Do I have to believe craniosacral works to be a DO?

[paramed2premed]

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I want to be a DO. I think I would do well.

I think of myself as interested in the whole person, seeking to allow a person to maintain balance and heal themself, etc.

But some of the stuff I just can't buy. I was just Medline searching for craniosacral therapy studies, and what I found was not exactly promising. Hell, it makes chiropractic seem plausible.

Does the proximity of craniosacral therapy to osteopathy scare anyone else? I want to be a holistic practioner, but I also believe in doing research and keeping up on the literature. As much as medicine is an art, it derives its strength from science.

Anybody scared by this sort of quacky stuff?

 

[DrQuinn]

Nope. You don't have to believe in craniosacral therapy to be a DO. I don't believe in it, and I'll be graduating in about 6 weeks...

I know some DOs who are very big OMT proponents, and some who believe it is quackery. Everyone is different.

You're a paramedic... so you will know how a lot of ER docs do different things. Some prefer LR, some prefer D5 1/2NS, some NS... some prefer Bactrim for UTIs, some go straight to the big guns, yet some use Macrobid... lots and lots of ways to practice medicine. You don't have to do the "blanket" belief at all...

I will never ever use Craniosacral Therapy. Ever. I still might use OMT, mostly soft tissue stuff, and likely not on my patients. But that doesn't make me less of a DO. We all have our reasons to not believe in what-not. My main one is that OMT doesnt' exactly interest me... plus I'm not that good at it. (Just like people don't like Surgery cause they aren't good with their hands, or people don't like Peds because they don't like kids)
Q

 

[DrMom]

As Quinn said, you don't have to believe in craniosacral. I know students who are really into OMT but aren't convinced about craniosacral...and others who are.

 

[paramed2premed]

Thanks for giving informed responses, and not responding in an incendiary fashion! When I saw both your names under replies I had a moment of concern, worried that I had ticked of two of the more articulate and thoughtful SDN posters.

Just to make sure that I have not overstated my case:

It sometimes seems to me almost immaterial if OMM or whatever works. Often, problems are of a weird somatic-emotional-social, but autoresolving nature. Patients come to doctors for comfort and validation. This is usually achieved by doing something for the patient, giving them something special. It doesn't have to be Zithromax every time, I imagine.

I think if we offered a fortune-teller and a chair-massage in the waiting room, we could cut our ED census in half. Well, except for the rash of table saw accidents we've been seeing...

Next topic: hydrogen pyroxide.

 

[DrQuinn]

Para-

You are indeed correct. A lot of Primary Care visits are of the socio-psycho-somatic etiology. One psychiatrist told me the statistic that 10% of all hospital admissions (medical admissions, not psych) are either psychosomatic or malingering (for whatever reason). Very impressive.

Well, how does OMT relate to this? Well, you are right. People do go to the doctor's office for reassurance and comforting. You'd be surprised how little some doctors touch their patients (I always shake their hand upon entering and leaving, and sometimes I'll pat them on the shoulder or touch their knee (in a non sexual way) for reassurance if they need it). Anyways, some patients love the satisfying "pop" of OMT as well... it is just another modality that may or may not work. Doesn't mean you have to like it, though...

And if we had masseuses at triage, our visits would unfortunately triple in about a weeks' time. I'm just glad that the indigent population hasnt' figure out that if they say they have chest pain, they get seen immediately, usually for either an 23 hour obs or admission, and a free meal (plus some IV fluids which makes anyone feel better)...

Q

 

[DOSouthpaw]

No you don't, but here are my experiences with cranial.

I didn't believe in cranial at all when I came to a DO school, but I changed my mind after I had a couple of good treatments with it.

I had a horrible eye injury when I was 11 years old. My pupil now stays dilated in that eye. I have worn sunglasses ever since then because the light kills me and I've had headaches about 3-4 times a week since then as well.

When I came here, I had a 4th year student screen me out and he told me that I had a lot of cranial restriction, especially around my orbit. He had no prior knowledge to my condition. After he treated me, my headaches have dropped tremendously. I might have one once a month. And the Sunglasses, I don't have to wear them inside anymore either, just outside on sunny days. Very nice!

One more thing. My fiance was recently diagnosed with scoliosis by her MD family doc during a physical. I took her to my same 4th year friend. He screened her out and said it was a cranial strain that was holding the curve. I thought, "Yeah right, someting in her skull is giving her a lateral curve all the way down in her lower back!" The man gave her an hour and a half cranial treatment and she stood up without a lateral curve. I don't understand it, but that is a result I can't deny.

