Petition To Eliminate Cranial Education

[PACtoDOC]

Here is a poll to see how many DO students and DO residents/attendings would be in favor of eliminating Cranial Method from DO education. In my opinion, this should be left for manip residents or those who want to learn it after medical school or on their own. I mean we get so little nutrition or other more accepted alternative therapies that this costs us dearly. MD's who practice holistic, natural medicine, and chelation certainly don't learn this in medical school, so I feel it is time for lesser accepted and proven theories to be abandoned. My theory is that if you polled ever DO on earth, over 75% would say to abandon the Sutherland and Cranial method philosophy because it is ludacrious to test over it on board exams, when 95% of students admit they don't feel or understand (don't believe in it). So, if this poll takes off, maybe it would be time to consider doing a real poll to address to the AOA. They will listen to many voices more than one.

And Please DO NOT vote if you have never sat through an entire semester or block of Cranial. No disrespect premeds, but this is not an issue you are familiar enough with to lend any help.

 

[DrQuinn]

I liked the cranial OMM lab because we all got to take a nap while our partners were feeling for our PRM.

Q< DO

 

[Old brain]

I don't think it should be left the way it is.

I think they should be required to and provide more evidence to show the bone movement.

With todays technology, they should be able to prove it one way or another, take some time do some sound experimentation within a structured procedure, draw conclusions and present the results. Put up or shut up I suppose.

There is a derth of information I think it should be a matter of integrity for the profession.

I don't know if you can edit your poll but if I could I would add a fourt choice>

4 prove cranial with compelling (hard)evidence

 

[PACtoDOC]

They have had 100 years to prove Cranial. Time is up! If it happens that they prove it for real, then my guess is allopathic and osteopathic schools will start teaching it again. But that is how medicine transpires....theory, proof, teach it. Not the other way around!

 

[Old brain]

Originally posted by PACtoDOC
But that is how medicine transpires....theory, proof, teach it. Not the other way around!

I guess thats how it got there

But I still think their proof is pityful

 

[RollTide]

COMs need to teach evidence based medicine period. Anyone who has read the limited research out there on this subject knows it is utterly embarrassing that they include this in our curriculum. A.T. Still himself would not condone teaching this quackery.

 

[PACtoDOC]

Truthfully, at our school, the whole manip training is subpar. We spend the entire first year memorizing and demonstrating techniques but we are never given scenarios as to when these techniques might be used. Then the 2nd year is spent learning scenarios but all the techniques they teach seem rather stupid compared to the problems we are addressing. For instance, for someone with GERD, I would simply feel stupid telling my patient that I need to adjust their sacrum, so that it will unempede the CRI related to how the sacrum is connected to the occiput, which in theory should help balance vagal input. If that is not a stretch I do not know what is. How about we actually do something that relates directly to the area so that we don't seem like we are a bunch of chiroquack snakecharmers? And my biggest pet-peave is for our practicals we have to diagnose our partner and treat them. This makes the assumption that EVERYONE has somatic dysfunction in every body part, which is BS. It would make much greater sense to simply play the "what if" during practicals and then demonstrate and verbalize the treatment of a given problem. My palpatory skills still suck, but who is a 3rd year fellow (aka MS3) to teach me anything based on their minutes of experience. I don't know how it is at your school, but 80% of all our lectures are done by PDF's. They stand up there and speak like they have this wealth of knowledge that makes them better than the rest of us. Would you let a 3rd year MS teach anatomy, physiology, or even clinical medicine? Its one thing to have TA's and PDF's help supervise in lab, but to teach is something altogether inappropriate. I realize we are low on manip residents but there are enough faculty to go around. Don't get me wrong, I came to DO school to learn manip, but I plan to use about 40% of it maybe!! And I can't be certain my palpatory skills will ever be good, but if it makes a patient feel better, to hell with the diagnosis.....treat in all directions until you make a difference!!! LOL

 

[Dr JPH]

PACtoDOC

It seems like your biggest beef is not with cranial, but with how OMM is taught at your school.

 

[Freeeedom!]

It should only be an elective at best...and in no way shape or form show its ugly head(forgive the pun) on the boards.

Cranial gives OMM a bad name.

