Cranial Sacral Rhythm

Discussion in 'Medical Students - DO' started by RollTide, May 11, 2000.

  1. RollTide

    RollTide Senior Member
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    I just finished reading the November 1995 volume of "Still Alive" that contained a research article about the validity of the cranial rhythmic impulse (CRI). This research was done at UNECOM.
    http://www.rscom.com/osteo/journal/vol1_1/cri.htm

    While at first I had difficulty understanding the principles underlying a CRI and was doubtful of the existence of one,and after several unsuccessful patient encounters, I was able to "feel" this rhythmic impulse and easily recognized it with future patients. After reading this article and assuming that the other research this article points to is true, I have a hard time understanding why this is taught in COMs if research has yeilded little support for it. Am I missing something? Has there been any research done since 1995 that showed something different. I am not yet a osteopathic medical student and hoped that some of you veterans could enlighten me. Is cranial osteopathy taught at all COMs? How much time is dedicated to this subject and what are your own feelings?

    -Joshua

    [This message has been edited by RollTide (edited 05-12-2000).]
     
  2. ewagner

    ewagner Senior Member
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    I think one of the major problems I have with the CRI and treatments based on such, is this...thus far all evidence is anecdotal. And any research has had virtually no subjects and not a single one that I have seen (outside of one published circa 1996 in "The Journal of Orthopedic and Sport Physical Therapy" has shown ANY results on inter and intrarater reliability! This is a major criteria for test validity!!

    Also, "feeling" movement does not presuppose treatment based on such movement is beneficial. I can feel the radial pulse, but attempting to physically alter it through pressure doesn't do anything to the source of the pulse. Thirdly, there is a HUGE placebo affect when someone actively touches your skull if you are in pain or have a headache. Simply saying "it feels better" is not proof.
    Try blinding the patients with "true" vs. "sham" cranial therapy...that would be an interesting study eh? Fourthly (is that a word?) where are the animal studies?
    Fifth, if simple hand placement supposedly works with treatment...what about wearing a helmet or leaning on your head, or handstands etc.
    We are entering into the age of evidence based medicine, simply "feeling" something that you have been taught exists does not prove anything (does it prove you wanted to feel it??) and does not mean that altering what you feel provides true treatment outside of massage or placebo.
    This particular email does not mean I have no faith in osteopathic medicine, I am proud as can be to be in osteopathic medical school! All it means is that a rational mind should critically look at details and draw logical conclusions based on specific evidence and science.
     
  3. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    It is taught out of tradition mostly; there is research out there---it's just that a lot of it isn't very good. Some patients find it very helpful.

    But, the phenomena won't go away. I consider myself a pretty skeptical person and I can palpate a rhythmic swelling and recession when I hold peoples' head. Is it related to the CRI? is it something about me? is it a combination of the two? Hard to say...
    ------
    J Orthop Sports Phys Ther 1997 Aug;26(2):95-103


    The controversy of cranial bone motion.

    Rogers JS, Witt PL

    United States Air Force, Colorado Springs, CO 80840-9999, USA.

    Cranial bone motion continues to stimulate controversy. This controversy affects the general acceptance of some intervention methods used by physical therapists, namely, cranial osteopathic and craniosacral therapy techniques. Core to these intervention techniques is the belief that cranial bone mobility provides a compliant system where somatic dysfunction can occur and therapeutic techniques can be applied. Diversity of opinion over the truth of this concept characterizes differing viewpoints on the anatomy and physiology of the cranial complex. Literature on cranial bone motion was reviewed for the purpose of better understanding this topic. Published research overall was scant and inconclusive. Animal and human studies demonstrate a potential for small magnitude motion. Physical therapists should carefully scrutinize the literature presented as evidence for cranial bone motion. Further research is needed to resolve this controversy. Outcomes research, however, is needed to validate cranial bone mobilization as an effective treatment.

    Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements.

    Wirth-Pattullo V, Hayes KW

    Physical Therapy Ltd, Chicago, IL 60611.

