Do skull bones move poll

[Dr JPH]

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Originally posted by PACtoDOC
Please JP, lets not try and place OMM as "holier than thou". I have had faculty work on my back for 2 years and it just isn't getting any better. You cannot always make structural defects better. I have 2 dessicated disks that are not going to reinflate simply with OMM, so lets be serious here. You are starting to sound like my chiro buddies!

So then what makes you think a mattress is going to change your chronic structural defects and alleviate pain?

 

[PACtoDOC]

Because the DO ortho surgeon recommended it as a way to spread the pressure points all along the body instead of just on the hips and shoulders. When you have some initials after your name feel free to take a history on me. You are just grasping at straws and attacking in all directions because you know you are surrounded, blindfolded, and desperate.

 

[Maxip]

PAC, I think its just time to accept that only a very few of OMM practitioners can reach the "Enlightened Plane". As with most accepted forms of traditional medicine, OMM can neither be proved or tested. Therefore, we rely on the word of the masters and gurus who have actually taken the time to perfect their technique. Your arguments clearly expose you as ignorant, as you are unwilling to accept unbacked and unscientific claims. How do you expect to practice as a physician if all you are concerned with is "reproducible results" and "evidence". For shame...

Kudos to you JP for single-handedly waging a war on logic.

 

[PACtoDOC]

ROFLMAO Max!!!

OMM to me is something I really do like and I find much of it alleviates pain quite well. I really don't even care if it can be proven to help as long as I as the practitioner using it feel I am making a difference and the patient desires it. When someone has neck and upper extremity pain, I like to do soft tissue on the neck and feel the muscles relax under my hands. I like to ajdust the c-spine and feel the difference I have made with my techniques. With cranial, I just don't feel squat, which is why I will never use it.

We had some guru of OMM come to our school yesterday and teach us some stuff I had never heard. He taught us about these things called "vertical vectors" in the spine and had one person as patient, one putting compression force on the head, and one compressing the sacrum. We were supposed to be able to feel the vector as if it were a piece of rebar coming through our hands, and compress until it melted. He taught that a person would have one of these vectors based on things like stepping off a curb wrong, hitting their head on a low ceiling, and from rear end collisions. He said that when you fix these vectors that all other problems related to somatic dysfunction would be alleviated much more easily.

And you know, maybe there are a few DO's out there who truly have this gift of being able to feel these unique things, but as for the other 99% of us, it just makes no sense to subject us to it. Thats why they have manip residencies!! You may as well bring in a psychic and teach that as well because my guess is that equal numbers of people would relate as relate to cranial.

 

[DD214_DOC]

Penn and Teller should do an episode about OMM on that Showtime show of theirs.

 

[Maxip]

LOL. Anybody that comes to a medical lecture hall with the title of "Guru" should automatically be given a lot of credit.

Seriously, I do think that some good could come from OMM, the same way that a good massage can really ease back and neck pains. Beyond that, it gets WAY to esoteric. The use of mystical terms like "melting away" and "energies" really makes it hard for me to swallow, though.

All in all, it sounds like a good technique to have under your belt so that when a patient presents with some muscular pain due to stress, or something else benign, you could provide relief without medication.

My two cents...

 

[Old brain]

One really deep breath (inspiration)

and

"click"

skull bones move
__________________
__________________

 

[pushinepi2]

....I also think the inability for most people to palpate the movement leads to a great deal of the discrediting of OCF, which is understandable. Not sure I believe in aliens...I've never seen one. But it I had, I think my doubts would be dispelled.

Maybe the skulls bones DO move. Whether the most higchly sophisticated doppler instruments from NASA detect it or not is besides the point. Teachers of OCF often cite these studies as evidence for cranial technique. Fact is, the issue of movement is only a small part of the OCF picture. Treatments are often predicated on an understanding of their effects. There's too much disagreement (and disbelief) about the primary respiratory mechanism to talk intelligently about purported effects. How do we know that inducing a cranial "still point" is beneficial to someone suffering from headaches? What if cranial tachycardia (>12 cycles per minute ) is my baseline rhythm ? Cranial is like early psychiatry.. its proponents suggest an entire spectrum of benefits that rests of extremely shaky physiological foundation.

Admittedly, i couldn't feel much when concentrating on my partner's scalp. What did turn me off is that the resident OMM fellows and professors very quickly labeled me as a, "nonbeliever." Furthermore, I was told how much can be cured or altered with cranial technique. We have an emeritus professor at our institution who talks about cradling autistic children in his arms and resetting cranial chaos. The claims to fame go on and on and on. While JP makes some excellent points about cranial's potential, its important to realize that some of the objections are a little more sophisticated then, "I cant feel it so it can't be true." Current studies should elucidate not only movement (if it is clinically relevant) but also a physiologic interpretation of the PRM's significance.

 

[Fenrezz]

Was this topic so hot it couldn't lay buried?

 

[hossofadoc]

If they fuse...then why did they move in the skulls in anatomy lab? Hmmm....I guess they unfuse when you die.

 

[Docgeorge]

If they fuse...then why did they move in the skulls in anatomy lab? Hmmm....I guess they unfuse when you die.

Because you took a stryker saw to them?

 

[hossofadoc]

Because you took a stryker saw to them?

The bones still should move...remember their fused.

 

[Sirius Black]

How can skull bones fuse if there are no epiphyseal plates? You all should know basic endocrinology, so you should know that growth hormone (GH) causes bone growth before puberty and fusion of the epiphyseal plates during puberty. As the flat bones of the skull do not have these plates, they continue to grow. Thus, if you're skull is still growing at a gradual pace, I don't see why it is so unreasonable to believe that the skull bones move.