 

[PACtoDOC]

JP,

You are incorrect in your assumption that my beef with Cranial has anything to do with my school. The problems associated with OMM at my school are not anything to do with my beef with Cranial. They are distinctly different entities. And from the looks of the poll early on, there is a 3 to 1 ration of those who think similarly. Our problem with OMM starts at the top, and works its way down. The chairman of the manip department is basically invisible at our school....more bothered by the research going on )can't say I blame him). The very last objective of OMM at our school seems to be the students. First comes research, then comes patients in clinic, and then we get sloppy 3rds at best. I feel bad for the PDF's who have to teach the majority of the course, because you know they feel stupid trying to pass off like they have all this experience to give us. Some are teaching only days after being 2nd year medical students!!! The director of our 2nd year, Dr. Russell Gamber, is an incredible man. But he is limited in what he can do for us. He has to see his patient load, and then find the time to prepare a lecture. There are not enough OMM faculty or residents to make teaching a priority. I think they should just give up and teach OMM in self-study and as long as we pass boards, who really cares?

 

[LovelyRita]

I'm sure it's true that most DO's don't practice Cranial. So you would think of eliminating it. But also, most DO's don't practice (and bill for) OMT. But eliminating it would probably take away from the DO degree.

Is having cranial therapy as part of a DO curriculum severely interfering with the ability of students to become physicians and practice medicine? Is there any evidence of this? If not, I say don't sweat it so much. However, if your school is doing overkill on the cranial stuff, then I can see the need to address this.

Overall, though I think most of us have bigger fish to fry right now. Just my $0.02.
M.

 

[DireWolf]

Originally posted by DrMaryC
I'm sure it's true that most DO's don't practice Cranial. So you would think of eliminating it. But also, most DO's don't practice (and bill for) OMT. But eliminating it would probably take away from the DO degree.

Is having cranial therapy as part of a DO curriculum severely interfering with the ability of students to become physicians and practice medicine? Is there any evidence of this? If not, I say don't sweat it so much. However, if your school is doing overkill on the cranial stuff, then I can see the need to address this.

Overall, though I think most of us have bigger fish to fry right now. Just my $0.02.
M.

By having questions on the COMLEX, cranial is "severely interfering with the ability of students to become physicians and practice medicine." There is your evidence. Board scores are going to suffer because of this. I refuse to waste my time studying this bogus therapy.

 

[LovelyRita]

Is this the first year that cranial is part of comlex? If not, when did it start?

 

[DireWolf]

Originally posted by DrMaryC
Is this the first year that cranial is part of comlex? If not, when did it start?

According to our OMM chair, cranial has ALWAYS been a part of all three steps of COMLEX. I remember hearing some fourth years complaining about the cranial questions on Step 2 this January.
So yes, it will be on COMLEX 1, 2, 3. For me, I'm already giving up points to the field because I won't be reviewing it.

 

[PACtoDOC]

bump

 

[Ohiobuddhist]

2 thoughts...all I have time for:
1. Every day I am forced to memorize what I call pharmacological trivia about drugs that may or may not be in clinical use by the time I can legally prescribe them. Often this includes a mechanism of action that is undefinable.

2. If you find the ten or so facts that you need to memorize for COMLEX cranial questions so difficult that it is going to bring down your board score significantly, then you're probably screwed anyway.

 

[DireWolf]

Originally posted by Ohiobuddhist
2 thoughts...all I have time for:
1. Every day I am forced to memorize what I call pharmacological trivia about drugs that may or may not be in clinical use by the time I can legally prescribe them. Often this includes a mechanism of action that is undefinable.

2. If you find the ten or so facts that you need to memorize for COMLEX cranial questions so difficult that it is going to bring down your board score significantly, then you're probably screwed anyway.

Your pharm argument is weak. We may not know the mechanisms for all drugs, but we know they work. They don't test us on drugs that don't have some therapeutic usefulness.

Cranial, on the other hand, has no proven mechanism AND no therapeutic usefulness.

Also, although the cranial questions will probably be difficult, the reason I'm not reviewing them is because I refuse to memorize something so ridiculous. I'll focus on something more high yield and important.

Am I screwed? I'll let you know in August.

 

[hossofadoc]

Sure, I think we should go ahead and quit teaching cranial...I mean hell if all we are going to teach all evidence based medicine then let's do away with the majority of medicine. Go do some research on why we do things....you'll be surprised (especially in pharm) how much we use today is actually well known. I saw some stat where something like 60-80% of medicine we don't understand.

Cranial is a vital part of an OMM education, we find that when you actually screeen a pt out about 25% have their area of greatest restriction in the cranium. Just because some people have problems with the OMM department at their school don't come here and complain without going to your schools admin.

