rest of the cranial crowd who is offended at the notion of someone speaking out about an aspect of their profession...

Cranial is a joke. You may not think so, based on whatever reasons, but myself and most physicians/students either a.) don't care about it, or b.) are irritated by it. Most osteopathic physicians don't do cranial, and mostly because of reason 'a,' and don't want to cause a ruckus.
If so many DOs don't care about it, why is nothing done to change it? Well, maybe it's because so many people in our profession distance themselves from the AOA. How many DO grads go into ACGME residencies? nearly 2/3...do all of them retain AOA membership? Certainly some, but not all.
It's rather hard to change things when the people who COULD choose to ignore things.
I've been posting because I fall into camp 'b'...I'm not trying to open minds ...my yelling at you isn't going to change anything...so why bother? It's an outlet... I just plain old like arguing; it's a hobby of mine. It just never fails to amaze me how willing people are to believe something just because someone tells them so.

I'm also a sucker...I should be studying for boards like everyone else, but I'm drawn to a good argument like a bug to a light. Unfortunately, there aren't very many people like that...careers take precedence. That, and students have more pressing things to worry about in this stage in their career...the combined match being a big issue nearly every student is united on, but once again, the AOA--in its paternal wisdom--sees a joint match harmful to AOA residencies.

The osteopathic profession faces a NUMBER of challenges in the coming years: the joint match, growing dissent over the practices of modalities such as cranial, and--of urgent importance--the fact we're opening up new schools like they're going out of style, with absolutely no plan to ensure post-grad education (and the admission standards for those schools is ABSOLUTELY PATHETIC. Several classmates of mine know friends going there who scored lower than a 20 on their MCAT and had GPAs lower than 3.1 ... which might work to your advantage Frog Boy). The AOA's position is that "there are unfilled AOA residencies every year," hence there couldn't possibly be a shortage of residencies as students claim. But as my Dean wrote in an article for my schools' alumni magazine, there's open residencies because students don't want them...having umpteen unfilled FP residences doesn't mean squat. Again, nearly 2/3 of DO grads go ACGME because either the training is better, the location is better, etc...it doesn't matter. Bottom line: the AOA is doing a poor job.

Nothing is going to be done about cranial until the more pressing matters are addressed, after which time, hopefully things such as cranial will be addressed. Until then, it remains the mere rantings of the handful of students and physicians on both sides of the argument passionate enough to make a stance.

No more posts for me...Qbank time.

 

[Mad Frog]

Hey Frogger, how 'bout this...you apply to DO school...you go through all this stuff than get back to me. Until then, your post is nothing more than irrelevant rambling from some naive (and rather self righteous) pre-med'er completely removed from the subject matter.
(btw--that quote you attributed to me was from a systematic review...like I said it was...done by the University of British Columbia...google it and you'll find it.)

And the following goes for you, vicky, and all the rest of the cranial crowd who is offended at the notion of someone speaking out about an aspect of their profession...

Cranial is a joke. You may not think so, based on whatever reasons, but myself and most physicians/students either a.) don't care about it, or b.) are irritated by it. Most osteopathic physicians don't do cranial, and mostly because of reason 'a,' and don't want to cause a ruckus.
If so many DOs don't care about it, why is nothing done to change it? Well, maybe it's because so many people in our profession distance themselves from the AOA. How many DO grads go into ACGME residencies? nearly 2/3...do all of them retain AOA membership? Certainly some, but not all.
It's rather hard to change things when the people who COULD choose to ignore things.
I've been posting because I fall into camp 'b'...I'm not trying to open minds ...my yelling at you isn't going to change anything...so why bother? It's an outlet... I just plain old like arguing; it's a hobby of mine. It just never fails to amaze me how willing people are to believe something just because someone tells them so.

I'm also a sucker...I should be studying for boards like everyone else, but I'm drawn to a good argument like a bug to a light. Unfortunately, there aren't very many people like that...careers take precedence. That, and students have more pressing things to worry about in this stage in their career...the combined match being a big issue nearly every student is united on, but once again, the AOA--in its paternal wisdom--sees a joint match harmful to AOA residencies.