 

[HokieDO]

Because you took a stryker saw to them?

A saw would definitely move them 🙂

However, even in "non-DO" books such as Bates (Physical Exam ) it lists that the fused bones of the skull can move up to 1mm. No surprise to the cranial-ers!

 

[raspberry swirl]

a good cranial session will keep my migraines at bay for about 2-3 mo. i used to get 3-4 a week. now i hardly have any. i'll take that to the bank any day.

if you dont like cranial, then just forget about it as soon as you're done with school. but there are patients out there (like myself) who benefit from it. if you learn it, and get good at it, there might be a patient you can help feel better without making her take meds everyday..

 

[Goose...Fraba]

I could zcite studies that show they do.

So my intial comparison was that just because we cannot prove something does not mean its value should be discredited.

what evidence? level 4 anecdotal evidence? gimme a break

 

[Goose...Fraba]

a good cranial session will keep my migraines at bay for about 2-3 mo. i used to get 3-4 a week. now i hardly have any. i'll take that to the bank any day.
.

The power of placebo my friends, awesome isnt it? 🙂

 

[Fenrezz]

The power of placebo my friends, awesome isnt it? 🙂

Anyone who thinks a placebo could rid a migraine has never witnessed someone being pulverized by one.

But if it helps your argument, more power to ya. 👍

 

[spazwow]

maybe they do, maybe they don't. why does it matter?

say they do move 1mm, why is that important.

as someone who takes skulls off for a living, i have to tell you that a living brain pulsates in that 'dem dar box'

but sorry, sportsfans, once you see, oh, a few hundred of these, you'll see that the only thing jiggling your jelly is your heart. THERE IS NO PRIMARY RHYTHM IN THERE! (I've been looking)

 

[Old brain]

maybe they do, maybe they don't. why does it matter?

say they do move 1mm, why is that important.

as someone who takes skulls off for a living, i have to tell you that a living brain pulsates in that 'dem dar box'

but sorry, sportsfans, once you see, oh, a few hundred of these, you'll see that the only thing jiggling your jelly is your heart. THERE IS NO PRIMARY RHYTHM IN THERE! (I've been looking)

Why? be cause if they move 1mm they can change the volumetrics of the cranial vault, is why this is important to me. Because cerebrospinal fluid does not compress the increase in pressure of the cerebrospinal fluid may determine it's directional flow throughout it's infundiblar structures such as the third ventricle and the optic nerve as well as other cranial neural transport systems.

lyphatic drainage is more interesting to me than primary rythm anyday 😉

the lymphatics gush into the blood stream during the deepest of inspirations if the cranial vault compresses during the vacuum draw of the lymphatics then the cervicle lymph nodes may be a secondary or alternate to the arachnoid villi/venous sinusses known method.

Ob1

 

[tarcher]

"You can try to DIScredit the cranial theory all you want and it doesn't make it NOT so"

It most certainly does. That is precisely what we need to do to practice scientific medicine. We need to throw out bizarre, discredited procedures.

You have the burden of proof all backwards. We don't come up with bizarre theories and then tell skeptics "OK. Now it's your turn to *disprove* it. If you don't, then I'll consider it correct." The quality, peer-reviewed research shows that Sutherland's theory is bunk and that the therapeutic techniques are unfounded. Cranial therapists make extraordinary claims; they need to demonstrate their theories with GOOD research, not crap written by Upledger for the JAOA. Give me large sample size, double blind, placebo-controlled, third party studies, then we can talk.

I apologize for my harsh tone. I once thought that CS sounded neat and plausible. Then I tried to argue with some docs and scientists that knew the real science and they completely (and I now see correctly) trashed my arguments. One of the most important marks of a good doctor, is the willingness to change his/her mind in light of contrary evidence. We can get so fooled by placebo, that we always need to question our practices.

The articles below describe the consensus of the scientific and medical community and why they don't believe in CS.

http://faculty.une.edu/com/shartman/sram.pdf

http://faculty.une.edu/com/shartman/Library/H-N 2004-05 on K-L in SRAM.pdf

You can try to DIScredit the cranial theory all you want and it doesn't make it NOT so.



--Bring some evidence that cranial bones DON'T move...I'm still waiting for that. --None of you on that side of the argument seem to be able to do that.

 

[tarcher]

You really can't take that to the bank. This anecdotal evidence is the *very thing* we have learned we can't trust.

a good cranial session will keep my migraines at bay for about 2-3 mo. i used to get 3-4 a week. now i hardly have any. i'll take that to the bank any day.

if you dont like cranial, then just forget about it as soon as you're done with school. but there are patients out there (like myself) who benefit from it. if you learn it, and get good at it, there might be a patient you can help feel better without making her take meds everyday..

 

[tarcher]

Two things:

Never underestimate the power of placebo.

Never forget regression to the mean.

Anyone who thinks a placebo could rid a migraine has never witnessed someone being pulverized by one.

But if it helps your argument, more power to ya. 👍

 

[M00se]

I feel the need to post my position as well as my basis for continued agnostic beliefs. If you have ever seen open spinal surgery, there is a rhythmic motion to the CSF as it ebbs and flows in and out of a dural sac. Now the rhythm I saw was not related to HR or Respiratory rate, but I am open to the idea that the 2 of them together may have some wave summation/subtraction thing going on that may explain the rate I saw.

This brings me to my other theory as a former anatomist.