Just because you don't want to study for something on the boards is a lame excuse to eliminate part of our education. Learn it the first time around and you won't have to worry about it much in the future.

 

[DireWolf]

Originally posted by hossofadoc


Cranial is a vital part of an OMM education, we find that when you actually screeen a pt out about 25% have their area of greatest restriction in the cranium.

Just because you don't want to study for something on the boards is a lame excuse to eliminate part of our education. Learn it the first time around and you won't have to worry about it much in the future.

Cranial is vital? If cranial is vital to OMM education, then all of OMM is B.S.

I am not in favor of eliminating cranial because I don't want to study it on boards. I want to eliminate it because it is useless. And because it is useless, it should be eliminated from the boards.

 

[hossofadoc]

Direwolf- I'm just interested in seeing why you think it dosen't work. I can line up the pt which will swear by cranial. Which my school teaches cranial a little bit different, we use indirect tech. and we get awesome results with it.

 

[sophiejane]

Originally posted by PACtoDOC
Truthfully, at our school, the whole manip training is subpar. We spend the entire first year memorizing and demonstrating techniques but we are never given scenarios as to when these techniques might be used. Then the 2nd year is spent learning scenarios but all the techniques they teach seem rather stupid compared to the problems we are addressing. For instance, for someone with GERD, I would simply feel stupid telling my patient that I need to adjust their sacrum, so that it will unempede the CRI related to how the sacrum is connected to the occiput, which in theory should help balance vagal input. If that is not a stretch I do not know what is. How about we actually do something that relates directly to the area so that we don't seem like we are a bunch of chiroquack snakecharmers? And my biggest pet-peave is for our practicals we have to diagnose our partner and treat them. This makes the assumption that EVERYONE has somatic dysfunction in every body part, which is BS. It would make much greater sense to simply play the "what if" during practicals and then demonstrate and verbalize the treatment of a given problem. My palpatory skills still suck, but who is a 3rd year fellow (aka MS3) to teach me anything based on their minutes of experience. I don't know how it is at your school, but 80% of all our lectures are done by PDF's. They stand up there and speak like they have this wealth of knowledge that makes them better than the rest of us. Would you let a 3rd year MS teach anatomy, physiology, or even clinical medicine? Its one thing to have TA's and PDF's help supervise in lab, but to teach is something altogether inappropriate. I realize we are low on manip residents but there are enough faculty to go around.

Hey PACtoDOC, does your class have curriculum meetings? We have them once a month with faculty phase directors, including manip and CM. You should go to one of those meetings and raise your concerns if you haven't already. Or take it to your MSGA curriculum rep. We've actually seen some changes because of things said at these meetings. Everything you said about out manip dept is totally valid. Speak your mind to the people who make the decisions--those who come after you will be in your debt if changes are actually made. Then, you should get involved with TOMA at some point. Until there are people other than old-guard, osteopathic good ol' boys in positions of power, nothing is going to change.

 

[bigmuny]

Originally posted by hossofadoc
Direwolf- I'm just interested in seeing why you think it dosen't work. I can line up the pt which will swear by cranial. Which my school teaches cranial a little bit different, we use indirect tech. and we get awesome results with it.

Posts like this from docs-to-be make me cringe, and truly frighten me. I hope you understand the fact that "a line of pts who swear by cranial" means nothing and proves nothing. I saw a documentary on traditional healers in the andes. Diagnosis and treatment is done by ripping open abdomen of a live guinea pig and examining the contents to find the problem which where then treated via some ritual. The guys dance card was full, and patients swear by him and trust him absolutely. So do you think this is evidence that what he does works? How about bleeding? This practice was performed for hundreds of years and was the standard of care. I betcha patients swore by that to. After hundreds of years though science was introduced into medicine and we began to quantify results and conduct controlled experiments, and what we found was that bleeding was BS and we eliminated the practice because it did more harm than good. Our schools do a poor job teaching statistics/research design and it makes me wonder how some students in our profession are ever going to learn how to critcally read a journal article or make an educated assessment of the claims of your pharmaceutical rep. Understand that cranial is largely promoted by a small but influential group within our profesision that make tons of money off it and have built their careers on it(look in the DO and JAOA there are constantly cranial seminars where you can learn to scam pt's too for a nominal fee). I believe treating(and charging for) a patient with a treatment, which there is no quantifiable evidence to prove works, is unethical at best.

