Cranial Osteopathy - What is your take on it?

[futIDdoc]

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I like the point you make and I'm not sure why I confused the two points.
I think I was just itching to talk about Kathryn Montgomery's book. I'm really digging it. I encourage everyone to check it out.

But Lokhtar, isn't a case report published in a peer reviewed journal by a physician antecdotal by definition? Would you discount these when considering treatment? If the treatment poses no harm, but antecdotally can produce benefit, what's the harm in utilizing it? I mean you have to admit cranial isn't on the top of the list in importance for studies to be conducted, so why not take the case reports seriously? After all, it's not like a UFO sighting, it's a professional documenting and submitting for peer review.
What's your take?

sweet jesus, how many logical fallacies can you put in one post? first point, there is harm done. You may attribute any positive responses to treatment as validation for future use of the treatment. So while no harm may be done to the first patients, harm is done on future patients. Second, case reports in the absence of true trial data does not mean that case reports are a more valid set of data.

 

[Lokhtar]

I'm an incoming DO student too, but I've been able to palpate the movement of those bones and show others too.

Not very well I bet because the interexaminer reliability is nonexistant. If you think otherwise, you could get a real nice publish by showing so.

 

[Styria]

Not very well I bet because the interexaminer reliability is nonexistant. If you think otherwise, you could get a real nice publish by showing so.

The rhythm isn't as regular as a heart beat. That's all that's necessary to demonstrate to get around interexaminer reliability complaints as regards the rate. As for interexaminer reliability regarding diagnosis, I'll just have to wait and be trained on it before I'm in a position to address that.

 

[Taus]

IMHO as a soon-to-be-graduating DO who actually likes and will use some aspects of OMM in a Sports/Pain PM&R practice:

This cranial **** was painfully embarrassing to learn and makes us look like quacks.

 

[Bleurberry]

sweet jesus, how many logical fallacies can you put in one post? first point, there is harm done. You may attribute any positive responses to treatment as validation for future use of the treatment. So while no harm may be done to the first patients, harm is done on future patients. Second, case reports in the absence of true trial data does not mean that case reports are a more valid set of data.

Yesterday was a train wreck. Thanks for correcting my mistakes for me.

 

[Bleurberry]

IMHO as a soon-to-be-graduating DO who actually likes and will use some aspects of OMM in a Sports/Pain PM&R practice:

This cranial **** was painfully embarrassing to learn and makes us look like quacks.

Well I'm going to shut up from here about cranial.
I'm really surprised that something that is being called out as absolutely ineffective is being defended by faculty who teach and do research for a living, though. Is that what you mean by painfully embarrassing? Taus, do you think cranial has any place in peds, or is it suggested to have - in class?

 

[Bleurberry]

Because its still n=1, and there are no controls. Case studies are useful only to form initial hypothesis, which must then be verified by a proper experiment.

Thanks for responding and having patience with me, Lokhtar. 😛

 

[Lokhtar]

The rhythm isn't as regular as a heart beat. That's all that's necessary to demonstrate to get around interexaminer reliability complaints as regards the rate. As for interexaminer reliability regarding diagnosis

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[Bleurberry]

Loky, Taus, what about the following take on cranial:

Granted that science looks at the statistical norm and demonstrates how something works if you try to remove the individual.
Osteopathy in the cranial field serves as a valid model -
using it one can make a prediction, plan an intervention and have a consistant result as a consequence with low side effect.
The acupuncture model makes less sense than its outcomes but permits the practitioner to do the same thing. Effective models have internal consistency and permit transmitting vast amounts of knowledge with regard to structure, function and other elements that are true and proven. The technique of "spreading the occipitomastoid suture" may have much less to do with "actually" spreading the suture ... it may work through cutaneous receptors or muscle responses at that site ... but the hand placement and direction of forces with a sense of "softening" in the region is coincident with reduction in headache and in alteration of vagal activity (which just happens to have anatomical connections with receptors associated with skin, muscle, bone, and dura in the exact same region. What mechanism is involved needs to be studied, but the clinical success is still there and changes in autonomic function is a measurable phenomenon that is currently being pursued with great preliminary data. Travell and Simons will talk about the palpable tissue texture changes at a cranial site as a myofascial trigger point and then describe a treatment that is exactly the same as the cranial techniques for a given dysfunction and using that model note that the referred pain pattern leaves and the related autonomic elements are altered favorably ... both models predict the symptoms, denote a biomechanical (or injection to the structural component) and have the same outcome. Each proposes a different model and mechanism but has the same outcome using similar treatment.
OCF is a model too that is clinically effective and helpful to teach students a "ton" of useful clinical and anatomico-physiological information
as long as they recognize that we too know that it is just a model and not dogma, then it is still the most useful way to share this information.
And that we are not helped by so many lay practitioners dogmatically making claims and demonstrating often ineffective outcomes after a weekend course
compared to the practice of a physician putting the model into context and applying it after years of study.