Many have asked why you would have a rhythm in the first place. I say that the direction of flow in the dural venous sinuses and the great vein of Galen are against gravity in most mammals. A pulsitile and gentle pressure would aid in the venous return of blood.

Lastly some imponderables:
If there is not any movement of the cranial bones whatsoever, why does it cause such a headache if you wear a hat too tight?

Why is sinusitus so painful if the bones don't move. ( It just makes so much more sense to me that the movement of these bones is what makes them so tender)

How does muscular neck pain cause headaches?

Why is suboccipital muscle tightness so closely related to headache?

Why are the bones so easily removed from each other (in cadavers <40)after they have been boiled?

Were members of our species really designed to outlive the fusion of our cranium?

What evolutionary sense does it make to have teeth be sensitive (unrelated , but I've always wanted to know.)

What was the appeal of the Bee Gees? (really unrelated but no less mysterious)

Now honestly I think there is a motion...for a while...that may have a purpose. I have to admit that I feel it. It is after this that I get lost. What possible contortion of these bones could fix a UTI? Otitis Media--- OK I'm there with you. Migraines?----I'm there with you too, but UTI? Bladder problems? GERD? Crohns?

I too would rather see this little problem of ours either verified by NASA's little toy or run out of town by the end of this decade. Maybe we are taking the wrong approach and we should be proving the existance and maybe neccessity of this rhythm in humans (and other animals) and admitting to our poor capability to measure it. Instead we steadfastly scream about our knowledge of its existance and say all those who can't feel it are non-believers. Don't you think we sound a little like the flat earth society?

I'm sorry, I'm so tired I just have to stop.

Hope this helps, 😀

 

[housecleaning]

 

[Old brain]

...Lastly some imponderables:
If there is not any movement of the cranial bones whatsoever, why does it cause such a headache if you wear a hat too tight?

Why is sinusitus so painful if the bones don't move. ( It just makes so much more sense to me that the movement of these bones is what makes them so tender)

How does muscular neck pain cause headaches?

Why is suboccipital muscle tightness so closely related to headache?

Why are the bones so easily removed from each other (in cadavers <40)after they have been boiled?

Were members of our species really designed to outlive the fusion of our cranium?

What evolutionary sense does it make to have teeth be sensitive (unrelated , but I've always wanted to know.)

What was the appeal of the Bee Gees? (really unrelated but no less mysterious)

Now honestly I think there is a motion...for a while...that may have a purpose. I have to admit that I feel it. It is after this that I get lost. What possible contortion of these bones could fix a UTI? Otitis Media--- OK I'm there with you. Migraines?----I'm there with you too, but UTI? Bladder problems? GERD? Crohns?

I too would rather see this little problem of ours either verified by NASA's little toy or run out of town by the end of this decade. Maybe we are taking the wrong approach and we should be proving the existance and maybe neccessity of this rhythm in humans (and other animals) and admitting to our poor capability to measure it. Instead we steadfastly scream about our knowledge of its existance and say all those who can't feel it are non-believers. Don't you think we sound a little like the flat earth society?

I'm sorry, I'm so tired I just have to stop.

Hope this helps, 😀

Lastly some imponderables:
If there is not any movement of the cranial bones whatsoever, why does it cause such a headache if you wear a hat too tight?

Why is sinusitus so painful if the bones don't move. ( It just makes so much more sense to me that the movement of these bones is what makes them so tender)

How does muscular neck pain cause headaches?

Why is suboccipital muscle tightness so closely related to headache?

Why are the bones so easily removed from each other (in cadavers <40)after they have been boiled?

Were members of our species really designed to outlive the fusion of our cranium?

What evolutionary sense does it make to have teeth be sensitive (unrelated , but I've always wanted to know.)

What was the appeal of the Bee Gees? (really unrelated but no less mysterious)

Now honestly I think there is a motion...for a while...that may have a purpose. I have to admit that I feel it. It is after this that I get lost. What possible contortion of these bones could fix a UTI? Otitis Media--- OK I'm there with you. Migraines?----I'm there with you too, but UTI? Bladder problems? GERD? Crohns?

I too would rather see this little problem of ours either verified by NASA's little toy or run out of town by the end of this decade. Maybe we are taking the wrong approach and we should be proving the existance and maybe neccessity of this rhythm in humans (and other animals) and admitting to our poor capability to measure it. Instead we steadfastly scream about our knowledge of its existance and say all those who can't feel it are non-believers. Don't you think we sound a little like the flat earth society?

I'm sorry, I'm so tired I just have to stop.

Hope this helps, 😀

Lastly some imponderables: Why so many bones ? (birth canal) Why do they not fuse ? (because they keep moving) .

"flat earth society", that comparison often comes up representing one side or the other depending who says it first 😉 heheh it might be we sound more like the hollow earth society a round earth that revolves around the sun in the middle.


"Now honestly I think there is a motion...for a while...that may have a purpose. I have to admit that I feel it. It is after this that I get lost. What possible contortion of these bones could fix a UTI? Otitis Media--- OK I'm there with you. Migraines?----I'm there with you too, but UTI? Bladder problems? GERD? Crohns?

"

The cerebrospinal fluid moves throughout and around the brain, the positioning of each bone determines the pressures and the rate of the flows.

The cerebrospinal fluid is the junction or the "black box" that controls movement of neurochemistry as the synaptic gap is continuous with the cerebrospinal fluid compartment. The blood enters the brain via arterial leakage and the choroid plexus to become cerebrospinal fluid within the brain.
The cerebrospinal fluid which was blood before (part of it) exits via the arachnoid villi of the venous sinusses returning to the blood carrying brain neurochemistry with it to communicate with the whole body directly or via interstitial fluid as it circulates.