 

[BamaAlum]

I completely agree with the above post. Using "a line of patients that say it works" as justification is ridiculous. Most patients aren't able to appropriately scrutinize treatments and we all know of the placebo effect. The fact of the matter is patients will try anything that they "believe" works. Just about every patient that comes through the door these days has a bag full of herbal "treatments", many of which interfere with actual medications more than they help anything. It is not the job of the patient to scrutinize treatments. We as physicians are to be healers, but we as "doctors" are to be teachers. Teaching a technique that 1. Has very questionable efficacy and 2. Has no confirmed mechanism of action is just wrong. We should never in medicine use a treatment because "It might have a chance of working." Try reading about cranial guru Viola Frymann one day. If she is what the world of cranial has to offer count me out.

 

[bigmuny]

Originally posted by Ohiobuddhist
2 thoughts...all I have time for:
1. Every day I am forced to memorize what I call pharmacological trivia about drugs that may or may not be in clinical use by the time I can legally prescribe them. Often this includes a mechanism of action that is undefinable.

2. If you find the ten or so facts that you need to memorize for COMLEX cranial questions so difficult that it is going to bring down your board score significantly, then you're probably screwed anyway.

The reason treatment protocol/DOC changes is because they are ruthlessly and constantly scrutinized, and when a better treatment is discovered then the protocol is modified. Cranial(most omm in general) undergoes no such investigation, and its application has remained largely unchanged for 100 years(should throw up a huge red flag). Some drugs do have a mechansim of action that is not clearly delineated, however as was stated earlier, all drugs on the market have to prove themselves better than placebo, and all at the very least must have a reasonable proposed mechanism of action. Cranial fails to do either.

 

[Old brain]

Originally posted by bigmuny
Cranial(most omm in general) undergoes no such investigation, and its application has remained largely unchanged for 100 years(should throw up a huge red flag).

You mean like "aspirin" ?

 

[DrMom]

Originally posted by Old brain
You mean like "aspirin" ?

we know the mechanism of action fo aspirin

 

[bigmuny]

Originally posted by Old brain
You mean like "aspirin" ?

Aspirin has been studied to death. Do a literature search, read some articles. You also missed the point of my post.

 

[Old brain]

Originally posted by BamaAlum
It is not the job of the patient to scrutinize treatments.

Plllllllleeeese

 

[PACtoDOC]

SJ,

I was the curriculum rep in year one But this issue of OMM is a difficult one because the OMM department never sends anyone to the meetings other than a PhD to represent them and take notes. We never made any progress with them other than to get them to change practicals to an actual grade other than pass/fail (mostly because only with written exams we had many people failing OMM!!!). I didn't really mean for this to become a school issue anyway. I was trying to keep it directed at the whole Cranial Philosophy, so I apologize for getting of on a tangent. I am also relatively satisfied with the OMM we get, but I just think our whole department needs more support so that they can support us. The residents are quite good and the faculty I have no complaints with.

 

[BamaAlum]

Plllllllleeeese

Nice reply. I stand by my original statement. You have a responsibility as a physician to offer patients treatments that have been tested and shown efficacious. When you don't you are misusing their trust.

Viola Frymann, D.O.-cranial guru supreme

 

[bigmuny]

Originally posted by Old brain
Plllllllleeeese

Society respects physicians because they believe them to have the highest of ethical standards, to be compasssionate, and to always act in the patients best interest. Because of this, we trust doctors with our health, and we rely on them to guide us through frightening life events, and expect them to provide us with the best treatment and sound advice. We are educated in science and medicine so that we may sort through all of the information, educate our patients who don't understand what is happening to them, and advise them on what course of treatment has proven itself to be the best. I generally follow my doctors advice because I believe he knows what he is doing and wants what is best for me. I feel that as physicians we have a responsibility not to violate this trust, and that as leaders in healthcare that we are responsible for protecting our patients from snake oil, algae miracle cure, magnet therapy... salesman/predators out there . I believe "cranial osteopathy" is at best highly suspect, and most likely is complete nonsense. I think that our profession violates the trust of patients by continuing to practice(and bill for) and teach this nonsense. I think we can do better than this.

 

[moo]

Can someone enlighten an MD student as to what cranial therapy is and what it's used for?