 

[Kritenoel]

I've waited to post because I wanted to see which direction this thread was going 🙂

I'd say that you don't have to "believe" in it but I'd reccomend keeping an open mind. I've had experiences with reiki and cranial that totally defy explanation - (I KNOW that reiki isn't related to OMT, but I'm including it because some see it as a "quack" therapy) - and it didn't make sense to me because I'm a scientist who wants to know how and why. I can't explain the how or why to anyone, but in my mind they are valuable therapies for people who are open to trying them.

If you just read what's online, or talk to people who believe one way about it, I'll agree with you, it sounds like a LOT of quacky-ness. I also agree that some of it relates back to the socio-psycho-somatic etiology and that physical touch can be a great placebo but my advice is still the same - please keep an open mind. 🙂

 

[H0mersimps0n]

I don't know, I heard that an available bathroom is hard to find after they teach those classes...

Reading research on OMT is going to be a risky venture as with any research you have to have a level of skepticism. If you could post the titles and authors I'd appreciate it.

All I'm saying is I hope the articles you looked at weren't all written by M.D. 😉

Also, I find it pretty tough to have already decided you don't believe in a technique you've never been properly taught to do and used on anyone.

Also if you go into OMT thinking 100% works 100% time you're setting youself up for disappointment, as you probably know no two bodies are alike, nerves and muscle spindles, etc aren't located in the same spot on everyone...

I'm not there yet but from what I've heard from my MSI friend at LECOM thats what I've gathered...

I actually started a thread a while back about people's favorite OMT technique- it was really interesting to see what people said. Maybe I'll see if I can find it

 

[paramed2premed]

Don't you folks worry, I got an open mind. I was just reading a very well constructed study in the JAOA "Benefits of OMT for hospitalized elderly patients with pneumonia" Noll DR et.al. 2000 Despite what you have warned about randomized controlled trials of OMT, DOsouthpaw, it appears to me that that they were pretty creative in eliminating any potential bias. Check it out! This study impressed me. While the effect of the treatment arm does not seem all that statistically separated from the control

Sounds like many people out there have had good, if not wonderful, experiences with cranio. But one good study like this, or the one on LBP in NEJM, will help osteopathy much more than millions of testimonials.

All of us have experiences that defied rationality, but we have faith nonetheless. This is some sort of essential element of being a human being. I would never say "Oh, that was all in your mind, that wacko therapy can't have helped."

Hamlet, addressing a philosopher-type, said something like, "there is more weirdness going on Earth than is dreamt of in your philosophy."

And QuinnNSU, you are right about the chair massages inundating the ED. Besides, any placebo has to be noxious to be most effective

Lots of thoughtful people here!

 

[jkhamlin]

I'm not going to take sides on this one, frankly I don't know enough yet to take a side. I would just like to point out that you don't have to understand something or have it researched to the point that you can look up the mechanism of action. Check your PDR, there are quite a few meds that don't have much of an explanation for mechanism of action. I have been a martial artist for many years, and I have seen pressure point techniques that defied the explanation of the IM doc and the Neuro doc in the class, yet they confirmed that it was very real.

 

[drusso]

Here are some articles that examine possible mechanisic explanations for craniosacral phenomenon:

The cytological implications of primary respiration

The effect of cranial manipulation on the Traube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry.

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

Role of cranial bone mobility in cranial compliance.

Radiographic evidence of cranial bone mobility.

Parietal bone mobility in the anesthetized cat.

The controversy of cranial bone motion.

The cranial mechanism: its relationship to cranial-mandibular function.

 

[paramed2premed]

I don't care about mechanism. Period.

Mechanism is something that drug reps talk about to make their product seem better than it really is.

For example "TNK is fibrin-specific, so it must be better than streptokinase!" Well, the outcomes are the same. Not the price, though. (See, I'm a skeptic about lots of things.)

Outcomes research is where the rubber hits the road. Sometimes it can be difficult to show an effect if the study is underpowered, or the patient population is poorly selected. Regardless, it must be done for a therapy to be considered proven.

So, I don't expect a CST mechanistic explanation, I do not require one, and I don't care about it. It's immatrial. We do not need a mechanism to know if it works or not. We are not quite sure what the beneficial mechanism of aspirin in CAD is (antiplatelet? antinflammatory?), but we know it works.

Drusso, let me quote from one of the papers you listed "The Controversy Over Cranial Bone Motion" They conclude that

Outcomes research, however, is needed to validate cranial bone mobilization as an effective treatment.

 

[H0mersimps0n]

hey P2P, If you're truly this interested in this stuff you should e-mail Dr Rawlins at EV VCOM. She is trying to build a medical school with a strong focus on clinical research and answering the questions brought up in clinical settings like the one's you are asking.

