Separate names with a comma.
Discussion in 'Medical Students - DO' started by drchrislareau, Mar 20, 2002.
Have you ever used osteopathy in the cranial field?
Personally I think it (Cranial sacral manipulation)should be thrown out of osteopathy. I think it is a lot crap and is an embarrassment to the field of osteopathic manipulation portion of our education. <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" /> I know this statement will cause a lot arguement but perhaps many other D.O.'s feel the same way?
why do ppl feel so negatively towards cranial?? i worked with a DO whose practice is based entirely on cranial and it is very effective. this DO has a very successful practice because of his use of cranial..it seems to get good results. i'll have to take a cranial course before i can be swayed either way. i cannot feel the cranial rhythm yet, but it probably takes some practice and patience. not everything in life can be instantly gratified.
Dr Miriam Mills who actually is an MD has done and is currently doing research with crainal on children at birth. She is noticing a significant decrease in otitis media in those she treats. Her research will be coming out in the DO journals in the near future so be sure to be on the lookout.
Cranial can be very difficult to learn, so many people disregard it as a crock of sh-t rather than admit their own shortcomings. At PCSOM, we learn and utilize cranial manip as much as anything else.
You may debate or maybe even disporove cranial manipulation in adults but saying it should be thrown out of the osteopathic profession is pretty rediculous.
Have you ever seen what cranial can do in a newborn? It is amazing! It is good for the patient and can be a very good financially for a practice. <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
How about the use of the percussion hammer? I've heard stuff about it but that's another topic that cracks me up.
Okay, one could make a great arguement for infants and toddlers but adults, I just do not know.
During my second year, we wanted to see if our school's cranial "guru" could really feel what he was claiming. So, we had him explain by example.
He had one student lay down on the table and he placed his hands on the students (patient) head. He then had the second student place his hands next to his own. He instructed the student (patient) to move his tongue to the left, then right and so forth. Then he did the same with the student's (patient) eyes (which were closed) The "guru" stated he felt the movement to the corresponding sides. The student (doctor) did not feel a thing. Little did the "guru" know the student (patient) was doing just the opposite as he instructed and even did nothing in one instance.
I am sorry, but this Dr. was feeling something that just was not there. There is no good science demonstrating anything in the cranial field. I have only seen attempts to prove that there is a cranial sacral rhythm that is so miniscule that it would be near impossible to feel with human hands.
I say, if you want to keep it in the osteopathic field, prove it (beyond testimonials). Otherwise, take a two week course outside of our main curriculum and use it to your heart's desire.
Problem is, you're confusing the skill of a particular doc with the validity of an entire field of practice. For whatever reason, subtle arts like cranial seem to attract the flakes and you end up with quacks out there. Its a shame you have irresponsible mentors that allowed someone like that to teach you the art.
All the same, there are people out there with a whole lot of skill that I've seen myself. Results with babies are amazing, but I've seen results that are interesting with adults too- such as complete cure of nausia, migraines, etc. ...and in my case a dramatic increase in tidal volume of respiration (I only noticed it after an onlooker pointed it out, so I'm sure it wasn't my imagination).
If you find someone who's full of it, go to someone else who claims to be really good at it and give them the test (or watch them treat someone with migraines) and make the judgement then.
If you're still a skeptic, go tell Viola Frymann that she's a quack and you'll be vomiting for hours (she's been known to knock obnoxious skeptics' temporal bones out of whack with a flick of her wrist).
If anything, cranial needs skill testing and accountability so you don't have fools with DO's after their names out there charging big bucks to just put their hands on people's heads. lack of regulation DOES make some practicioners of cranial a discrace to the profession, and in that regard i agree with you.
All right so this quack is suppose to be the guru of the cranial sacral field in metropolitan Phoenix and has trained with the best which is why AZCOM has him teaching. However, I know he is a quack.
Now, illustrate via literature the validity of cranial sacral manipulation in adults so there is no room for skeptisism. If this can be done, I will retract my statement about throwing this portion of our education out. Until then, I feel that I as an osteopath should be forced to learn something that can not scientifically illustrated.