The osteopathic profession faces a NUMBER of challenges in the coming years: the joint match, growing dissent over the practices of modalities such as cranial, and--of urgent importance--the fact we're opening up new schools like they're going out of style, with absolutely no plan to ensure post-grad education (and the admission standards for those schools is ABSOLUTELY PATHETIC. Several classmates of mine know friends going there who scored lower than a 20 on their MCAT and had GPAs lower than 3.1 ... which might work to your advantage Frog Boy). The AOA's position is that "there are unfilled AOA residencies every year," hence there couldn't possibly be a shortage of residencies as students claim. But as my Dean wrote in an article for my schools' alumni magazine, there's open residencies because students don't want them...having umpteen unfilled FP residences doesn't mean squat. Again, nearly 2/3 of DO grads go ACGME because either the training is better, the location is better, etc...it doesn't matter. Bottom line: the AOA is doing a poor job.

Nothing is going to be done about cranial until the more pressing matters are addressed, after which time, hopefully things such as cranial will be addressed. Until then, it remains the mere rantings of the handful of students and physicians on both sides of the argument passionate enough to make a stance.

No more posts for me...Qbank time.

Completely removed from the subject? This affects my future as much as yours. Irrelevant ramblings? I believe I pointed out several from you. If the quote I attributed to you is from the "systematic review" you mention, then it defeats your own arguments. It clearly states that the research to disprove cranial's effectiveness has not been done. Am I self-righteous? You bet. If I believe something as strongly as you claim to, I actually try to do something about it, not just whine. Naive? Possibly, but at least I make the effort. Am I offended by your stance on cranial? Not in the least. You may be absolutely right. My offense is to your approach to the matter. You are correct that many problems in osteopathic education need to be addressed. Whining is not addressing the problems. You want to address the problems, as I said, make formal proposals and back them up. By the way, I am deeply offended at your insinuation that lower admission standards may be to my benefit. By your stance apparently anyone who is not already at least a second year med student is obviously beneath your level of intelligence and therefore has no right to address any issue on which you have spoken. If this is truly your attitude, I would be ashamed to have you as a colleague in the future. Will you be able to relate to patients who are not educated to your level? Or will you only practice medicine on other physicians? I am insulted by your entire approach to the issues and to other students. As for cranial, as I said, you may be correct. As for your skills in dealing with people, you need to work on it.

 

[FutureNavyDOc]

Completely removed from the subject? This affects my future as much as yours. Irrelevant ramblings? I believe I pointed out several from you. If the quote I attributed to you is from the "systematic review" you mention, then it defeats your own arguments. It clearly states that the research to disprove cranial's effectiveness has not been done.

Why should research time and effort be put into disproving something when there has never been evidence to prove it? I can go out there and claim that smoking 20 packs of cigarettes everyday decreases the risk of ACL tears, I bet no one wastes the time and effort to prove that its not true.

This applies perfectly to cranial, why should anyone waste time and effort disproving what the majority of DO's and MD's know to be false?

Here's a good link from Quackwatch.com all about Cranial. It includes links to articles about how a Chiropractor killed a 30 year old female patient by doing cranial on her.

Here's a research paper where they found that "the proposed mechanism for cranial osteopathy is invalid and that interexaminer
(and, therefore, diagnostic) reliability is approximately zero."

Here's an abstract from PubMed that says the fluctuation of the CSF is due to the circulatory system, NOT some intrinsic cranial movement.

Here's another article from a PT magazine that says "Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably."

Another PT article "The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably."

There is plenty of evidence debunking cranial from DO programs and PT alike despite the fact that as Homeboy said, the majority of DO's and DO students disagree with it.

Am I self-righteous? You bet. If I believe something as strongly as you claim to, I actually try to do something about it, not just whine.

Starting dialogue about this topic and hearing different points of view about it as well as defending one's on point of view is a great first step.
As many intelligent people in the past have said, "Dialogue is the first step towards progress."

Also, I believe that many DO's and DO students have been afraid to speak out against cranial for fear of repercussions at their school and from the AOA. Through this board, many have had a place to freely come share their thoughts without these fears.