 

[Lokhtar]

Loky, Taus, what about the following take on cranial:

Granted that science looks at the statistical norm and demonstrates how something works if you try to remove the individual.
Osteopathy in the cranial field serves as a valid model -
using it one can make a prediction, plan an intervention and have a consistant result as a consequence with low side effect.
The acupuncture model makes less sense than its outcomes but permits the practitioner to do the same thing. Effective models have internal consistency and permit transmitting vast amounts of knowledge with regard to structure, function and other elements that are true and proven. The technique of "spreading the occipitomastoid suture" may have much less to do with "actually" spreading the suture ... it may work through cutaneous receptors or muscle responses at that site ... but the hand placement and direction of forces with a sense of "softening" in the region is coincident with reduction in headache and in alteration of vagal activity (which just happens to have anatomical connections with receptors associated with skin, muscle, bone, and dura in the exact same region. What mechanism is involved needs to be studied, but the clinical success is still there and changes in autonomic function is a measurable phenomenon that is currently being pursued with great preliminary data. Travell and Simons will talk about the palpable tissue texture changes at a cranial site as a myofascial trigger point and then describe a treatment that is exactly the same as the cranial techniques for a given dysfunction and using that model note that the referred pain pattern leaves and the related autonomic elements are altered favorably ... both models predict the symptoms, denote a biomechanical (or injection to the structural component) and have the same outcome. Each proposes a different model and mechanism but has the same outcome using similar treatment.
OCF is a model too that is clinically effective and helpful to teach students a "ton" of useful clinical and anatomico-physiological information
as long as they recognize that we too know that it is just a model and not dogma, then it is still the most useful way to share this information.
And that we are not helped by so many lay practitioners dogmatically making claims and demonstrating often ineffective outcomes after a weekend course
compared to the practice of a physician putting the model into context and applying it after years of study.

Well, forget for a second the ludicrousness of the proposed mechanism which alone propels this field into quackery and pseudoscience (and has no place in a medical school), and let's focus on the outcomes. I'd like to see those proper studies with good outcomes. It's a bit rich to only have 'preliminary' data after 100 years of existence. 'It's being extensively researched' has been the rallying cry of quacks for decades, with the results never quite arriving.

 

[Bleurberry]

Ok, check out for me

The Journal of Pediatrics
Volume 148, Issue 5 May 2006, Pages 706-707
Volume 148, Issue 5

and

Arch Pediatr Adolesc Med. 2003 Sep;157(9):861-6.

Glad you're hanging around, Lok.

Well, forget for a second the ludicrousness of the proposed mechanism which alone propels this field into quackery and pseudoscience (and has no place in a medical school), and let's focus on the outcomes. I'd like to see those proper studies with good outcomes. It's a bit rich to only have 'preliminary' data after 100 years of existence. 'It's being extensively researched' has been the rallying cry of quacks for decades, with the results never quite arriving.

 

[Lokhtar]

Neither of the links work for me.

EDIT:
Went directly to the journal through another link for the first source. Found it the 'Letters' section - not an auspicious start.

And all it is doing is calling for research. Which is fine. Do all the research you want. Take another 100 years if you want. Stop treating as anything but quackery until you do.

 

[Bleurberry]

Neither of the links work for me.

EDIT:
Went directly to the journal through another link for the first source. Found it the 'Letters' section - not an auspicious start.

And all it is doing is calling for research. Which is fine. Do all the research you want. Take another 100 years if you want. Stop treating as anything but quackery until you do.

They weren't intended to be links, but citations, I'll ammend that.
Ugh, why are you summarily dismissing me? And that's tough to argue with, because you're not in the business of discussion, but of being right.
You asked for the "preliminary data".

 

[Lokhtar]

They weren't intended to be links, but citations, I'll ammend that.
Ugh, why are you summarily dismissing me? And that's tough to argue with, because you're not in the business of discussion, but of being right.
You asked for the "preliminary data".

No, I asked for actual data. I said it was a bit rich to only have preliminary data after a hundred years.

I'm not dismissing you - I want to see these studies. Because there are a lot of studies showing it has no effect and/or its not reliable at all, and obviously the mechanism is bonkers scientifically. So to go against all that, I'm very keen to see data that support and show evidence of its efficacy. Frankly, there'd need to be a lot of data to overcome all the studies showing its unreliability, but I'm open to the idea. If it works, great, I've no problem with it.

And if that's all that exists, they shouldn't be teaching it, let alone 'explaining' its mechanisms. I'm happy to have a discussion with you. What are we discussing though - that there are studies that prove it (show me), that it makes sense scientifically (how?)?

 

[Bleurberry]

No, I asked for actual data. I said it was a bit rich to only have preliminary data after a hundred years.