Check out the EV VCOM site and that'll probably give you a better idea of the kind of students they want (i.e. research oriented to do that kind of clinical research)...

Unless of course you aren't interested and just like to stir the waters 😛

 

[tkim]

Originally posted by paramed2premed
So, I don't expect a CST mechanistic explanation, I do not require one, and I don't care about it. It's immatrial.

You meant immaterial ...

Spelling flames always come back to haunt the ones who use them ...

- Tae

 

[DOSouthpaw]

ouch again... lol

 

[paramed2premed]

I don't know about stirring the waters. I just don't like to be fed a line, by anyone.

I have tried to show that I am very wary of unsupported claims in medicine, whether they come from "holistic" doctors or from the drug companies. Frankly, I have very little interest in conducting research. I reserve my energy for evaluating the research that is out there, and applying it to my clinical practice.

Tkim, you must know your ACLS quite well. When was the last time you gave lidocaine in a refractory v-fib arrest? You will recall that, in addition to assigning recommendations to each therapy (e.g. class I is "definitely indicated"), they also now grade the quality of the research that supports each therapy; e.g. supported by RCTs vs supported by animal models. Lidocaine was shown, in a high-quality study, to have no worth, and is now judged to be of "indeterminate" utility. It would hardly be called "stirring the pot" to ask why anyone would want to continue using lido in this context.

Therapies that have been long-accepted (both allo- and osteopathic therapies) are coming under this sort of scrutiny.

I refer to my example of aspirin use in acute cardiac syndrome; we don't know how it works, but we sure know that it does work. If good research is out there, then you don't have to worry about, say, ad hominem references to Viola Frymann. You just cite the studies.

 

[tkim]

Originally posted by paramed2premed

Tkim, you must know your ACLS quite well. When was the last time you gave lidocaine in a refractory v-fib arrest? You will recall that, in addition to assigning recommendations to each therapy (e.g. class I is "definitely indicated"), they also now grade the quality of the research that supports each therapy; e.g. supported by RCTs vs supported by animal models. Lidocaine was shown, in a high-quality study, to have no worth, and is now judged to be of "indeterminate" utility. It would hardly be called "stirring the pot" to ask why anyone would want to continue using lido in this context.

Huh?

- Tae

 

[Vince]

No you don't have to believe in cranial to be a DO....you just have to learn some of it to take a test and pass OMM(if your school still teaches cranial....i believe most do though).....you may forget it after that....even though a couple concepts will likely be on the COMLEX.

I believe the trouble with cranial research is there really isn't much...kinda hard being so subjective....one doc will say they are in flexion, another will say extension. One will say that the temporal bones aren't moving on the left....another will say they're fine....

seems that the basis of the teachings are all anecdotal........

we had a week of cranial at COMP.....i was interested the first day....less the 2nd....wishing the week was over by Wednesday......some of the students were all over it though!

Those that are firm believers....more power to you though...

 

[paramed2premed]

Tkim -

I hope I didn't come off as a wiseacre using the lidocaine analogy. I rather abreviated my example above, so I may not have been totally clear. Let me take another stab. The big point was that, despite any "conventional wisdom" or tradition, therapies must be tested in order to confirm their effectiveness. CST should be no different

We use lots of therapies in (allo-) medicine that have no good evidence attached to them, and we use a few that have good evidence that they do not work.

Many people are attached to giving lidocaine in a cardiac arrest, as they have used it for years, and may even have a few "saves" associated with its use. They have a strong belief in its efficacy. Why should't they? The drug has a long history of use, a very plausible mechanism of action, and great utility in analogous situations (the non-arrest patient). Sure, there were some thoughts that the drug wasn't that helpful, but tradition and convention trumped those thoughts.

The ALIVE trial looked at the efficacy of lido in cardiac arrest, and found that it was no better than placebo. This was the first study to look at the outcome of lidocaine use in the arrested patient (not just some analogous population). It was a randomized controlled trial (RCT). True, it was a drug company study, for Amiodarone, but that's another thread.

ACLS, being obsessively evidence-based, justifies their class of recommendations (e.g. defibrillation for v-fib is class I, verapamil for WPW is class III) with a ranking of the quality of evidence supporting that recommendation. RCTs in humans are the best sort of study, and are ranked at the top. One good RCT can be worth far more than a raft of animal studies, in their view.

Since a high-quality study showed that it was no better than placebo, ACLS now ranks lido in cardiac arrest as beng of "indeterminate" utility. While there had been a long history and familiarity with its use, clinicians now recognize that the evidence shows that they should change their practice.

So, my point was that you probably have not used lido in a cardiac arrest in a while, and there is a reason why, and it has to do with the quality of studies being conducted.