    BACKGROUND AND PURPOSE. The evaluation of craniosacral motion is an approach used by physical therapists and other health professionals to assess the causes of pain and dysfunction, but evidence for the existence of this motion is lacking and the reproducibility of the results of this palpatory technique has not been studied. This study examined the interexaminer reliability of craniosacral rate and the relationships among craniosacral rate and subjects' and examiners' heart and respiratory rates. SUBJECTS. Participants were 12 children and adults with histories of physical trauma, surgery, or learning disabilities. Three physical therapists with expertise in craniosacral therapy were the examiners. METHODS. One of three nurses recorded heart and respiratory rates of both subject and examiner. The examiner then palpated the subject to determine craniosacral rate and reported the findings to the nurse. Each subject was examined by each of the three examiners. RESULTS. Reliability was estimated using a repeated-measures analysis of variance and the intraclass correlation coefficient (2,1). Significant differences among examiners and the scatter plot of rates showed lack of agreement among examiners. The ICC was -.02. The correlations between subject craniosacral rate and subject and examiner heart and respiratory rates were analyzed with Pearson correlation coefficients and were low and not statistically significant. DISCUSSION AND CONCLUSIONS. 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. Measurement error may be sufficiently large to render many clinical decisions potentially erroneous. Further studies are needed to verify whether craniosacral motion exists, examine the interpretations of craniosacral assessment, determine the reliability of all aspects of the assessment, and examine whether craniosacral therapy is an effective treatment. [Wirth-Pattullo V. Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements.


    Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates.

    Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T

    Texas Woman's University, Houston 77030, USA.

    Craniosacral rhythm (CSR) has long been the subject of debate, both over its existence and its use as a therapeutic tool in evaluation and treatment. Origins of this rhythm are unknown, and palpatory findings lack scientific support. The purpose of this study was to determine the intra- and inter-examiner reliabilities of the palpation of the rate of the CSR and the relationship between the rate of the CSR and the heart or respiratory rates of subjects and examiners. The rates of the CSR of 40 healthy adults were palpated twice by each of two examiners. The heart and respiratory rates of the examiners and the subjects were recorded while the rates of the subjects' CSR were palpated by the examiners. Intraclass correlation coefficients were calculated to determine the intra- and inter-examiner reliabilities of the palpation. Two multiple regression analyses, one for each examiner, were conducted to analyze the relationships between the rate of the CSR and the heart and respiratory rates of the subjects and the examiners. The intraexaminer reliability coefficients were 0.78 for examiner A and 0.83 for examiner B, and the interexaminer reliability coefficient was 0.22. The result of the multiple regression analysis for examiner A was R = 0.46 and adjusted R2 = 0.12 (p = 0.078) and for examiner B was R = 0.63 and adjusted R2 = 0.32 (p = 0.001). The highest bivariate correlation was found between the CSR and the subject's heart rate (r = 0.30) for examiner A and between the CSR and the examiner's heart rate (r = 0.42) for examiner B. The results indicated that a single examiner may be able to palpate the rate of the CSR consistently, if that is what we truly measured. It is possible that the perception of CSR is illusory. The rate of the CSR palpated by two examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other. It appears that a subject's CSR is not related to the heart or respiratory rates of the subject or the examiner.

    A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness.

    Green C, Martin CW, Bassett K, Kazanjian A

    BC Office of Health Technology Assessment, University of British Columbia, Vancouver, Canada.

    OBJECTIVES: The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention. DESIGN: A systematic search for and critical appraisal of research on craniosacral therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative Medicine, Scisearch and Biosis were searched from their start date to February 1999. MAIN OUTCOME MEASURES: A three-dimensional evaluative framework with related appraisal criteria: (A) craniosacral interventions and health outcomes; (B) validity of craniosacral assessment; and (C) pathophysiology of the craniosacral system. RESULTS: The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found. CONCLUSIONS: This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.

    Cranio 1992 Jan;10(1):9-12 Related Articles,


    Changes in elongation of falx cerebri during craniosacral therapy techniques applied on the skull of an embalmed cadaver.

    Kostopoulos DC, Keramidas G

    Craniosacral therapy supports that light forces applied to the skull may be transmitted to the dura membrane having a therapeutic effect to the cranial system. This study examines the changes in elongation of falx cerebri during the application of some of the craniosacral therapy techniques to the skull of an embalmed cadaver. The study demonstrates that the relative elongation of the falx cerebri changes as follows: for the frontal lift, 1.44 mm; for the parietal lift, 1.08 mm; for the sphenobasilar compression, -0.33 mm; for the sphenobasilar decompression, 0.28 mm; and for the ear pull, inconclusive results. The present study offers validation for the scientific basis of craniosacral therapy and the contention for cranial suture mobility.