If you look on the Osteopathic threads page of SDN, there is a thread with a poll asking if you would remove cranial from curricula, boards, both, or keep it.
The overwhelming response 48/67 (72%) favor dropping it completely, 8/67 (12%) favor dropping it from curricula or boards, while only 11/66 (16%) want to keep it. While this is not a scientific poll and calling it such would be a great folly, the simple fact that 72% of what one must assume to be DO students want to get rid of cranial speaks volumes. From conversations at my school, I would expect the actual percent to be much greater.

Would you prefer Homeboy do as Martin Luther did in Wittenberg in 1517 and nail his arguments to the door of the AOA headquarters then start his own Osteopathic Association? With $1 million and land to do it, he could start his own DO school, so I guess why not have him start his own Osteopathic association?

I feel it is much more mature and productive to discuss his opinions on the subject in a place which enables dialogue back and forth, allowing him to get a feel for the waters and meet some like-minded people (72% of DO's according to the survey) and discuss options of making changes on a National and Organizational level.

By your stance apparently anyone who is not already at least a second year med student is obviously beneath your level of intelligence and therefore has no right to address any issue on which you have spoken.

He never said you were below his intelligence level, merely that you have less experience with the subject. How can you even begin to defend this if you have not been through it?

You are falling perfectly into the OMM world's trap of believing without seeing. Keep this pace up and you may well end up running your own OMM department at one of the dozens of new school popping up annually.

If this is truly your attitude, I would be ashamed to have you as a colleague in the future. Will you be able to relate to patients who are not educated to your level? Or will you only practice medicine on other physicians? I am insulted by your entire approach to the issues and to other students.

My how little you know young grasshopper. The attitude/opinion that people are not as intelligent/educated/experienced as you leads people to explain things more thoroughly. Would you rather your physician assume you knew everything about a procedure and just do it or that he explain it to you in slightly simpler terms than you need?

I along with a majority of people would choose the latter. As far as relating to less educated people, I know from reading other threads that Homeboy organized and participated in health care fairs for immigrants and worked to help them understand the US healthcare system and the options available to them if they cannot afford health care in the case of an emergency.

He probably has not mentioned this because he does not seem like the type to toot his own horn, but he clearly does have great ability in relating to less educated people as well as a desire to help them.

I personally would be ashamed to have as a collegue someone who merely follows what they are told blindly and does not occassionally question the status quo and wonder how better care could be given to his/her patients. If no one ever questioned the status quo;
1. Surgreons wouldn't wash their hands or wear gloves to perform surgeries
2. Immunizations wouldn't exist and millions of kids the world over would die from preventable illnesses
3. We would still expel mentally ill patients from our towns and villages and shun them.
4. A patient with epilepsy would still be considered a witch and would be killed at the earliest opportunity
5. We would still use leeches to "suck the bad humor" out of sick patients.
6. Slavery would still exist in the US.

The list can go on and on. The bottom line is that Docs, med students, and citizens in general having the guts and intelligence to question the status quo have brought about some incredible and extremely benificial changes.

Take a few years off of this board, get into a DO school and go through OMM including Cranial, have two different OMM profs diagnose the Cranial sacral rhythm and strain pattern on a student separately as I did and watch them give totally different answers like I did. It speaks wonders to you when even the "experts" in a field can't get a simple diagnosis right!

 

[Mad Frog]

Why should research time and effort be put into disproving something when there has never been evidence to prove it? I can go out there and claim that smoking 20 packs of cigarettes everyday decreases the risk of ACL tears, I bet no one wastes the time and effort to prove that its not true.

This applies perfectly to cranial, why should anyone waste time and effort disproving what the majority of DO's and MD's know to be false?

Here's a good link from Quackwatch.com all about Cranial. It includes links to articles about how a Chiropractor killed a 30 year old female patient by doing cranial on her.

Here's a research paper where they found that "the proposed mechanism for cranial osteopathy is invalid and that interexaminer
(and, therefore, diagnostic) reliability is approximately zero."