Is there anything in science for which there is "no room for skepticism"? Read any Hume lately?
There is a substantial ammount of research evidence that supports OCF concepts. And, there is much more on the way. In fact, OCF is perhaps the best studied manipulative modality.
Accurate, what OCF concept or claim freaks you out in particular?
Theories have been studied, but there is virtually ZERO reliability and validity studies!!!
For a TEST valid (test what it is supposed to test) it must also be reliable between testers (inter-rater reliability). Unfortunately, this type of study is absolutely lacking in cranial research. Despite the simplicity in testing reliabilty between testers (considering this is a non invasive diagnostic techniques) it simply hasn't been done...and if it has been done, the power has been notoriously poor.
Regardless of validity or reliability...what about outcome based research? Where is that?
I do not have time to post refernces now.
There are two major inter-rater reliablity studies associated with OCF research.
One was published in a major PT journal. It was on a test of OCF. It was a test inter-rater reliablity between PT who had been studying Upledger's CST for 10 months. They had poor inter-rater reliablity to palpate the CRI. Big deal.
The other study that everyone cites in from Norton at UNECOM. It was only published as a JAOA research abstract. It had some major design flaws; they did not use classic OCF holds. Instead they used techniques that seemed to have been inspired by Jealous who tends to focus more on "energy" modalities than classic OCF. Furthermore, inter-rater reliabilty of CRI palpation for highly experienced practicioners had a correlation coefficient close to +.80. Thats not bad when compared to other interpretive diagnostic techniques like psychiatric diagnosis.
The Nelson group at CCOM is doing some very interesting work with PRM and THM ossicaltions. See their article form last spring that appeared in JAOA.
They are actively persuing studies of inter-rater reliability of the CRI/PRM and THM.
As for outcome studies; there are a number of studies in progress.
I am not freaked out about the cranialsacral field, but I do think it is based on testimonials and junk science. At the very least one could state that there is a suggestion that there is something to cranialsacral manipulation, but to say it is supported or substantiated is a little off course.
Look placebos work too. If someone wants to practice cranialsacral manipulation, I think that it is fine. If one of my patients wants to have it done, great. I will support their decision. I certainly do not feel it will harm them.
I just plain and simple disagree that it should be part of our core curriculum as osteopaths. If one day there is strong, validated, and reproducible evidence supporting it's efficacy then re-enter into the core curriculum and you can make me a believer. However, I really think it tarnishes the name of osteopathy to have it in our core curriculum without good scientific evidence.
I guess it is kind of like religion, no one can prove it but many believe in it, yet we agree that it should not be taught in our public schools.......
I agree that OCF is lacking in basic science support, but consider how many medications we use every day that are also lacking in such support. Look through a pharm text and note how many meds say "Mechanism of action unknown," or consider the meds where we understand the mechanism but don't understand why they benefit the disease. For example, SSRIs inhibit seratonin reuptake, thus increasing seratonin in the synaptic cleft. They are beneficial in depression, but we don't understand how seratonin acts to cause or potentiate depression. If you take a non-depressed person and deplete his seratonin, he will not get depressed, but if you take a formerly depressed person and deplete his seratonin, he will get depressed. So we use SSRIs because we see that they work, even though we don't know exactly why.
The same is true for OCF. When performed by an experienced practicioner the effects can be remarkable. Just because we don't exactly understand the mechanism of action doesn't mean we shouldn't use the treatment, provided one understands the possible risks and adverse reactions.
Brian Loveless, MSIV,COMP
Just a thought (It's a forum, right?)
If one's central focus is seeking hard-core evidence for every single thing, you might miss out on the human experience. There is uncertainty in everything, and this is part of the joy of the human experience. If C/S manipulation is still considered by and large to be important enough to be included in the osteopathic curriculum, then so be it. If you move on to specialize in derm, onc, etc., where treatment is based on proof, proof, proof, then so be it. You'll excel in whatever you feel is best for you.