    : J Neurosurg 1982 Apr;56(4):529-35 Related Articles, Books


    Skull growth after coronal suturectomy, periostectomy, and dural transection.

    Babler WJ, Persing JA, Persson KM, Winn HR, Jane JA, Rodeheaver GT

    Using radiocephalometric procedures, the authors examined the separate effects of suturectomy, periostectomy, and dural transection on the growing skull in young rabbits. When the coronal suture was surgically removed during normal growth, The freed frontal and parietal bones separated at a significantly accelerated rate. No accelerated separation was found when only the overlying periosteum and aponeurosis were transected. Furthermore, no additional separation was observed when the dura mater and falx cerebri were transected following suturectomy. Analysis of growth at the adjacent frontonasal and anterior lambdoid sutures suggested that the accelerated separation of bones after suturectomy was compensated for by reduced growth at these adjacent sutures. The result of these compensatory actions was that the total length of the skull remained unchanged. This study not only supports earlier observations that sutures grow in response to extrinsic separative forces but, significantly, that the suture tissue itself, rather than the dura or pericranium, acts as a restraint during normal translatory growth.

    Mechanical properties of cranial sutures.

    Jaslow CR

    University of Chicago, Department of Anatomy, IL 60637.

    Many bones in mammalian skulls are linked together by cranial sutures, connective tissue joints that are morphologically variable and show different levels of interdigitation among and within species. The goal of this investigation was to determine whether sections of skull with cranial sutures have different mechanical properties than adjacent sections without sutures, and if these properties are enhanced with increased interdigitation. To test these hypotheses, bending strength and impact energy absorption were measured for samples of goat (Capra hircus) cranial bone without sutures and with sutures of different degrees of interdigitation. Bending strength was measured under both dynamic (9.7 mm displacement s-1) and relatively static (0.8 mm s-1) conditions, and at either speed, increased sutural interdigitation provided increased strength during three-point bending. However, except for very highly interdigitated sutures loaded slowly, sutures were not as strong in bending as bone. In contrast, sutures absorbed from 16% to 100% more energy per unit volume during impact loading than did bone. This five-fold increase in energy absorption by the sutures was significantly correlated with increased sutural interdigitation.

    Do the skull and dura exert influence on brain volume regulation following hypo- and hyperosmolar fluid treatment?

    Doczi T, Kuncz A, Bodosi M

    Albert Szent-Gyorgyi Medical University, Department of Neurosurgery, Szeged, Hungary.

    The present studies were performed to determine the response of the brain water and electrolytes to acute hypoosmolality and hyperosmolality in animals with intact skull and dura, in comparison with those subjected to extensive bilateral or unilateral craniectomy and dural opening. Four to 5 weeks following extensive unilateral or bilateral craniectomy and dural opening in rats, a 50 mosm/kg decrease in plasma osmolality was produced by systemic administration of distilled water ("water intoxication"), or a 28 mosm/kg increase in plasma osmolality was produced by systemic administration of either 1 M NaCl or 1 M mannitol in 0.34 M NaCl. Tissue water, Na, and K contents were determined after 120 minutes. Tissue water accumulation or water loss was proportional to the decrease or increase in plasma osmolality. However, the tissue water accumulation following "water intoxication" was less (40% of the predicted value) than that predicted for ideal osmotic behaviour. The brain tissue was also found to shrink less than predicted on the basis of ideal osmotic behaviour (40% of the predicted value after mannitol treatment, and 60% after NaCl administration). This non-ideal osmotic response of the brain tissue is consistent with the finding in other studies and indicated a significant degree of volume regulation. Water and electrolyte changes were not different in operated and non-operated animals, demonstrating no effects of extensive skull and dura defects on tissue volume regulation under hypo- and hyperosmolar conditions of a degree that may be encountered under clinical circumstances.

     
  4. ewagner

    ewagner Senior Member
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    Drusso,

    wow, you put those articles up quick!!
    I must say, you always post good responses.