Here's an abstract from PubMed that says the fluctuation of the CSF is due to the circulatory system, NOT some intrinsic cranial movement.

Here's another article from a PT magazine that says "Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably."

Another PT article "The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably."

There is plenty of evidence debunking cranial from DO programs and PT alike despite the fact that as Homeboy said, the majority of DO's and DO students disagree with it.



Starting dialogue about this topic and hearing different points of view about it as well as defending one's on point of view is a great first step.
As many intelligent people in the past have said, "Dialogue is the first step towards progress."

Also, I believe that many DO's and DO students have been afraid to speak out against cranial for fear of repercussions at their school and from the AOA. Through this board, many have had a place to freely come share their thoughts without these fears.

If you look on the Osteopathic threads page of SDN, there is a thread with a poll asking if you would remove cranial from curricula, boards, both, or keep it.
The overwhelming response 48/67 (72%) favor dropping it completely, 8/67 (12%) favor dropping it from curricula or boards, while only 11/66 (16%) want to keep it. While this is not a scientific poll and calling it such would be a great folly, the simple fact that 72% of what one must assume to be DO students want to get rid of cranial speaks volumes. From conversations at my school, I would expect the actual percent to be much greater.

Would you prefer Homeboy do as Martin Luther did in Wittenberg in 1517 and nail his arguments to the door of the AOA headquarters then start his own Osteopathic Association? With $1 million and land to do it, he could start his own DO school, so I guess why not have him start his own Osteopathic association?

I feel it is much more mature and productive to discuss his opinions on the subject in a place which enables dialogue back and forth, allowing him to get a feel for the waters and meet some like-minded people (72% of DO's according to the survey) and discuss options of making changes on a National and Organizational level.



He never said you were below his intelligence level, merely that you have less experience with the subject. How can you even begin to defend this if you have not been through it?

You are falling perfectly into the OMM world's trap of believing without seeing. Keep this pace up and you may well end up running your own OMM department at one of the dozens of new school popping up annually.



My how little you know young grasshopper. The attitude/opinion that people are not as intelligent/educated/experienced as you leads people to explain things more thoroughly. Would you rather your physician assume you knew everything about a procedure and just do it or that he explain it to you in slightly simpler terms than you need?

I along with a majority of people would choose the latter. As far as relating to less educated people, I know from reading other threads that Homeboy organized and participated in health care fairs for immigrants and worked to help them understand the US healthcare system and the options available to them if they cannot afford health care in the case of an emergency.

He probably has not mentioned this because he does not seem like the type to toot his own horn, but he clearly does have great ability in relating to less educated people as well as a desire to help them.

I personally would be ashamed to have as a collegue someone who merely follows what they are told blindly and does not occassionally question the status quo and wonder how better care could be given to his/her patients. If no one ever questioned the status quo;
1. Surgreons wouldn't wash their hands or wear gloves to perform surgeries
2. Immunizations wouldn't exist and millions of kids the world over would die from preventable illnesses
3. We would still expel mentally ill patients from our towns and villages and shun them.
4. A patient with epilepsy would still be considered a witch and would be killed at the earliest opportunity
5. We would still use leeches to "suck the bad humor" out of sick patients.
6. Slavery would still exist in the US.

The list can go on and on. The bottom line is that Docs, med students, and citizens in general having the guts and intelligence to question the status quo have brought about some incredible and extremely benificial changes.

Take a few years off of this board, get into a DO school and go through OMM including Cranial, have two different OMM profs diagnose the Cranial sacral rhythm and strain pattern on a student separately as I did and watch them give totally different answers like I did. It speaks wonders to you when even the "experts" in a field can't get a simple diagnosis right!

Thank you for taking the time to actually place material here to back up what you say. That is what is needed. I do not defend cranial. A I clearly said, I do not know if it is effective, and I have seen evidence for both points of view. I did not attack Homeboy's opinion, merely his method of presenting it. By all means qyestion the status quo, otherwise no progress is ever made. I suggested Homeboy do as you have done, and place his souces here for those who haven't seen the articles to view for themselves.