Which part or the brain produce specific neurochemistry and its rate of flow from that specific area may be determined by the positioning of the bones.

Some of the interstitial fluid reaches the lymphatic system where those neurochemical transmitters communicate with the immune system, but also where there is a flucuation in the bodies pressured fluid systems such as a deep inspiration which causes the lymph to "gush" into the bood leaving a lower pressure in the lymphatic system a vacuum so to speak there is also a fluxuation of pressure within the brain and since cerebrospinal fluid is also known to reside along many cranial nerves they may also drain directly into the lymphatic system via the cervicle lymph nodes and the csf communicates with the lymph directly by csf high pressured to escape and lymph system low pressured ready to accept.

The csf is the "controller" of the neurotransmitions from the brain to the blood and to the lymphatics and the way it gates its way through the brain may depend on the positioning of the skull bones. The muscles connecting to the bones move the bones...

Heres a summary of my experiment...

Take out your happy scale and pick a number between 0 and 9 to measure your current state of happiness.

you got your number? good

now form your face into a big smile, force the muscles and hold a big genuine smile for three seconds.

ok let go of your face and bring out your happy scale again and check how your brain feels between 0 and 9 again.

If your like most people you'll feel a couple of numbers happier.

Ob1

 

[Dr. Ram-Rod]

I've skimmed throught this post and I have not noticed anyone bringing up this very important point: (mind you I skimmed...)

Do the bones move?
First off, I think they may bend a little under pressure, much like any other bone.
For those who say yes, it is pretty much given that the motion is incredibly minute. So minute that I think two conclusions can be drawn.

1) We most likely can't feel the motion since the body has pulses and the patient is breathing. From the studies I've been presented with-- the proposed movement is so small it would be virtually impossible to sense it over the other motions going on in the body. You'd have to have some pretty super-human two-point tactile ability.
2) The motion being as small as it is, (let's assume we can detect it like some believe)-- how is manipulating that movement for a second or so going to have a positive effect on a patient? We take it out of 'torsion' and move it back to regular old flex/extend-- so what?? The patient's IQ goes up? Are they are at a decreased risk for a subdural/epidural hematoma? I don't think so. Putting on helmet and riding on a motorcycle for an hour, or sleeping on a bare floor is going to do just as much, if not more than the manipulation we are supposedly doing.

In resopnse to the hat too tight= HA, I say it's a blood flow problem,
Sinusitis is painful because of the inflammation, pressure and your immune system attacking you, we normally don't boil our skulls in real life, 212 degrees+ would likely kill us-- its not an in vivo situation, sensitization in the teeth is probably so we don't break them and lose them for good-- our evolutionary ancestors didn't have blenders and straws.

I really hope the AOA dumps cranial. It makes us look like fools.

 

[mathman]

My father is an Oncologist and my mother has a PhD in Biology and did research on anti-depressives for twenty years. I start Medical School to study (probably) Ophthalmology this fall. It took me seven years but I graduated with three degrees in mechanical engineering and mathematics from Georgia Tech and I will complete a Masters degree in Physics from Auburn in the summer. (I'm trying to establish that I've been around people skilled in science, that I can practice and understand the scientific method but I'm not trying to brag about what I've been doing.) I was considering other medical programs such as DDO, DO, Chiropractic, Allopathy, Homeopathy, etc. but decided not to practice in fields like this (although they interest me very much) because there is a perception that these fields are less legitimate than other traditional medical fields.

I have an older sister who is normal and successful. I also have a younger sister who was born with agenesis of the corpus collosum (poor formation of the organ that connects the hemispheres) and hypertopia (deficient folding of brain). My younger sister appears normal at first but she has problems moving (poor balance, poor coordination, poor muscle tone), she develped very slowly, she has about an 80 IQ and she is generally pleasant to be around but does not exhibit several of the extremely negative characteristics of patients with these problems.

When I was younger my parents tried several (almost every) type of conventional and nonconventional therapy with Jenny. Eventually we tried CranioSacral therapy and myofascial therapy at the same time. The results were positive and immediate. This was a real puzzler to my family. You have to understand, the success of these treatments flies in the face of science. I mean we all understood that Craniosacral has problems at the core of its philosophy. The fact that its practioners claim the fluid rate is important yet cannot get a consistent reading from the same patient is a huge problem that its practioners should resolve. All of the other mechanical/physical/biological inconsistancies were understood by everyone in my family. I'm convinced Jenny had pronounced improvement due to these therapies. Her movement and awareness definitely improved substantially. Her treatments/therapy is ongoing.

When most of this was going on I was a high school student. When I learned to drive I would occasionally drive her to her CS and MyF treatments. Naturally I was very curious. My mother could see that I wanted to know more and she suggested that I try the therapy myself. (I kept insisting that my sister's Neurologist was incompetent and my parents angrily told me that humans don't react the same way to the same stimulus)

I don't know what happens when you get Craniosacral therapy but something happens at the base of your skull down to about the chest area. It is a release of tension or stress and there is also a release of congestion in your sinuses. My neck was sore afterwards although the therapist never pushed or pulled hard. I played a lot of basketball in high school and in college (as recreation) and I had an injured shoulder with less thatn the full range of motion. I never told the physical therapist this but she detected it and cured it. After the shoulder was "Unlocked" she preceded to massage my frontal neck/chest area when I felt very strangely. I got very angry (out of character - I'm generally a stoic/observer type) and then I felt relieved of an emotional burden. My girlfriend at the time claimed I was immediately more relaxed at our next meeting. I never told her that I received therapy.