    Once again, just because (for the sake of argument) the CRI MAY exist, it does not mean you can alter it for a lengthened period of time by small pressures placed upon the head... and even if you were able to change a tenth of a MM of movement could that possibly mean anything. AND, based upon physics, if there was a measureable amount of movement placed on the sutures, wouldn't that mean that same amount of movement forces would be placed in the opposite direction (upon the brain)at an equal force?!

    Also, if the sutures of the skull were so incredibly mobile, wouldn't it follow that post mortum a skull would seperate when allowed to fully decompose to skeletal remains...like other joints, including the SI joint. Wouldn't it also follow that trauma to the head (when causing a fracture) would break the skull at the most mobile (areas of least resistance) areas, the sutures? According to the pathologist at our school, this simply does not happen.
    Once again, all I am doing is trying to make sense of something that does not follow logic.
     
  5. Toran

    Toran Senior Member
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    I am a Cranio-Sacral Therapist from Dr. John Upledger's School in Florida, and I can feel and affect the CS Rhythm. To answer all of the questions out there would be a lengthy reply, something like Drusso's (that was quite impressive). Yesterday, I was working on a woman, a physical therapist, who has chronic SI dysfunction. I corrected her SI extension, and eliminated her pain through CST. If it does not work, I can only be happy that I reduced her (and many other people's pain).
    The questions of cranial bone movement, are some that I had when initially training in CST. Here goes: the mm of movement is felt by movements in the sutures, and caused by the underlying mater of the brain. If you repeat Dr. Upleder's dissections of the brain you will see that the tantorium cerebeli, and the outer dura mater are connected in the "handhold" positions for CST. While moving the bones minutely, you are actually pulling on the outer sheath of the CNS, for the outer mater is a discontinuous sheath that envelopes the length of the spinal cord.
    In fact, that sheath is how Dr. Upledger discovered the CSR; one day he was assisting a neuro-surgeon attempting to remove some bone on the outside of the dura in section of the spinal cord. This attempt was seemingly difficult because the dura had a continuous rhythm, moving up and down.
    Well after a some curiosity set in, Dr. Upledger was set on research. He did use a helmet in fact to determine the movement of the cranial bones, and he did find movement of the sutures. On a side, one thing that people do not realize is that if you take a rib out of a fresh cadaver, that bone will bend something like 10-15 degrees. When the bone dries it becomes hard, rigid, and much like the sutures of the skull.
    The many injuries of the skull do in fact move the sutures of the brain, but you must remember that we are a higher organism with fewer bones so they do not move much. What is more greatly affected though is the dura underneath during accidents (like in a car accident).
    The interesting thing to me is that the cauda equina is still in some way attached to the sacrum, and you can pull on the dura from that end just as affectively.
    Just a few thoughts, that hopefully add to Drusso's logical and informative report on keeping an open mind.
    Toran

    Check this out: http://www.upledger.com/
     
  6. jlep2003

    jlep2003 Member
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    I am just a first year DO student, so I wouldn't even presume to confirm or deny any elements on craniosacral techniques. My frustration is that a great deal of time is spent on teaching the positioning, palpating, and manipulating cranial dysfunction in my first year of school. It seems to me that this is a somewhat advanced osteopathic technique, something that only an experienced osteopathic physician who specializes in OMT could truly master with any degree of reliablity. By integrating craniosacral rythms into a first year OMM curriculum, you are only going to create more doubters because most "just can't feel it".
     
  7. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    The "standard" answer is that the CRI is a physiological phenomena and can only be accurately studied in vivo. Ewanger makes good points about the clinical utility of the CRI---even if it does exist, then so what! What is it good for? My experience has been that some people with migraines, tension headaches, and TMJ problems benefit from cranial for reasons that I can't pinpoint. Placebo? Quite possibly...who knows...more quality research, please...

    My favorite theory about why cranial bones might have a small degree of movement at the sutures has to do with evolutionary remnants of echolocalization. Apparently, whales and dolphins have quite mobile cranial bones that are believed to underlie the basis of their ability to use sonar. The sutures are innervated with mechanoreceptors and this is believed to be how they tranduce sound waves into information about where they are in space. Apparently, human sutures ALSO have innervation...