My prior post was confusing for even me to read. Thank you for the opportunity to explain more carefully.

 

[tkim]

Originally posted by paramed2premed


...

So, my point was that you probably have not used lido in a cardiac arrest in a while, and there is a reason why, and it has to do with the quality of studies being conducted.

My prior post was confusing for even me to read. Thank you for the opportunity to explain more carefully.

Uh, I was making fun of you for misspelling immaterial after you flaming someone for misspelling gait. Did you miss that? 😉

- Tae

 

[BamaAlum]

Aspirin is cardioprotective due to its inhibition of the arachidonic acid metabolite thromboxane A2. Thromboxane A2 is released by activated platelets and bind to other platelets intiating release of additional aggregating agents.

 

[paramed2premed]

Tae-
Yeah, I saw you were making fun of me after I made a good-natured jibe, which I thought I was fairly humble about. You caught me with a typo. I just felt like moving on.

The lidocaine example was not in response to that, it was intended to be an example drawn from a field with which you have great experience. Basic point: we need proof of what we do, even if it is a traditionally accepted therapy. It was not germane to the whole spelling/typo thing.

So, what do you think of CST's place in the osteopathic curriculum. I am interested in your opinion, as you usually offer thoughtful comments. And I promise to be kind about typing!

BamaAlum-
Yeah, ASA is a prostaglandin inhibitor. But there seems to be some recent controversy over whether its chief effect comes from its antiplatelet properties or its antiinflammatory properties. Since some of the oral IIb/IIIa inhibitors have not shown much efficacy, some people are think that the antiiflammatory effect may be more important.
Of course, because we have studies showing ASA's beneficial effects, the controversy over mechanism or action has little bearing on its utility.

 

[tkim]

Originally posted by paramed2premed
Tae-
Yeah, I saw you were making fun of me after I made a good-natured jibe, which I thought I was fairly humble about. You caught me with a typo. I just felt like moving on.

Eh, it's all good - you turn on my lights and siren and switch off the master, I K-Y yer steering wheel. No blood spilled.

So, what do you think of CST's place in the osteopathic curriculum. I am interested in your opinion, as you usually offer thoughtful comments. And I promise to be kind about typing!

I'm in the dark about cranial. As you point out, there isn't much reproducible data that one can point to to justify CST.

However, one thing caught my eye. There was some thread, where one person from one school said 'mumble mumble - after X OM procedure, I always make a bee-line to the bathroom,' and another person from another school replied 'yeah I know that feeling - it happens to me.' I think it's more than just suggestion or placebo to experience some side effect from a treatment - especially if two different people from different sites report the same experience.

I have a feeling that OMT is far from sham medicine, but isn't as accepted as other therapies because of the lack of research. It really comes down to that.

- Tae

 

[paramed2premed]

Originally posted by tkim6599


... There was some thread, where one person from one school said 'mumble mumble - after X OM procedure, I always make a bee-line to the bathroom,' and another person from another school replied 'yeah I know that feeling - it happens to me.' I think it's more than just suggestion or placebo to experience some side effect from a treatment - especially if two different people from different sites report the same experience.
...
- Tae

I recall a quote about OMM causing the urgent need to get out of the room and find a bathroom, but it wasn't quite the same context as you describe. A DO student was commenting on the effect that the topic of cranial osteopathy had on the students in class; it made them leave!

For my own part, I think that that is a poor, passive-aggresive approach to dealing with any qualms one might have about OMM, cranial, or any items in the curriculum. If you have an intelligent concern about the topic, ask questions, talk to the prof, formulate an argument, whatever. Be constructive.

Take it easy.

 

[tkim]

Originally posted by paramed2premed
For my own part, I think that that is a poor, passive-aggresive approach to dealing with any qualms one might have about OMM, cranial, or any items in the curriculum. If you have an intelligent concern about the topic, ask questions, talk to the prof, formulate an argument, whatever. Be constructive.

Take it easy.

Huh?

- Tae

 

[paramed2premed]

Ok, sometimes my writing is a bit opaque.

When I was referring to a "poor, passive-aggresive approach to dealing with any qualms one might have," I was describing how some DO students deal with their aversion to learning OMM.

They say they "bitch about it after class," or leave class, or just cynically parrot the lessons. It seems intellectually lazy to complain about objections one would have (about the curriculum, the evidence, the presentation) without articulating your concerns.

You have any folks like this in your class?

 

[tkim]

Originally posted by paramed2premed

You have any folks like this in your class?

Wouldn't exactly know, 'cause I'm not in school yet.

But if I find any 😡 I'll do a little cranial OM tapdance on their heads and make'em run to the bathroom. 😀

- Tae