 

[Dr JPH]

Originally posted by moo
Can someone enlighten an MD student as to what cranial therapy is and what it's used for?

moo

I think you would be better off doing your own research on this topic. Looks like you will only find negative opinions and biased information here. If you want an opinion from someone who has experience with cranial OMM, please feel free to PM me. I am fully aware of the evidence based information on both sides of the arguments and I can direct you in the direction to make your own opinion as to the validity (or lack thereof) of cranial.

I have no interest in changing the opinions of people who don't believe in cranial OMM. My time is better spent studying and learning to become a better physician.

 

[PACtoDOC]

Originally posted by JPHazelton
moo

If you want an opinion from someone who has experience with cranial OMM, please feel free to PM me.

I am sorry JP, but this statement really cracked me up!!! You call all our arguments biased but your own cranial knowledge is suposedly "somone with real experience". Aren't you a 2nd year MS or something close to that? That is what cracks me up in OMM. TA's are experts, PDF's are scholars!!! Would you ever call a person in their first couple of years of ANY training someone to go to with real experience? In that case I suppose Lebron James will be coaching next year!!

 

[docslytherin]

i have to chime in now...

as a disclaimer, i have no experience with cranial (and it does seem a bit fishy to me... BUT)

most of the arguments against cranial here seem to be based on whether or not students can feel the movement in lab. if JPHazelton can provide measured evidence to the fact that they do move, then how is it still his responsibility to prove his point that the bones are not fused? it seems to me that he already proved that. if you disagree with the statement or the research then you need to find the flaw with it (and not just saying "it was done by DOs" because almost every study published is sponsored by some company with a vested interest in the outcome), not just disregarding it because you haven't felt the small amts of movement in lab.

i'm not sure that i buy into the idea of cranial either, but at this point the only legitimate argument i have read on this board has been the argument with proof that the bones do move, opening up the possibility that cranial may, in fact, work.

 

[coreyw]

FYI

A literature search (PubMed) for 'cranial therapy osteopathic medicine' and 'craniosacral therapy' came up thus. I hope the combatants in this debate find this list useful.

-----------

Rivera-Martinez S, Wells MR, Capobianco JD. ' A retrospective study of cranial strain patterns in patients with idiopathic Parkinson's disease.' J Am Osteopath Assoc. 2002 Aug;102(8):417-22.

King HH. ' Osteopathy in the cranial field: uncovering challenges and potential applications.' J Am Osteopath Assoc. 2002 Jul;102(7):367-9.

Nelson KE, Sergueef N, Lipinski CM, Chapman AR, Glonek T. 'Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.'
J Am Osteopath Assoc. 2001 Mar;101(3):163-73.

Kimberly PE. 'Osteopathic cranial lesions.' 1948. J Am Osteopath Assoc. 2000 Sep;100(9):575-8.

Rogers JS, Witt PL. 'The controversy of cranial bone motion.'
J Orthop Sports Phys Ther. 1997 Aug;26(2):95-103. Review.

Ferre JC, Chevalier C, Lumineau JP, Barbin JY. 'Cranial osteopathy, delusion or reality?' Actual Odontostomatol (Paris). 1990 Sep;44(171):481-94. French.

Jecmen JM. Related Articles, 'A cranial osteopathic approach to correcting malocclusions employing Kernott and fixed labial appliance therapy.' J Am Acad Gnathol Orthop. 1988 Mar;5(1):10-5, 17.

Bowden R. 'Cranial osteopathy.' Australas Nurses J. 1983 Mar;12(1):3-5.

Hehir B. 'Head cases: an examination of craniosacral therapy.' Midwives (Lond). 2003 Jan;6(1):38-40. Review.

Hartman SE, Norton JM. 'Craniosacral therapy is not medicine.' Phys Ther. 2002 Nov;82(11):1146-7.

Moran RW, Gibbons P. 'Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum.' J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):183-90.

Green C, Martin CW, Bassett K, Kazanjian A. 'A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness.' Complement Ther Med. 1999 Dec;7(4):201-7. Review.

Rogers JS, Witt PL, Gross MT, Hacke JD, Genova PA. 'Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons.' Phys Ther. 1998 Nov;78(11):1175-85.

Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T. 'Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates.' J Orthop Sports Phys Ther. 1998 Mar;27(3):213-8.

McPartland JM, Mein EA. 'Entrainment and the cranial rhythmic impulse.' Altern Ther Health Med. 1997 Jan;3(1):40-5. Review.

Elsdale B. 'Craniosacral therapy.' Nurs Times. 1996 Jul 10-16;92(28):173.