    Things that make you go "hmmmm."

    I remain a cranial agnostic.
     
  8. ADRIANSHOE

    ADRIANSHOE Senior Member
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    this is really simple physics...you arent going to move interdigitating joints which are fused together by: calcium matrix bridges, dura, periosteum, collagenous layers, fibrous sheathing, the gala, and the dermal layers with a slight amount of pressure. Nor will you be able to define if: a. you are moving the dermis on the dense collagenous layer..., b, you are moving the loose matrix, c. you are moving the aponeurotica, d. your moving other layers...
    each of which require less force to move than cranial sutures...so, common sense tells ya, it aint gonna happen and as ewag said, if it were mobile with slight pressure, it would be hypermobile with trauma and we would have all kinds of entrapment syndromes of the dura similar to orbital entrapment syndromes if the skull bones did in fact move, which they CLEARLY do not in adults. Do some people actually feel something, do they imagine they feel something due to their suggestibility, are they feeling their own pressure receptors undergoing some type of tonic damping, are they feeling the transmitted flow of lymphatics or the chi force or the photons of sunlight reflecting off the scalp....or is it just another snake oil thang....who knows...do some patients feel better: yes, do some patients feel better after placebos: yes, is it good medical education to teach cranial bone movement and dural treatment when in fact it is completely unproven, defies physics logic and evidence? NO. so teach that touching people often makes them feel better, but dont teach and invent an entire nonsensical hypotheses and then extrapolate reasons why these hypotheses defy physics and common sense...thats just silly. occams razor doesnt even require a sharp blade to dissect the good science from the sham here.
    ewag, transmitting pressure to the brain wouldn't occur since the forces are being applied PERPENDICUALARLY TO THE SKULL, besides if you were magically able to separate the joints at one suture, natural common sense tells me that you would be inducing a compressive force into the adjacent sutures so that by correcting one imaginary problem you would be causing another imaginary restriction.

    On a side note, at Nova in the anatomy lab, deep in a tank unseen by only the occasional lab instructor (me in this case) is a cranium with the vertebrae and the sacrum attached with the dura definitely connecting the sacrum to the interior of the vault...it is a tenable theory that sacral flexion causing dural tensions, since this is DEMONSTRABLE on this cadaver spine. It is also demonstrable that sacral extension causes relaxation of the dura....what are the clinical implications? perhaps there is some efficacy to treating dural tension pain with sacral or hip positioning. I am not aware of any great diagnoses of dural tension pain however, so scientifically this would require a lot of exploration.
     
  9. ewagner

    ewagner Senior Member
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    The points that Adrianshoe brings up are very good and I must agree with him.
    I also tend to agree with the first year student who asks why so much time must be spent on a such a technique...well I think the answer can only be "tradition".
    Good luck to everyone in finding their own answers, and please always question something that "just doesn't sound right or make sense".
    e
     
  10. Toran

    Toran Senior Member
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    Leaving cranial movement aside for a moment, do you all agree that there is interverterbral movement? I would hope so, now because the dura is connected to the skull and sacrum it is possible to affect either side with flexion, extension, and traction.
    Have you seen a brain dissected so that only the dura remain? That would be something important to how the structure of the dura are affected by touch.
    Back to the cranial movement: because the skull has been shown to have movement of several mm, then affecting that through touch does not seem like too much of a leap. Imagine wet spongy bone, compared to the hard dry skull you have in your closet. We all clearly agree that a babies skull has movement between the infant sutures, so why would that movement completely disappear in adults?
    By the way, I think the sonar thought is interesting...imagine what Carl Sagan (the exobiologist "billions of billions' guy) would do with that!
    Toran
     
  11. ADRIANSHOE

    ADRIANSHOE Senior Member
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    The SKULL has not been shown to move a few millimeters in adults,
    WITHOUT A SHOTLOAD of force exerted on it.

    Having Sutured up at least fifteen persons with open head wounds, I can assure you that hard clunking sound you hear when you tap your forehead represents not a wet spongy bone but a hard calcified helmut (albiet vascular) designed to protect your brain so that you can make up elaborate mystical meanderings to delude gullible people. DO YOU KNOW ONE OF THE STEPS TO CLOSING A SCALP WOUND?..press on the bone to see if it moves....if it does, then that indicates PATHOLOGY..a fracture! Then you do a ct scan which shows continous rim of calcified protection and you look for a break in it...