As for the survey you cited, I believe it was 72% of "what must be assumed to be DO students", and that only accounts for those replying on these forums. Pretty good stats for your argument, and if it is any real indication, the majority of DO's and students agree with you. That being the case, it shouldn't be that difficult to find the support neede to make the curriculum changes you and others suggest. Go for it. As I said several times before, you may be absolutely right.

As for a chiropractor killing someone by performing cranial, that is a terrible thing. It is a terrible thing when a patient dies during any procedure. Does the fault lie with the procedure or the practitioner? I'm sure you can find such tragic examples in practices that you do accept. I know I can.

Why should time and effort be wasted to disprove somthing when there has never been any evidence to prove it? Cranial has been an accepted practice for years. That doesn't mean it should not be questioned, it should. However, by your reasoning, any drug which has not been proven effective should be removed from the market. While it may be a good idea, that is not how the system works. Once the FDA has approved a drug, it must be shown to be harmful or potentially harmful before it is withdrawn ( example: Vioxx). The point is that the burden of proof lies with those who are challenging the accepted standard. Cranial may be harmful or in the least ineffective, but the burden to show this lies with those who wish to remove it. I would have no objection to removing it from the curriculum or making it optional material. But the fact is, it is required at this time. If you want it to change, make the formal proposal. I would back it if it were properly presented, as would the great majority of DO's and students if your numbers are even close to being accurate.

As for my taking offense to Homeboy's attitude, perhaps I misread his suggetion that lower admission standard at osteopathic schools would work to my benefit. Perhaps I also misundertand your suggestion that I should not comment until I have reached the level of instruction that you have reached now. I must be a little oversensitive to read these statements as insults.

I am skeptical of cranial therapy. I believe the status quo should be challenged. I don't believe the approach of simply bashing those who appear to disagree with your opinion is acceptable.

By the way, I see that you and Homeboy are both about to tackle the COMLEX. I understand it can be tough, and I wish you the best as you prepare. Good luck.

 

[homeboy]

The point is that the burden of proof lies with those who are challenging the accepted standard.

Quick study break...
Actually, the burden of proof lies on those purporting the claim...

But the whole drug correlation is a mute one, as cranial (and all of OMT for that matter) falls under complimentary and alternative medicine, and has little FDA oversight. Herbal / CAM companies cannot legally make claims that their product cures or treats any actual disease. BUT........OMT is claimed by the osteopathic profession as being an official treatment...

 

[JohnDO]

I definitely "felt" something with a rhythm during cranial labs. However, I am convinced it was due to the inherent gullibility of my CNS rather than the inherent motility of my partner's CNS. After I began to consistently feel a rhythm, I started doing my own little studies on what I was feeling. For example, I would wait till I thought I felt peak flexion. After that, I would take my hands off and wait a few seconds. Then I'd put my hands back on and see where in the cycle I began to feel the rhythm. Curiously, I began to notice that I always began to feel the cycle in the exact same phase no matter what interval I had waited: maximal flexion. I also noticed that I could not feel the rhythm in a loud room. Some of my professors might argue that I needed to focus--but I would say that's exactly the problem. Still, there are those who swear by it and are chock full of anecdote. As for me, I am still waiting for the cranial community to positively demonstrate its claim.

 

[AmaurosisFugax]

I agree that cranial is a joke.

Not because it is or isn't effective--I'm nowhere near experienced enough to say that.
But, as an OMSIII student, I can easily say that cranial is a joke because:

1. It is NOT well-taught
2. It is NOT well-received

No one can dispute these two points. They are simple facts. If #1 were true than more students like me, who are skeptical but willing to learn, would be able to learn it. As homeboy has stated, cranial is taught with the one-two punch of
1. an odd theory that most of the class scoffs at, and
2. faculty anecdotes

Hey, whether or not it truly is efficacious, cranial has some serious hurdles that it needs to overcome if it wants to be taken more seriously. In the meantime it will continue to be considered "a joke" by the majority of students (who are only future DO's)

 

[UltimateDO]