I don't know what to believe. I understand your arguments about the problems with the Craniosacral philosophies/practices and I acknowledge those are really severe problems fro a rational, structured, scientific framework. On the other hand what I observed flies in the face of the contradictions. Something is going on with craniosacral/myofascial therapy that exceeds the Placebo effect but that may not be medicine in the true sense of the word. Like I said, the more I think about it the more confused I get.

 

[Dr JPH]

Something is going on with craniosacral/myofascial therapy that exceeds the Placebo effect but that may not be medicine in the true sense of the word. Like I said, the more I think about it the more confused I get.

One of the definitions Merriam-Webster gives to Medicine is "something that affects well-being".

I agree that this whole rhealm of osteopathy is controversial, confusing and a continual source of criticism from both within and outside the DO community.

Part of me thinks "well, even if it IS all placebo, does it really matter if the patient is having an appreciable benefit?"

Traditional medicine can sometimes offer no help or hope so rather than allow ourselves to be open to the fact that something else may indeed benefit our patients, we ridicule it because we could not do it ourselves. Its almost like admitting defeat. I would be mad as hell if I treated a patient over and over with OMT, along with all of my other medical modalities, and they eventually get relief of their back pain from eating some root or berry.

The smart ones will read about the berry, though.

 

[The Engineer]

Yes. They do move, just not much at all. I recently took a beginning cranial course at KCOM. I felt the movement of the bones and the relationship between the occiput and the sacrum via the "core link." I think at most the movement was about 2mm and you had to ignore the arterial pulses and the movement from breathing.

As far as the effectiveness of cranial OMM, I have seen it relieve headaches and clear sinuses like nobody's business. This is still a relatively new area in OMM and a lot more research is needed.

I have heard that work on the fourth cranial ventricle can kickstart labor which is why cranial manipulation is contra indicated in pregnant women. It is also good to use on neonates to take care of the cranial deformity caused by pressure during the birthing process. But like I said, more research and analysis needs to be done to either validate or expand the field.

Hope this helps.

 

[Dr. Ram-Rod]

No, they don't move that much. If they moved 2mm, it would be much, much , much easier to see them move and prove that they do. If they moved 2mm, I'd believe it. If they moved 2mm, we wouldn't have this debate.


*Heisey & Adams Study in 1993 using a cat found 30-70microns laterally, 250 microns in parietals. (0.03-0.07mm and 0.25mm respectively).

*Zanakis in 1995 found 100-200 microns (0.10 to 0.20mm)

Now run this by me: how did you feel 10 times the motion that these guys actually measured? I'm not calling you a liar; I just think you are looking for something that isn't there, perceived something and then named it something that it wasn't.

Remember, even the research that found measurements 10x smaller than what you claim to feel can be considered biased. I'm not sure of the exact methods, but I find it really hard to prove that the motion that small can't be contributed to blood pumping, breathing or measuring error.

I will admit that infants can benefit from cranial manipulation. At that stage, we all know that the bones aren't fully fused and I'm sure outside forces can influence the way the will eventually fuse.

The only people who really seem to buy this cranial for adults crap is the far left wing of osteopathic medicine. The types that would subscribe to even more ridiculous ideas if they fell under the category of 'natural' or 'holistic' because some other whack-job D.O. labeled them as such. I can't wait until the AOA dumps this crap (though I doubt it will happen).

Yes. They do move, just not much at all. I recently took a beginning cranial course at KCOM. I felt the movement of the bones and the relationship between the occiput and the sacrum via the "core link." I think at most the movement was about 2mm and you had to ignore the arterial pulses and the movement from breathing.

As far as the effectiveness of cranial OMM, I have seen it relieve headaches and clear sinuses like nobody's business. This is still a relatively new area in OMM and a lot more research is needed.

I have heard that work on the fourth cranial ventricle can kickstart labor which is why cranial manipulation is contra indicated in pregnant women. It is also good to use on neonates to take care of the cranial deformity caused by pressure during the birthing process. But like I said, more research and analysis needs to be done to either validate or expand the field.

Hope this helps.

 

[homeboy]

No, they don't move that much. If they moved 2mm, it would be much, much , much easier to see them move and prove that they do. If they moved 2mm, I'd believe it. If they moved 2mm, we wouldn't have this debate.


*Heisey & Adams Study in 1993 using a cat found 30-70microns laterally, 250 microns in parietals. (0.03-0.07mm and 0.25mm respectively).

*Zanakis in 1995 found 100-200 microns (0.10 to 0.20mm)

Now run this by me: how did you feel 10 times the motion that these guys actually measured? I'm not calling you a liar; I just think you are looking for something that isn't there, perceived something and then named it something that it wasn't.

Remember, even the research that found measurements 10x smaller than what you claim to feel can be considered biased. I'm not sure of the exact methods, but I find it really hard to prove that the motion that small can't be contributed to blood pumping, breathing or measuring error.

I will admit that infants can benefit from cranial manipulation. At that stage, we all know that the bones aren't fully fused and I'm sure outside forces can influence the way the will eventually fuse.

The only people who really seem to buy this cranial for adults crap is the far left wing of osteopathic medicine. The types that would subscribe to even more ridiculous ideas if they fell under the category of 'natural' or 'holistic' because some other whack-job D.O. labeled them as such. I can't wait until the AOA dumps this crap (though I doubt it will happen).