Phillips CJ, Meyer JJ. 'Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery.' J Manipulative Physiol Ther. 1995 Oct;18(8):525-9.

Upledger JE. 'Craniosacral therapy.' Phys Ther. 1995 Apr;75(4):328-30.

Quaid A. 'Craniosacral controversy.' Phys Ther. 1995 Mar;75(3):240.

Greenman PE, McPartland JM. 'Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome.' J Am Osteopath Assoc. 1995 Mar;95(3):182-8; 191-2.

Wirth-Pattullo V, Hayes KW. 'Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements.' Phys Ther. 1994 Oct;74(10):908-16; discussion 917-20.

Sucher BM, Heath DM. 'Thoracic outlet syndrome--a myofascial variant: Part 3. Structural and postural considerations.' J Am Osteopath Assoc. 1993 Mar;93(3):334, 340-5. Review. Erratum in: J Am Osteopath Assoc 1993 Jun;93(6):649.

Kostopoulos DC, Keramidas G. 'Changes in elongation of falx cerebri during craniosacral therapy techniques applied on the skull of an embalmed cadaver.' Cranio. 1992 Jan;10(1):9-12.

Heinrich S. 'The role of physical therapy in craniofacial pain disorders: an adjunct to dental pain management.' Cranio. 1991 Jan;9(1):71-5. Review.

Ehrett SL. 'Craniosacral therapy and myofascial release in entry-level physical therapy curricula.' Phys Ther. 1988 Apr;68(4):534-40.

Weiner LB, Grant LA, Grant AH. 'Monitoring ocular changes that may accompany use of dental appliances and/or osteopathic craniosacral manipulations in the treatment of TMJ and related problems.' Cranio. 1987 Jul;5(3):278-85.

Gillespie BR. 'Dental considerations of the craniosacral mechanism.' Cranio. 1985 Sep-Dec;3(4):380-4.

 

[Dr JPH]

Originally posted by PACtoDOC
I am sorry JP, but this statement really cracked me up!!! You call all our arguments biased but your own cranial knowledge is suposedly "somone with real experience". Aren't you a 2nd year MS or something close to that? That is what cracks me up in OMM. TA's are experts, PDF's are scholars!!! Would you ever call a person in their first couple of years of ANY training someone to go to with real experience? In that case I suppose Lebron James will be coaching next year!!

I have taken cranial courses and I am a member of the Cranial Academy.

What did my post say? "Someone with experience with cranial OMM." Could be as a patient as well, depending on how you interpret the statement.

When did I claim to be an expert?

Again, you seem to be an expert in the anti-cranial movement group yet you have no information to back up your statements. No literature cited. Only negative statements and ridicule on your part.

If you can't feel or don't understand cranial OMM, then maybe it's time for you to stick to what you know and leave this subject alone.

 

[Dr JPH]

Originally posted by docslytherin
i have to chime in now...

as a disclaimer, i have no experience with cranial (and it does seem a bit fishy to me... BUT)

most of the arguments against cranial here seem to be based on whether or not students can feel the movement in lab. if JPHazelton can provide measured evidence to the fact that they do move, then how is it still his responsibility to prove his point that the bones are not fused? it seems to me that he already proved that. if you disagree with the statement or the research then you need to find the flaw with it (and not just saying "it was done by DOs" because almost every study published is sponsored by some company with a vested interest in the outcome), not just disregarding it because you haven't felt the small amts of movement in lab.

i'm not sure that i buy into the idea of cranial either, but at this point the only legitimate argument i have read on this board has been the argument with proof that the bones do move, opening up the possibility that cranial may, in fact, work.

Good post. Fair and well thought out...unlike many other posts from other members.

 

[gioia]

This is a curiousity to me.

My spouse, who sought DO treatments in Europe, swears by the cranial therapy.

Enlighten me:

So, worse case scenario is that cranial therapy doesn't actually move the bones (I didn't agree with what I just wrote, that is a worst case deal) BUT, could it do something equally efficacious? Say, release tension and stimulate blood flow in a way that myofacial treatments don't address. Which, could in turn ellicit a desired response?

I am talking about adults, not infants.

Do remember, that only recently did massage therapy become a
proven mode of therapy. Even two years ago physicians were likening massage therapy to the placebo effect. I have no opinions either way but publications can be misleading.