While I agree that hard research needs to be done (there are several projects currently in progress) the counter research, at least the Quackwatch one (only one I had time to look at so far, Q-bank ya'know) there are no references either direct or indirect to SCTF, AAO, or AOA. I had not even heard of Uplander until I was on SDN and I have taken several cranial courses and seminars. If you are going to discredit something, I would go after the foundation upon which it is built (SCTF is the "caretaker" of osteopathic cranial). The couple of projects that I mention above themselves have preliminary raw objective data that discredits the Uplander 5 gram treatment load claim and attributing of the cranial rhythm to a cardiovascular origin. The waveforms seen with the hand/fingertip transducers used in one study indicate the treatment load are about a min of 1 lb and that the palpated rhythm correlates with the Traub-Hering-Meyer wave (a cardiopulmonary derivative) . I know I am going to regret involving myself in this thread but there is a continuing effort to place a foundation for evidence based cranio-sacral theraputics. My background as an engineer demands that I always ask for data, but there are times when empiric procedures are followed by the supporting data scattered throughout engineering/medical science history.

 

[homeboy]

While I agree that hard research needs to be done (there are several projects currently in progress) the counter research, at least the Quackwatch one (only one I had time to look at so far, Q-bank ya'know) there are no references either direct or indirect to SCTF, AAO, or AOA. I had not even heard of Uplander until I was on SDN and I have taken several cranial courses and seminars. If you are going to discredit something, I would go after the foundation upon which it is built (SCTF is the "caretaker" of osteopathic cranial). The couple of projects that I mention above themselves have preliminary raw objective data that discredits the Uplander 5 gram treatment load claim and attributing of the cranial rhythm to a cardiovascular origin. The waveforms seen with the hand/fingertip transducers used in one study indicate the treatment load are about a min of 1 lb and that the palpated rhythm correlates with the Traub-Hering-Meyer wave (a cardiopulmonary derivative) . I know I am going to regret involving myself in this thread but there is a continuing effort to place a foundation for evidence based cranio-sacral theraputics. My background as an engineer demands that I always ask for data, but there are times when empiric procedures are followed by the supporting data scattered throughout engineering/medical science history.

I think you're referring to Upledger.
The only problem is, outside the small group of osteopaths that supports cranial, no one makes the distinction between Dr. Upledger's cranial and the cranial taught at DO schools. Upledger is a DO, and regardless of how much people ignore or distance themselves from him, people who are up on their consumer advocacy (docs and patients) are well acquainted with him.

Fused or unfused, PRM or no PRM (regardless of its origin), and 5 grams or 1 lb, there is absolutely nothing to suggest that diagnosing "dysfunctions" associated with the cranial PRM is reproducible from 1 physician to the next, that it can be done accurately by manual means, and even if those two hurdles were overlooked, treatment for the supposed dysfunctions has absolutely no basis and is not defined within the parameters with which it is taught.
We learn many types of torsions and dysfunctions, but no pathology associated with them other than the means in which the torsion or dysfunction was caused (eg. blow to the side of the head, blow to posterior-superior aspect of the head, etc...). Maybe that's a shortcoming in my cranial dept (though I'm not sure that's the case), but for all intent and purpose, the yield from cranial dx/tx is infinitesimal.

 

[UltimateDO]

I think you're referring to Upledger.
The only problem is, outside the small group of osteopaths that supports cranial, no one makes the distinction between Dr. Upledger's cranial and the cranial taught at DO schools. Upledger is a DO, and regardless of how much people ignore or distance themselves from him, people who are up on their consumer advocacy (docs and patients) are well acquainted with him.

Fused or unfused, PRM or no PRM (regardless of its origin), and 5 grams or 1 lb, there is absolutely nothing to suggest that diagnosing "dysfunctions" associated with the cranial PRM is reproducible from 1 physician to the next, that it can be done accurately by manual means, and even if those two hurdles were overlooked, treatment for the supposed dysfunctions has absolutely no basis and is not defined within the parameters with which it is taught.
We learn many types of torsions and dysfunctions, but no pathology associated with them other than the means in which the torsion or dysfunction was caused (eg. blow to the side of the head, blow to posterior-superior aspect of the head, etc...). Maybe that's a shortcoming in my cranial dept (though I'm not sure that's the case), but for all intent and purpose, the yield from cranial dx/tx is infinitesimal.