I agree, but more importantly, I don't think it matters if it moves 2 microns or 2 millimeters...is that sufficient for a physician to make an accurate and continually-reliable diagnosis? Hardly, and until such time when the efficacy of cranial Dx can be confirmed, it is absolutely unethical to charge patients for something that is so highly variable in dx from 1 physician to the next.
And even if that dx were accurate + reliable...is there a standard + efficacious mode of treatment for the variety of torsions + strains?

I think the "fusion of the bones" argument isn't the issue...the issue is, even if they do move, even if there is a PRM...is there any consistent and reliable way to measure it manually, and if so, what is the therapeutic value in doing so and the efficacy of treatment.

 

[billclinton]

Just because you can't feel them move doesn't mean they don't move.

Millions of people believe in God and has never seen him (or her).

Yes, but there are these things called diagnostic procedures such as MRIs and CAT scans that allow us to view bones, underneath the skin. So far, there is no machine that allows us to see God. Pretty amazing that we can visualize bones this day in age. 🙄

 

[calichik]

Yes, they do move. Try having a really bad tension headache where your head feels "stiff" then you'll realize how important it is for movement of the skull bones to occur. I'm so glad DOs know how to do cranial.

 

[Dr. Ram-Rod]

Yes, they do move. Try having a really bad tension headache where your head feels "stiff" then you'll realize how important it is for movement of the skull bones to occur. I'm so glad DOs know how to do cranial.

Okay, so some meds fix my 'CRI' and get the tension headache to go away? Come on.

Its a vascular and/or muscle problem here. The etiology is not because a persons skull bones are not moving right. As a DO you should realize that the musculature and vasculature are important here.

As a person of science, you should understand the scientific method-- just because your head feels "stiff" this is not evidence of movement of the skull bones. That's like saying, 'Try having a really bad Meningioma, then you'll realize how important it is for movement of the skull bones to occur'.

Be realistic and be scientific. Look at the failed research (see my previous post). Look at the inaccuracy of consistant diagnosis. It is junk science to actually practice and charge for cranial manipulation in an adult.

I'm sorry but you're a damn fool if you see cranial in the way that DOs are taught. I've said it before, yes-- you can manipulate children with unfused bones-- it works and we've SEEN it work (take for instance the helmets made to 'round-out' infant's heads. YES you can put pressure on the skull and maybe have some effect on it.. I can squeeze the joints on my computer desk and have an effect on them (simple newtonian physics) by slightly bending the wood (however insignificant it may be.. I still affected it by squeezing it just now) BUT THIS DOES NOT MEAN THAT THE FLIPPIN' DESK HAS ITS OWN MOTION!!!! Even if cranial manipulation can benefit an adult (which beyond placebo effect is still debatable), that does not show that there is a CRI! it just means that the laws of physics apply to the head!

Please guys, you're making us look bad by buying into this cranial motion garbage. Let's jump into the science side of things rather than the VooDoo.

 

[Haemulon]

Yes. They do move, just not much at all. I recently took a beginning cranial course at KCOM. I felt the movement of the bones and the relationship between the occiput and the sacrum via the "core link." I think at most the movement was about 2mm and you had to ignore the arterial pulses and the movement from breathing.

As far as the effectiveness of cranial OMM, I have seen it relieve headaches and clear sinuses like nobody's business. This is still a relatively new area in OMM and a lot more research is needed.

I have heard that work on the fourth cranial ventricle can kickstart labor which is why cranial manipulation is contra indicated in pregnant women. It is also good to use on neonates to take care of the cranial deformity caused by pressure during the birthing process. But like I said, more research and analysis needs to be done to either validate or expand the field.

Hope this helps.

O .... M .... G

Has anyone actually held an adult skull before? Seen the fusion of the bones??

Relieve headaches and sinus? Couldn't possibly be from pressure on any soft tissues ... hmmmm.

Had to ignore arterial pulses and breathing to feel a subtle 2mm move .... hmmmm. And some people have felt a "pulse" in stone statues of religious icons too. Couldn't possibly be anything else that was felt.

Compressing the fourth ventrical with pressure to the outside of the head. Isn't cranial supposed to consist of only very light pressure, approximate that of 5grams? And you are gonna squeez a ventricle with that. I could sit on your head and still not squeeze a ventricle I bet.

And re-shaping baby's head after birth? They usually do go back to normal on their own you know.

I do appologise for the sarcasm. As you can tell I am highly skeptical of cranial efficacy. There just doesn't seem to be much commen sense in many statements on here. I don't mean to pick on you The Engineer. Sorry.

 

[JohnnyOU]

 

[DiscoDO]

O .... M .... G

Has anyone actually held an adult skull before? Seen the fusion of the bones??

If I push on the suture between my frontal and parietal bones, I can make a cracking noise. And I'm too old to still have a soft spot.

Because I am able to do this, I am convinced that cranial bones don't move! For if they did, it would be PAINFUL. Just pushing a little to do this parlor trick kind of hurts. Imagine if the bones were "breathing," Yow!

 

[HVLA]

I am deeply saddened that a DO wrote this.

Penn and Teller should do an episode about OMM on that Showtime show of theirs.

Seriously, if this is your attitude why become a DO?

I must say this thread is very concerning to me as a practicing DO. If this is the attitude why not just switch all our schools to allopathy?

I actually can not believe this is a topic worthy of debate.

Do cranial bones move? Well hell yes they move otherwise a common fever would break your skull.