 

[PACtoDOC]

The numbers speak for themselves. Roughly 1/3 of those polled even wish to continue learning cranial they way they presently are teaching it. Its not up to scientific world to prove that cranial does not work. It is up to the cranial buffs to prove it does work. Allow me to site one of your so called landmark studies on cranial. Please note the this study had a grand total of 23 patients, where 10 received cranial and 13 some sham version of cranial. Based on the ridiculous setup of this study, the outcome was stated to prove that cranial therapy affects the autonomic nervous system. I remember them showing us this study in class and recall seeing how it was severely flawed. When they tried to show us the CRI on a graph and how it related to doppler flow on the same graph, the two were not shown to be very close together from one examiner to the next. BOTTOM LINE....YOU CAN'T PROVE JACK SQUAT WITH TEN PATIENTS!!!!

 

[docslytherin]

i'm all for having a say in our educations, but, seriously, what sense does it make for us to "decide" what our medical schools teach us? to think that we should band together and protest the teaching of cranial simply because we can't feel it move is absurd. the assumption is that we already know the information the schools are going to teach us. in fact, we know it SO WELL that we can disregard it as false or irrelevant. all of these strike me as very odd ideas considering most of us are paying $30K/year in tuition to people who apparently know less about OMM than we students do...

just a thought...

 

[coreyw]

Originally posted by PACtoDOC
Allow me to site one of your so called landmark studies on cranial. Please note the this study had a grand total of 23 patients, where 10 received cranial and 13 some sham version of cranial. Based on the ridiculous setup of this study, the outcome was stated to prove that cranial therapy affects the autonomic nervous system. I remember them showing us this study in class and recall seeing how it was severely flawed. When they tried to show us the CRI on a graph and how it related to doppler flow on the same graph, the two were not shown to be very close together from one examiner to the next. BOTTOM LINE....YOU CAN'T PROVE JACK SQUAT WITH TEN PATIENTS!!!!

Sorry, I didn't catch the paper you're citing? (This isn't a salvo... I really didn't.)

 

[PACtoDOC]

I was referring to the paper by Nelson.

I guess this is a good time to make a general conclusion about Cranial. There is a close to 3 to 1 ratio of people wanting it changed in a drastic way, and a 2 to 1 ratio of people wanting it eliminated in DO education. I don't think any argument can speak much more loudly than this. Maybe it is time we invest in sending a similar poll to all practicing DO's nationwide. My guess is that it would be similar in its results. Then what? My guess is then it is time for the AOA to start listening to its constituents. There is a place for Cranial, but it is among the other relatively unproven therapies in medicine such as aromatherapy, accupuncture, herbal remedies, magnet therapies, chelation etc... Maybe one day all of these things will be proven and viable therapies, but for now, we can't simply seek out poorly designed studies as a basis of fact. I guarantee that you can do a literature search and come up with 10 studies supposedly proving that magnet therapy works for arthritis, but that does not mean it is accepted. Don't hide behind poor studies, but seek to help truly prove the things you feel are treatments deserving of mention and acceptance. That is how medicine gets advanced. Any infomercial can "prove" something works, but proof is truly in the pudding!!

 

[governator]

things i disagree with cranial teaching:
1. i remember as a 2nd yr at COMP when we did our cranial, not 2 mentors could come up with the same diagnosis (for some reason, everybody in my class has cranial abnormality and i highly doubt that 100% pt population suffer from cranial dysfunction)
2. my mentor was a dentist (DDS), seems to be very passionate about cranial but cranial should be able to be correlated to medicine at large and a dentist just doesn't have the knowledge
3. i actually read the cranial manual and pretty embarrased to come upon a cranial technique for resuscitation (to replace CPR)........ is it still in the cranial manual (for COMP students)?

Cranial should definitely be taught at osteopathic schools but not as a requirement but as an elective for those who do want to learn cranial. I mean it is an asset because we're the only one who could bill for it but to put cranial questions on the board exams when it's not yet proven, even to the osteopathic community?

 

[Dr JPH]

Originally posted by governator

3. i actually read the cranial manual and pretty embarrased to come upon a cranial technique for resuscitation (to replace CPR)........ is it still in the cranial manual (for COMP students)?

I have a copy of this manual. I will have to look through it, but I can't imagine there being a technique to REPLACE CPR as the standard of care for cardiac arrest.