    Why dont you try arguing this bull**** logic with a brain surgeon or an ENT, they see "spongy wet moist bone" all the time, not through made up approximations from outside the skin, I just asked two ENTS their opinions of this cranial movement farce, and they assured me that after five and fifteen years of opening up flaps into and around the temporal and frontal bones that these are fused tightly. so ask the experts in live bone...call up your local head and neck and brain surgeon, dont rely on snake oil salesmen.
    The problem with the "well, dead bone is different" argument, is that it is only useful to delude people without experience working with LIVE bone, I assure you, surgeons use a BONE saw for BONE because BONE is hard, not spongy (except the ribs which you use rib cutters for and which any intelligent person realizes is pliable for physiologic reasons, just as the skull is NOT pliable for other physiologic reasons...
    Cynically, I suppose that this is precisely WHY cranial sacral is taught to inexperienced students...an intelligent person with experience in open wounds and amputations would shoot down this logic faster than superman catching lex luther, which unfortunately is a good equivalent.
     
  12. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Really, there is science out there to guide this discussion about cranial bone compliance. I don't particularly buy into the Southerland model of cranial movement (I think that it reflects more of a mechanistic philosophy that was prevalent in medical thought at the turn of last century) than what we know about cranial bone compliance from modern investigations and instrumentation.

    Still, instead of arriving at a conclusion based upon a logical deduction from extant facts, lets be empirical and try to infer what "the truth" might be based upon trends in current data. Many, many things seemed perfectly "logical" until new FACTS (derived from empirical investigation) changed underlying suppositions. I do not think that the issue of cranial bone compliance is settled. And, even if there is significant compliance that can be influened from a manual medicine modality, what might be its clinical significance?

    TITLE: Parietal bone mobility in the anesthetized cat
    AUTHORS: Adams T; Heisey RS; Smith MC; Briner BJ
    AUTHOR AFFILIATION: Department of Physiology, Michigan State University, East Lansing 48824-1101.
    SOURCE: J Am Osteopath Assoc 1992 May;92(5):599-600, 603-10, 615-22
    CITATION IDS: PMID: 1601696 UI: 92290854
    COMMENT: Comment in: J Am Osteopath Assoc 1992 Sep;92(9):1088, 1090, 1093

    ABSTRACT: To quantify parietal bone motion in reference to the medial sagittal suture, a newly developed instrument was attached to the surgically exposed skull of anesthetized adult cats. The instrument differentiated between lateral and rotational parietal bone movements around the fulcrum of the suture. Bone movement was produced by external forces applied to the skull and by changes in intracranial pressure associated with induced hypercapnia, intravenous injections of norepinephrine, and controlled injections of artificial cerebrospinal fluid into the lateral cerebral ventricle. Responses varied considerably among test animals. Generally, lateral head compression caused sagittal suture closure, small inward rotation of the parietal bones, increased intraventricular pressure, transient apnea, and unstable systemic arterial blood pressure. Graded increases in intracranial volume produced stepped increases in pressure, lateral expansion at the sagittal suture, and outward rotation of the parietal bones. We attribute variations in animal response largely to differences in intracranial and suture compliance among them. Cranial suture compliance may be an important factor in defining total cranial compliance.


    TITLE: Role of cranial bone mobility in cranial compliance.
    AUTHORS: Heisey SR; Adams T
    AUTHOR AFFILIATION: Department of Physiology, College of Human Medicine, Michigan State University, East Lansing.
    SOURCE: Neurosurgery 1993 Nov;33(5):869-76; discussion 876-7
    CITATION IDS: PMID: 8264886 UI: 94088854
    ABSTRACT: Increases in intracranial pressure are normally buffered by the displacement of blood and cerebrospinal fluid from the cranium when there is an increase in intracranial volume (ICV). How much pressure increases with an increase in ICV is expressed in the calculation of cranial compliance (delta ICV/delta P, where delta P is change in pressure) and elastance (delta P/delta ICV). Data reported here indicate that the movement of the cranial bones at their sutures is an additional factor defining total cranial compliance. Using controlled bolus injections of artificial cerebrospinal fluid into a lateral cerebral ventricle in anesthetized cats and a newly developed instrument to quantify cranial bone movement at the midline sagittal suture where the bilateral parietal bones meet, we show that these cranial bones move in association with increases in ICV along with corresponding peak intracranial pressures and changes in intracranial pressure. External restraints to the head restrict these movements and reduce the compliance characteristics of the cranium. We propose that total cranial compliance depends on the mobility of intracranial fluid volumes of blood and cerebrospinal fluid when there is an increase in ICV, but it also varies as a function of cranial compliance attributable to the movement of the cranial bones at their sutures. Our data indicate that although the cranial bones move apart even with small (nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid migration from the cranium when ICV increases are less than approximately 3% of total cranial volume. Cranial bone mobility plays a progressively larger role in total cranial compliance with larger ICV increases.