There was a time when the allopaths actually thought the SI joints were immobile and we all know how well that "theory" went over.

 

[Taus]

I am deeply saddened that a DO wrote this.



Seriously, if this is your attitude why become a DO?

I must say this thread is very concerning to me as a practicing DO. If this is the attitude why not just switch all our schools to allopathy?

I actually can not believe this is a topic worthy of debate.

Do cranial bones move? Well hell yes they move otherwise a common fever would break your skull.

There was a time when the allopaths actually thought the SI joints were immobile and we all know how well that "theory" went over.

HVLA, I think the only major prob here is that many students let their beliefs (or lack there-of) about cranial to influence their opinions about the rest of OMM. Just because one questions the cranial theories and some parts of OMM doesn't mean they don't "deserve" to a be a DO or anything of that nature. I think some of the OMM stuff I have learned so far is a little wacky or bs...but there are plenty of things that I like and use regularly. Whats your opinion on people who look at OMM like I do (which I think is how the majority of my peers view it)?

 

[Dr. Ram-Rod]

Good Lord.

Run by me how a fever breaks your skull if the skull is immobile doc. I'm really curious why you think this is.

Like I said before, there is surely going to be some bending and bowing of the skull on very, very small scale-- physics applies to it as it does everything. However, the idea of a 'Cranial Motion' with its own rate that generates itself if idiotic.

The bothersome issue here is that we are not debating nano-mechanics or signalling on the cellular level. We are debating the core of a WHOLE field of osteopathy. That in itself should trigger the bull**** detector in ANY person-- no matter what your view on cranial is. It is good that we debate this-- but to me, it is sad that people such as yourself perpetuate this garbage and apply it to adult medicine.

I do not look as cranial as proof that whole OMM approach is garbage-- DO is more than just cranial manipulation. Assuming that all of us debating this topic and arguing against it should just give up osteopathic medicine and go allopathic is ridiculous and fascist.

One final note-- yeah, the allopaths may have been wrong about motion at the SI joint-- but RESEARCH and TESTING THE HYPOTHESIS suggested otherwise so motion at the SI is now accepted!
WHY CANNNOT THE OSTEOPATHS REJECT CRANIAL WHEN RESEARCH HAS CONSISTANTLY SUGGESTED AGAINST IT! Oh yeah, the AOA is run by hardcore right-wing DOs.

 

[HVLA]

I think a person of your opinion should reserve judgement until you have practiced for sufficient time to make up your own mind. Remember, there are a substantial amount of politics and money that would love to see manual medicine (of any sort) vanish forever. Make sure you have a clear mind and clear conscious before you make judgements about what is "wacky" and what is demonized.

Remember, this stuff has been around over several thousand years. There is a reason it doesnt go away which has more to do with efficacy than it does research.

It is extremely difficult to do controlled scientific studies on manual therapies of any sort. That is why the science (behind manual medicine) has always been questionable but the results have NEVER been questionable.

Remember, you are a Doctor. Keep your mind open and inquiring.

 

[HVLA]

One final note-- yeah, the allopaths may have been wrong about motion at the SI joint-- but RESEARCH and TESTING THE HYPOTHESIS suggested otherwise so motion at the SI is now accepted!

I agree.

Problem is that before the research could be revealed the MDs went cutthroat agains DCs, and DOs about being quacks for suggesting it did move. A move that the AMA has all to often been to quick to pur$ue.

Oh and I agree debate is great and a healthy part of any discipline. But when somebody that is a student of a profession dismisses the main tenet of said profession as bullsh-t maybe that person has landed him/herself in the wrong field.

 

[Dr. Ram-Rod]

I agree.

Problem is that before the research could be revealed the MDs went cutthroat agains DCs, and DOs about being quacks for suggesting it did move. A move that the AMA has all to often been to quick to pur$ue.

Oh and I agree debate is great and a healthy part of any discipline. But when somebody that is a student of a profession dismisses the main tenet of said profession as bullsh-t maybe that person has landed him/herself in the wrong field.

Okay, great. Financially motivated MDs were wrong a while back. Now-- DOs-- who realistically should support what their governing body (AOA) support-- are very vocal about their complete and utter disbelief of cranial manipulation because practical knowledge and research have constantly suggested it is junk medicine.

The only people I've come across in the real world who give manipulation the time of day are teachers who are required to support it (and most all I've come across give it a teaspoon of sugar to help it go down when teaching as well as admit to the level of quackary involved) AND the far left of DO students who will throw themselves at anything with the word 'Chinese' , 'Old-world', 'Accupuncture', 'Tea' or 'Alternative' and support it over evidence based medicine.
On the contrary, most of the folks, including practicing doctors laugh at the idea that there are still people out there that are gung-ho on cranial.

Whether or not the AMA has an interest in discrediting the DOs and DCs is of no importance in this debate. I'm sure is complicated to prove the efficacy of manipulative approaches-- but I've seen/felt them work and the science is legit when viewed on paper-- bones move, muscles get tense-- its totally plausible. On the other hand-- the small degree to which we've mechanically measured skull bones move makes it completely debatable as to whether or not they actually are moving at all (and how can we micrometers of movement anyway?!). Research has suggested docs that practice cranial can't tell a torsion, from a strain from a normal motion consistantly (assuming the motion exists), and we have absolutely NO reason to believe these bones can move on their own (i.e. what the hell may cause a CRI if it does exist). As far as I'm concerned these are all the ingredients in quakary. Lets be doctors and student doctors and take an evidence based approach.

