the end of craniosacral teaching??

Discussion in 'Medical Students - DO' started by MOZ, May 20, 2002.

  1. MOZ

    MOZ Member

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    i just got an email from a student government official about a petition to remove cranio-sacral teachings from DO schools nationwide. apparently some students from maine feel that there is not enough scientific evidence support cranial therefore it shouldn't be taught. anyone have any more info on the topic??
     
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  3. Dr. Nick

    Dr. Nick Senior Member

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    Can you direct us to any websites that explain the fundamentals of this field?
     
  4. osteodoc13

    osteodoc13 Member

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    Dr. Nick:

    If you give me an email address I can send you a Word file which has a signigicant number of research articles which support OCF
     
  5. bones

    bones Osteopathic Physician
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    osteodoc,
    you should post some refs on here so everyone else can look it up too.

    Cranial is the most controversial tool in our osteopathic bag of tricks since it is very subtle, and apparently enough so that many question whether there is anything at all too it. Some treatments have been shown VERY helpful for infants in correcting birth trauma to the skull, promoting suckling, etc (I actually don?t know how much research has been done on this, but few question its efficacy in this particular area- though maybe they should).

    The real burning question is whether there is any value to it beyond infant procedures- since quite a few use it on adults, yet adult cranial bones are theoretically not able to move! (?course, most of the cranial bones we look at are on cadavers- there is just a tad of hinge motion going on by the temporals in living breathing adults?). Positive effects have been shown repeatedly in adults as well as infants, but I don?t know how they can do a well-controlled study to show this isn?t placebo- double blind studies just don?t seem to be in the cards.

    In the meantime, I?ll be taking our elective cranial class at KCOM this summer, after which I?ll give you my honest opinion on the matter- for what its worth...

    bones
     
  6. Dr. Nick

    Dr. Nick Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by osteodoc13:
    <strong>Dr. Nick:

    If you give me an email address I can send you a Word file which has a signigicant number of research articles which support OCF</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Hey Osteodoc,

    Can you post some titles/authors and I can just do a search from there.

    Thanks,
    Dr. Nick
     
  7. Dr. Nick

    Dr. Nick Senior Member

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    Bones,

    Sensing movement of adult cranial bones? Now you got my attention!

    I'm also interested in the peds techniques - sounds cool.

    Is there no OMM dedicated web resource out there?

    Dr. Nick
     
  8. CADO2B

    CADO2B Member

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    COMP does alot of cranial stuff, you can contact their OMT department and I'm sure that they can direct you to relevant literature.
     
  9. Stillfocused

    Stillfocused Senior Member

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    This is a very, very contentious topic.

    It opens a view to the deepest patterns of stress and strain in Osteopathy, not only in the US, but also worldwide.

    It also reflects some of the greater tensions in western intellectual life in the modern era (subject/object duality, representation vs. abstraction, empiricism vs. vitalism, etc.)

    Therefore, many of us have very passionate feelings about this topic.

    So, be passionate about your views.

    But PLEASE, let's try to keep a kind, open and thoughtful tone to this discussion.
     
  10. Stillfocused

    Stillfocused Senior Member

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    At the outset, "craniosacral" is NOT an osteopathic term. It denotes a therapy practiced by non-physicians. It is not a medical treatment.

    "Craniosacaral therapy" is a form of "bodywork," practiced by people licensed in professions like message therapy, psychology, PT, OT, and acupuncture.

    "Craniosacral Therapy" (CST) was developed by John Upledger DO (formerly FAAO). It is a popularized, dumbed-down and frequently dangerous version of a set of extraordinarily sophisticated but controversial osteopathic techniques.

    These techniques, and the theory that underlies them, are part of a school in Osteopathy known as "Osteopathy in the Cranial Field" (OCF).
     
  11. Stillfocused

    Stillfocused Senior Member

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    Osteopathy in the Cranial Field was developed by William Garner Sutherland DO. It first introduced to the literature in 1939 with his publication of the monograph ?The Cranial Bowl.?

    Sutherland based OCF on a number of very weird, strange anatomical and physiological observations and subtle clinical examinations.

    Remember, just because an idea initially seems weird and strange does not mean that it is necessarily wrong. This is a key to the development of scientific discovery (see Thomas Kuhn).