    TITLE: In vivo analysis of bone strain about the sagittal suture in macaca mulatta during masticatory movements.
    AUTHORS: Behrents RG; Carlson DS; Abdelnour T
    SOURCE: J Dent Res 1978 Sep-Oct;57(9-10):904-8
    CITATION IDS: PMID: 102671 UI: 79068184
    ABSTRACT: In vivo strain gauge analysis demonstrated that tensile bone strain is transmitted along the cranial vault to the parasagittal region during isotonic temporalis contraction. This strain is sufficient to cause measurable separation of the sagittal suture, and thus could influence growth at the sutural margins.
     
  13. Toran

    Toran Senior Member
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    Somewhat off topic...Did you know that it was only in the early 80's that Man discovered how to calculate intracerebral pressure with accuracy. I was remembering this while reading your quotes drusso. What would happen in early head trauma, spoken about by adrianeshoe, was that a physician might drill a hole in the skull to relieve the pressure due to CSF. Well, the fluids would squirt out all over, and the pressure would not equilibrate. This might suggest that there must be a range in pressure, do to the skull, that either positively or negatively switches on the CSF production. That would make sense as a method to control production.
    "Keep your eyes open...and your mouth shut" my dad's funny little saying somehow fit in here. I am a die hard skeptic, but I do enjoy debate. The best debates, I have found, are those in which no one really knows who is correct.
    Toran
     
  14. ewagner

    ewagner Senior Member
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    Once again, adrianshoe brings up very good points...but I have to say it once more. Just because the dura are attatched to the sacrum and sphenoid in the specimens that you have examined...this does not prove any sort of treatment based on that observation. Lumbar nerve root impingement can be observed while performing a straight leg raise in supine or the "slump test" in sitting. THis doesn't mean you treat the back by altering these movements. If the sphenoid moves a nanometer when you flex forward..."so what?!" That doesn't mean a thing. Do you see what I am getting at? It doesn't mean a thing until you can prove cause and effect. Something that just hasn't been shown repeatedly in studies.
    everyone have a swell day.
     
  15. jlep2003

    jlep2003 Member
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    Toran brings up an interesting topic. Would a noncommunicating hydrocephalus occuring in an adult, cause a change in shape of skull on x-ray. In an adult, would the sutures show a compensatory movement. Would the sphenobasilar articulation show torsion or relative rotation in response to increased ICP? Perhaps there is a place for cranial manipulation after these patients recover, to restore normal craniosacral rythms and perhaps prevent dural headaches.

    On the other hand, If craniosacral theories insist on the mobility of adult sutures, why is it not exaggerated in cases of extremely elevated intracranial pressure? Is there any objective data that shows articular movement of the sutures and other articulating bones of the skull. Something more than "just being able to feel it?" I am not doubting the concept, I just need objective evidence or research, not just anecdotal case studies, to form an opion on the efficacy and validity of craniosacral motions.
     
  16. DO Boy

    DO Boy Senior Member
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    I won't be in med school until this august, but craniosacral rhythm seems kinda bogus hocus pocus to me. First, there's the question of it's existence. Then there's the question of theraputics. Then there's the question of placebo.

    Hey, if we have REALLY sensitive instruments that can detect the most minute tremors of the earth hundreds of miles away, can't we use something like this to measure CS rhythm?

    Don't mind my nieve-not-even-first-year-med-student-responses. i'm jsut talking.
     

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