I'm not dismissing you - I want to see these studies. Because there are a lot of studies showing it has no effect and/or its not reliable at all, and obviously the mechanism is bonkers scientifically. So to go against all that, I'm very keen to see data that support and show evidence of its efficacy.

And if that's all that exists, they shouldn't be teaching it, let alone 'explaining' its mechanisms.

Seriously, I agree. And if it's going to happen anywhere/has had the opportunity of happening, it's at at St. Barnabas hospital in the Bronx, right? So why they haven't commissioned such a study is well beyond me- they seem to have the staff, expertise and opportunity. I'll see what I can do. Alright then... 😏 Well thanks for playing, you've got me on the right track.

 

[Lokhtar]

So why they haven't commissioned such a study is well beyond me

Well, I can completely understand why they haven't, but then again, I'm a pretty cynical person when it comes to CAM and CAM practitioners.

 

[Bleurberry]

Well, I can completely understand why they haven't, but then again, I'm a pretty cynical person when it comes to CAM and CAM practitioners.

But it works both ways - students need to take the initiative to set up these studies and get approval/carry them out. Otherwise threads like these end up happening. I appreciate that students who are skeptical
may find it a waste of time, but it would be good for the profession.

 

[Lokhtar]

But it works both ways

I don't understand - what works both ways? It's been a hundred years, if someone preaches it, they need to prove it first. Or they need to shut it.

Or cynically, they don't because what happens if it shows no effect? Would they be intellectually honest and stop practicing it when its what keeps them employed? Isn't it better to just keep going with the status quo response that 'research is coming, I promise.' You can do that in perpetuity while making a living off it.

 

[Bleurberry]

I don't understand - what works both ways? It's been a hundred years, if someone preaches it, they need to prove it first. Or they need to shut it.

Or cynically, they don't because what happens if it shows no effect? Would they be intellectually honest and stop practicing it when its what keeps them employed? Isn't it better to just keep going with the status quo response that 'research is coming, I promise.' You can do that in perpetuity while making a living off it.

Well putting your "normal" self and "cynical" self together for a moment, do you suspect that the instruction and use of cranial technique is intellectually dishonest?
I ask because there's more to OMM than cranial (that's obvious), and even the origins of cranial don't originate with the beginnings of osteopathic medicine. And its distressing, to say the least, that faculty would be intellectually dishonest with themselves and their students, is my principal concern

 

[Lokhtar]

Well putting your "normal" self and "cynical" self together for a moment, do you suspect that the instruction and use of cranial technique is intellectually dishonest?

Yes. Now, do people who practice it genuinely believe it? Yea, I'm sure many of them do. I've met several homeopathic practitioners who truly believe what they do, and give it to themselves, and their kids, etc. But is it honest to call it a science without following scientific methodology? No.

 

[futIDdoc]

I'd be willing to bet most of the professors teaching it know that it is bunk. Just like televangelist consciously know that they are bilking their parishioners. It is in their best interest to keep the racket going.

 

[Bleurberry]

I see. That's a disturbing prospect.

 

[dcratamt]

This thread is 4 years old so I think the voting stopped a long time ago! I just wanted to be a good SDN participant and talk about my concerns by using a relevant, pre-existing thread

I was not trying to elicit inflammatory responses. My question is, is cranial osteopathy still taught? And is it actually used?

I saw articles dated 6 years ago that claimed that cranial manipulation is on the COMLEX exams. Is this true? How much cranial is there?? Here's an example COMLEX test question I saw from years ago:

"A 33-year-old female presents to the emergency department with pain in the back of the head after being struck by her spouse. Cranial osteopathic examination reveals no true sphenobasilar flexion/extension, only a monophasic rocking motion. The most likely cranial diagnosis is
(A) right lateral strain
(B) inferior vertical strain
(C) left sphenobasilar torsion
(D) sphenobasilar compression
(E) right sidebending rotation”

I've worked in the ED for quite some time, had the pleasure of working under many doctors, DO and MD alike, and I have never heard of or seen such a diagnostic test for traumatic injury. When I see a head trauma I think 'CT scan', not "let's get some cranial osteopathy in here". And whilst I've heard crazy medical jargon before, I think I would remember a diagnosis of cranial 'monophasic rocking motion' 😕

Again, I'm not a doctor, I have never seen this stuff practiced, but I can read journal articles. I can't find one good paper that backs up this practice, and by 'good' I mean a fairly large double-blind clinical trial, not 7 people who know what treatment they're getting.

It just seems to be an scientifically unproven and unverified tool...I'm hoping the above comlex question are old remnants of a changed system.

The answer is B.

 

[Terpskins99]

Just ask Leonard Nemoy. 😡👍

Look at that form!

 

[235750]

The answer is B.

lol thanks man

and Terpskins99, lol times a thousand! I love star trek, never thought of him doin the cranial. So it must be a logical practice 👍