 

[DOSouthpaw]

The Cranial CPR you refer to comes from a story Sutherland told. He arrived on the scene where a man had drown in a Lake. A nurse has already been performing CPR for quite some time when Sutherland arrived. Both of them felt that working further was useless because of how long the CPR had already been administered. Sutherland decided to try a little "experiment" and he forcfully thrust the temporal bones into external rotation twice and the man started to breath. Sutherland postulated that the man's Secondary Respiration (lungs) had shut down and his Primary Respiration (CRI) had shut down as well. Therefore CPR was usuless until the Primary Respiration was restarted since it is the first to start and the last to go.

The Magoun book does not say that this technique should replace CPR but rather augment it and it is only necessary is the PRM has stopped. If Secondary Respiration is not present but the PRM is still intact then normal CPR will suffice.


It's funny how people bash Sutherland when they have never read his works.

 

[PACtoDOC]

Hey, here is a thought. If your heart stops, and your breathing follows, then you are clinically dead. I would guess that if the CRI exists at all, which I simply cannot believe with the evidence to date, then the CRI could not be present either. So in every case, with the previous poster's explanation, the CRI would be absent. It would make sense that you would have no CSF flow if you have no circulation period. So in this case, we need to get a hold of the AHA and the Red Cross and have them completely revamp their BLS and ACLS curricula to include forced temporal external rotation. So I guess the V-Fib algorithm could be ammended to reflect this new idea. But where would we put it, after checking the airway?, or after checking pulse? Or better yet, lets just incorporate it into the 2 man CPR technique so that the rescuer going to the head has to be responsible for squeezing the poor chap's grape upon arrival there. Do you even realize how bad you people are making DO's look? I think we need a petition next to give all these flake DO's a new degree, the DO-ILL......DO in lala land! My suggestion would actually be to put this new step right before calling "clear" for defibrillating, so as to help the palpator actually feel something!!

 

[Dr JPH]

Originally posted by DOSouthpaw

It's funny how people bash Sutherland when they have never read his works.

They did this to a guy named Copernicus too who once had an idea people didn't believe...or want to believe.

I wonder how many of the people who decide to continually bash cranial osteopathy would NOT turn to it for treatment if they had recurring migraines that didn't respond to medication...as many migraine sufferers complain. I would find THAT funny.

I have friends in school who have the same attitude as PACtoDOC and the like, but who is the first person they come to when they have a headache, sinusitis or any other of a multitide of MSK complaints?

I don't think it's DOs who teach and use cranial that give osteopathy a bad name...I think it's the DOs and DO students who go around criticizing their own profession that attract more negative feeling.

Of course, these are just my own opinions...but I believe in cranial...so I must be stupid.

 

[Teufelhunden]

Cranial is pure bullsh|t.

The AOA will never listen to us. From what I can see, the AOA is a bunch of weird-looking old guys in really bad suits, who hold weird osteopathic conventions every other week or so. When I graduate next year, I will enter into allopathic training and never look back. Unfortunately, I won't be able to practice in 5 states...but oh well. Isn't it funny how the AOA "eats it's young." What other organization actually works AGAINST it's own? I mean...think about it...the only people limiting the practice rights of DO's is the AOA! Think about that for a minute...it's crazy!

Anyway, I hate the AOA.

Don't misinterpret me. I am a believer in OMM. It has its place in treating a lot of musculoskeletal problems. But 'cranial' just makes us look stupid. Really stupid.

 

[sdude]

I found this thread really interesting.

I have to admit I'm a bit disturbed, though. The fissures in the skull are fused joints. To move them you would have to break bone tissue. I seriously doubt that is happening during cranalsacral therapy. This therapy may well work, but I suspect it is really a form of acupressure.

For the sake of absurd argument, if the skull plates do move why haven't studies been done under fluroscopy to show them moving?

Talking about adjusting skull plates simply makes DO's sound like quacks. This is of great concern to me because I may be one in several years. I plan to do family practice and sports medicine, and OMM sounds incredibly useful for diagnosing and possibly treating soft tissue injuries.

I can hear my allopathic collegues now, though! "hey dave, my sacrum is out of allignment! I know you aced the COMLEX so you must know how to readjust it! Cure my depression while you're at it!" Seriously, guys, this makes DO's and OMM look really bad.

I don't get the AOA; they seem to have completely lost touch with reality. Many DO schools are obviously excellent, and DO's have been a credit to medicine for over a century. Why are DO graduates who go on the best allopathic residencies (esp. in primary care) seen as "traitors" rather than as a credit to osteopathic medical training? And why this bizzare cultish quackery?

Thanks for listening!