My point was not about Upledger, it was more about the exclusion of documentation from the other legit, recognized organizations in Quackwatch. Like I said maybe it is me living in the NE but I have been to several convocations, SCTF seminars and Cranial courses and have never heard him referenced. Anyone can claim to be the end all be all source for a technique
allopathic or osteopathic, I have never seen him referenced (that doesn't mean he hasn't been) in either the Stillpoint, Cranial Newsletter, or JAOA which would be the sources most osteopaths I know use as resources.

As to pathology, PCOM's Hollis Wolfe presentation at convo this year (I helped put it together) was a great example with indirect objective evidence that the cranial tx worked. Pt was Hypothyroid d/t pituitary tent strain with TSH labs at baseline, with synthroid, and after cranial. I have attached the ppt for those curious. All of the cranial courses that I have been a part of have mentioned cranial nerve impingement as symptomatic pathology that is readily txable with cranial. Infants who chronically spit up respond really well to an OM spread technique. I have seen a pt with Bell's Palsy respond dramatically to a SS pivot tx. I agree with you homeboy that too much of cranial is based on single case presentations and anecdotal evidence and that rigor is needed. There is quite a bit of research in the works right now with some of the palpatory metric technology finally being durable enough to collect data. I have seen too many cases personally though to dismiss cranial tx responses to being psychosomatic.

(edit: we cannot upload ppt files, PM me if anyone wants the presentation w/ data)

 

[homeboy]

My point was not about Upledger, it was more about the exclusion of documentation from the other legit, recognized organizations in Quackwatch. Like I said maybe it is me living in the NE but I have been to several convocations, SCTF seminars and Cranial courses and have never heard him referenced. Anyone can claim to be the end all be all source for a technique
allopathic or osteopathic, I have never seen him referenced (that doesn't mean he hasn't been) in either the Stillpoint, Cranial Newsletter, or JAOA which would be the sources most osteopaths I know use as resources.

As to pathology, PCOM's Hollis Wolfe presentation at convo this year (I helped put it together) was a great example with indirect objective evidence that the cranial tx worked. Pt was Hypothyroid d/t pituitary tent strain with TSH labs at baseline, with synthroid, and after cranial. I have attached the ppt for those curious. All of the cranial courses that I have been a part of have mentioned cranial nerve impingement as symptomatic pathology that is readily txable with cranial. Infants who chronically spit up respond really well to an OM spread technique. I have seen a pt with Bell's Palsy respond dramatically to a SS pivot tx. I agree with you homeboy that too much of cranial is based on single case presentations and anecdotal evidence and that rigor is needed. There is quite a bit of research in the works right now with some of the palpatory metric technology finally being durable enough to collect data. I have seen too many cases personally though to dismiss cranial tx responses to being psychosomatic.

(edit: we cannot upload ppt files, PM me if anyone wants the presentation w/ data)

Sure, and I understand your point, and the same logic goes for much of OMT (as much of it is not based on EBM but personal experiences and what has traditionally worked), though I differentiate the two when it comes to applicability in the scope of medical practice by physicians. I think what 'LukeWhite' said a few pages back is accurate, and that cranial continues to be endorsed to "protect the identity of the profession at the expense of actual utility to patient." As the AOA has endorsed cranial from the get-go, their reputation is on the line and it wouldn't look very consistent if the practice was dropped, much less proven ineffective by 3rd party researchers.

The U. of British Columbia systematic review put it the best: "Clinicians require a reliable means of assessment for decision making. Craniosacral assessment has not been shown to be reliable."

(And if your primary sources for evidence are as biased as those presented in the JAOA, Stillpoint, etc...it's quite hard to find refuting evidence. I would take an article found on a PubMed search over anything printed in the "Cranial Chronicle.")

 

[Hardbody]

I am a pre med (Osteo) student that has recently shadowed a fam practice D.O. that heavily uses OMT in his practice. The doc uses cranial and I must be honest, to me it looked like a bunch of crap. Sorry, I like the Osteo philosophy and I am open to learning the rest of OMT and perhaps one day using some of it, but this cranial business needs to go. I thought I was watching a Vodoo doctor!