Whats next, crystals and magnets? Please, this is hokey pokey. As for SSRI therapy, there are many studies demonstrating efficacy. These studies do not exist in OCF so get rid of it.
True, there are articles showing efficacy of SSRIs, but what aout the recent article in JAMA showing equal efficacy of Zoloft, St. John's Wort, and placebo? (in fact, placebo was non-significantly better.) There are also articles showing efficacy of OCF. Granted the majority of them are case-studies or of small power, but unfortunately for the profession the point of view of most osteopaths is "my results speak for themselves, and I have a full practice of patients, so I don't need studies." My point was that there are many instances in allopathic medicine where we use treatments without understanding the science behind them because they work. How about using Ritalin for ADHD? No one knows why giving a stimulant calms kids down, but we do it daily. This whole concept of double-blind, randomized study is a tool of the pharmaceutical industry to create the need for more medications. I would be careful of placing too much reliance on some kind of artificial standard.
It is a good point that many allopathic medcine's mechanism of action are not fully understood. However, the efficacy of these medicines have a scientific basis. Small case studies do no more than suggest efficacy. You can not teach me to believe in something that has zero proof of efficacy so why do I have to learn about it. If I wanted that type of education I would have become a naturopathic or homeopathic physician (NOT TO SAY THEY DO NOT HAVE SOME GOOD AND EFFICACIOUS TREATMENTS).
Now, on the same page I would agree with you that some things MAY be true that are difficult to prove. Just do not force them down my throat during my education as an osteopath.
I also agree that OCF should not be part of the curriculum. Even if it can be shown to work in studies, the variation between practicioners in their skill in utilizing makes it more well suited for an elective at best. Sevral things are beneficial to different patients ie prayer has been shown to have beneficial results; however, it is not taught in as part of our education. As for as pharm. treatments that the mechanisms are unclear, at least the treatment is uniform ie it does not require subjective means to administer it. Just my thoughts.
I have just two words to say
PLACEBO EFFECT!!!!!!!!!!!!! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
Ooops, I knew I would need to say more. I too go to AZCOM and am initmately familiar with the the "Cranial Guru", and once again...where's the beef!!!!!!!!!
Until I see valid scientific evidence that there is even a semblence of its successfullness, let alone usefulness I will continue to practice as an osteopathic physician and utilize VALID Osteopathic practices and principles.
There will always be "MONEY" in being "UNIQUE"; however unique does not mean competent!!! I have a theory, "not don't hate me because I speak my mind", but I believe after my experiences over the last three years, that those who have "gravitated toward the "fringes" of osteopathy (that being cranial) are those that were never competent as physicians to begin with, and their only chance at success was to delve into the "totally subjective" and "unprovable" field of osetopathy.
Just ask any of the "GURUs" what they do to treat HTN or even Otitis media, none will give you an adequate response. Most have not even picked up a prescription pad in years and if you can't even take care of a child's OM when needed than you have no business "manipulating" his frontal, occiptial or any other bones.
The Phoenix and Scottsdale area is one of the most affluent communities in all of this grand country of ours, and there is always someone who will pay for your services. As a matter of fact in this community it is well known that the utilization of "alternative" therapys is very sheik and a matter of status. Ask yourself why none of these "Gurus" care for the poor or indigent. They need the therapy more than anyone...oh, but I forgot they are POOR. <img border="0" title="" alt="[Eek!]" src="eek.gif" />
I have nothing against alternative therappys and manipulation is certainly considered by the mainstream to be alternative...but cranial takes away from the real validity of Osteopathic medicine.
My humble opinion of course <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
Cranial osteopathy is just OMM applied to the head. I don't see how, if you feel that we should learn OMM in meedical school, you can feel that we should not learn cranial. I understand that most people do not have the time and patience required to truly learn and become skilled at OCF, but everyone should be exposed to the concepts and, I feel, every student should get a treatment at some time in their schooling, in the hopes that they will see the efficacy for themselves.