I'm still waiting for why increased temperature (fever) would cause the skull to fracture if the bones didn't move.

 

[HVLA]

we have absolutely NO reason to believe these bones can move on their own (i.e. what the hell may cause a CRI if it does exist).

Believe? Lets prove. Remember these theories still have not been disproven. The researchers have yet to even come up with a model to legitimately test them. Until that date it should not be dismissed as quackery given the overwhelming ancdotal evidence which stands on over thousands of years of efficacy.

If cranial therapy came out only to be as effective as placebo for tension HA but was still more effective than tylenol would it be worth it?

Please consider toxicity, risk, and satisfaction.

 

[Dr. Ram-Rod]

Believe? Lets prove. Remember these theories still have not been disproven. The researchers have yet to even come up with a model to legitimately test them. Until that date it should not be dismissed as quackery given the overwhelming ancdotal evidence which stands on over thousands of years of efficacy.

If cranial therapy came out only to be as effective as placebo for tension HA but was still more effective than tylenol would it be worth it?

Please consider toxicity, risk, and satisfaction.

That's it. I'm starting my own osteomanipulative form of medicine called Staring Position Release. I stare at the muscle group I want to alleviate the somatic dysfunction from and it goes away. I when I ask patients if it feels a little better and they say, yeah a little-- that is clinical proof it works. Disprove it, otherwise a whole group of physicians should subscribe to it. No need to be scientific about it in anyway or explain the underlying mechanics in a reasonable way.
----
If cranial is as effective as a placebo for tension HA, it is still worthless and we should not be charging for it-- if we are we might as well give them a prescription for Obecalp.

Lack of disproof does not equal a plausible theory.

Overwhelming clinical evidence?? When have we seen this? Only when left-wing DOs get together and pine about it. That's the only time I've ever heard a SINGLE good thing about cranial on adults. We've seen no research to prove any greater effect than a placebo effect and what little reliable research we do have only supports the lack of value or quackary of cranial.

And yes, if cranial was shown to be more effective for a tension HA than Tylenol-- we should do cranial manipulation. Again, as far as I know, there is NO RESEARCH to show this. If there is, I'd like you to still go back and explain why this isn't due to time elapsed during treatment, laying the PT down and relaxing him/her or the fascial release in the head during the treatment itself-- it sounds like a tall order but that is EBM!

Come on... the arguements I'm seeing on here for cranial or existance of a CRI all come back to A) Disprove it or B) It works clinically... is there anything else in medicine so far out there that there is clinical support but absolutely NO explanation on the underlying science whatsoever?
(and I'm not talking about something like Metformin where we dont' the specific MOA of the drug)

 

[HVLA]

I think all of the sudden we are talking about different topics.

I am speaking more in the general sense about manual therapies. Like I said the evidence for Cranial work is still "out". That being said the evidence is still "out" on plenty of allopathic procedures. This does not prevent the usage and or billing of said procedures. Elective cosmetic surgery???? 😱

Are the surgeons that did what they did to Michael Jackson quacks or heroes?

At least OMT and CT are non-invasive and absurdly safe.

 

[Dr. Ram-Rod]

I think all of the sudden we are talking about different topics.

I am speaking more in the general sense about manual therapies. Like I said the evidence for Cranial work is still "out". That being said the evidence is still "out" on plenty of allopathic procedures. This does not prevent the usage and or billing of said procedures. Elective cosmetic surgery???? 😱

Are the surgeons that did what they did to Michael Jackson quacks or heroes?

At least OMT and CT are non-invasive and absurdly safe.

<Shaking head in disbelief>
Elective cosmetic= people know what they are getting into-- patient is changed after treatment.... cosmetic surgery= not healing yet still a branch of medicine.

There is at least clincial evidence for most other procedures that are out there.
BTW... I'm assuming when you say "allopathic" you really mean clinically helpful therapies used by doctors... I don't think its fair to subscribe those things to just MDs by calling them allopathic... I am not aware of any therapy that is almost exclusively MD.... by stating that in the fashion you did, that's just driving a wedge for no good reason between MD & DO-- we are one in the same with some differences.
Cranial work is "out" in all branches... research, clinical efficacy, etc... I honestly think I've said all I have to say here. I'm getting redundant.

Bye-bye "Do skull bones move".

 

[HVLA]

Elective cosmetic= people know what they are getting into-- patient is changed after treatment.... cosmetic surgery= not healing yet still a branch of medicine.

Oh really? What of all the super glamourous "makeover shows" would you consider these to be ethical, reasonable, scientific? Would you suggest maybe these shows glamourize medical operations? If so what are the ethical considerations? Do any pharmaceutical companies hold interests in companies that produce these shows? (answer = yes) You can talk to me all you want about the lack of evidence and I can talk to you all I want about the fact that producing evidence is all but impossible when the very scientists that might want to do research on said subjects will be condemned as was Lister. The same notion remains that physicians whose very livelyhood depends on certain diseases will revolt at the notion that such diseases could be {gasp} cured {gasp}. That my friend is allopathy.


Yes and they "know what they are getting into" when they have their spine manipulated.

 

[OSUdoc08]

If I push on the suture between my frontal and parietal bones, I can make a cracking noise. And I'm too old to still have a soft spot.

Because I am able to do this, I am convinced that cranial bones don't move! For if they did, it would be PAINFUL. Just pushing a little to do this parlor trick kind of hurts. Imagine if the bones were "breathing," Yow!

Why?

Please enlighten us.....

The motion of the frontal bone is not is the same direction as the force you apply.