I fear that if too many patients go to a D.O.'s that use this questionable practice, it will cheapen/taint the osteopathic degree and unfairly stigmatize all other D.O.'s out there. The best physician I have shadowed is a D.O. and the worst physician I have shadowed is a D.O.!

 

[NoBarsHeld]

I find this whole discussion extremely fascinating and must admit see things from both sides of the aisle.

I found the article by Hartman a bit over the top but he brought up important points that need to be addressed and the back and forth comments were helpful.

http://www.chiroandosteo.com/content/14/1/10/abstract/

A main issue is the balance of EBM and patient’s options with alternative care, and the difference between what researchers perceive a patient needs and what the patient "marketplace" demands. When treatment is patient driven, meaning they perceive a significant benefit, whom is the clinician supposed to listen to, and how much research is enough to prove or disprove a treatment's methodology? What are the risk benefit ratios for the care patients are receiving versus what are the risk benefit ratios for the alternatives such as surgical or pharmaceutical intervention?

If cranial has been proven to be of no value then no reduced risk warrants its use, yet reliability aside, if there are sufficient case studies that seem to show something is happening, before it is dismissed it is possible that the problem is not with cranial techniques but the way it needs to be studied.

.... Or maybe it is just a powerful way into stimulating the wonders of the placebo effect, which in and of itself is not such a bad thing.

 

[AwesomeO-DO]

I just heard from someone that took the COMLEX Level II saying there was a bunch of Cranial questions on the test. What kind of horse$hit is that! Not once did I see someone practice cranial (or CV4) on a patient during my past 8 months of rotations with DOs. Now i have to go back through my 2nd year notes and try to memorize what my hands do when someone has a left torsion or flexion or whatever.... HORSE$HIT!!!

 

[ThinkTwice]

This is probably my first official reading on SDN, all other reading have been nervous requests for advice, etc. Honestly, I'm pre-chiropractic, and strongly leaning towards osteopathy, so here I'm meddling with the big boys. All in all this weighs a bit on what I have to say about all this.

First of all, Homeboy's anger was pretty rampant, and kind of funny towards the end, but seriously, I question not whether the cranial techniques actually work, but how many people are capable of using them --- in other words, don't be upset that you can't do it, if it's not your skill set, then leave it up to someone else.

I think that all arguments aside, people are going to differ in opinions, and this is a huge idea to reconcile. It reminds me of a discussion I had the other day on evidence based practice versus homeopathy (or whatever Shaman one believes in), and it's just a fact that people are going to differ in opinions. You can't tell one school to change the way they think, but you can let them do what works for them. The fact is, evidence based medicine doesn't cut it for everyone, and without the various schools of thought, I think that our society would fall short, and become too narrow minded. Amongst all the things that I would love to say, the one thing that comes to mind is the fact that I've shadowed a few chiropractors (and as most of the population thinks that they are full of b.s.) I've seen some really amazing things go down, and yes, heard some amazing stories, and frankly, that's all I need to go off of. If I can go in week after week and see smiling patients who have been helped by this one person, who primarily uses manipulations as a healing tool, then that's all that matters. I don't need medical books to tell me that what they do is legit, because they know that what they do is legit, and frankly, they cover completely different fields, so I'm pretty pissed that you put them down with 'low level health care providers' - that a way to put someone down, when it seems you don't even know what they stand for (or do).

Also, despite the fact that I appreciate Kerry much more than Bush, I completely back the statement that we can't run osteopathic professional codes like Kerry would.

As much as I want to be an osteopath, based on what I think it holds as its principles, I'm skeptical that this is what I actually want, because I see so many stories of DO's not getting into med school, and DO's who aren't connected on some major Osteopathic teachings, but this last statement should really be made to a different site. But are there really that many MD failures in DO school?

Sweet chatting.

 

[homeboy]

First of all, Homeboy's anger was pretty rampant, and kind of funny towards the end, ...

Huh?