    As a medical student at the American School of Osteopathy (ASO, now KCOM) in 1899, Sutherland was examining a disarticulated human skull and he was struck by an observation he made when examining the sphenoid. He noticed that is was ?beveled like the gills of a fish, indicating articular mobility for a respiratory mechanism.?

    The novelty of this idea kept coming back to him. Eventually, he came to understand that these articular surfaces were designed to accommodate the function of the central nervous system (CNS), the cerebral spinal fluid (CSF) and the dural membranes. To Sutherland, these pieces comprised a single functional unit, which he termed the primary respiratory mechanism (PRM).

    In forty years of solitary experimentation, dissection, clinical observation, Sutherland concluded that there were five main anatomic-physiologic components to the primary respiratory mechanism (PRM).

    1. Inherent mobility of the brain and spinal cord.
    2. Fluctuation of the cerebral spinal fluid.
    3. Mobility of the intracranial and the intraspinal membranes.
    4. Articular mobility of cranial bones.
    5. Involuntary mobility of the sacrum between the illia.

    He termed this functional unit as ?primary? because he understood it to precede thoracic respiration.

    Now the mobility that Sutherland was referring to is extremely subtle, at the order of microns.

    However, remember that in the early 20th century, before the development of safer and more effective drugs like penicillin DOs practiced almost exclusively with their hands. They had developed a safe, effective system of physiological control and treatment based almost solely on manipulation. Manipulation was considered akin to knifeless surgery.

    Traditional DOS were taught extremely sophisticated palpatory skills. They developed the ability to feel a human hair under 20 sheets of paper or to count the number of seeds in an unpeeled orange. They could tell where a bone break had mended years previously by the drag felt in surface tissues.

    So, the skill to palpate subtle movement of a few microns was not all that unusual for an experienced traditional DO. However, it may take some students more that the 200 hours of instruction required in today?s COMs to develop this skill.

    It takes a lot of practice to become proficient at OCF.
     
  12. bones

    bones Osteopathic Physician
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    <a href="http://www.osteohome.com/" target="_blank">http://www.osteohome.com/</a>

    <a href="http://www.cranialacademy.org/" target="_blank">http://www.cranialacademy.org/</a>
     
  13. Stillfocused

    Stillfocused Senior Member

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    Sutherland thought and wrote in the culture and vernacular of the American Midwest in the late 19th and early 20th century. He used language a little differently than we do. He also was trying to articulate a number of strange, weird ideas. So, he often used metaphor. Many of today?s students do not know enough about language of Sutherland?s milieu appreciate and understand what is meant by terms like ?the fluid within the fluid? or the ?Breath of Life.? Also, a number of contemporary teachers and writers bring their own agendas to OCF. This includes spiritual/msytical/vitalistic agendas.

    This comment does dismiss the very real fact that Osteopathy is the offspring of Still?s wedding of anatomy, Spencer?s evolutionary theory, 19th century practices of medicine and surgery, ?Bonesetting?, ?Magnetic Healing?, ?Spiritualism? and American Pragmatism. Osteopathy is undoubtedly a weird intellectual love child.

    Vitalism is one of the deepest strands in Osteopathic philosophy. This makes almost all of today students uncomfortable and it should. But, it is a part of the tradition. To cover it up for the sake of ?Scientific Objectivity? is intellectually dishonest and cowardly.

    OCF is also grounded in this marriage of science and Vitalism.

    However, this is not to say that there is no solid science to support its claims. There is.
     
  14. Stillfocused

    Stillfocused Senior Member

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    The American Academy of Osteopathy does not have an online database of OMM materials so there is no official OMM dedicated web resource.

    However, their quarterly journal, the JAAO is online. It has a number of important recent articles. Also see their book catalog section.

    <a href="http://www.academyofosteopathy.org/" target="_blank">http://www.academyofosteopathy.org/</a>
    <a href="http://www.academyofosteopathy.org/journals.htm" target="_blank">http://www.academyofosteopathy.org/journals.htm</a>
    <a href="http://www.academyofosteopathy.org/bookcatalog.htm" target="_blank">http://www.academyofosteopathy.org/bookcatalog.htm</a>

    Also see <a href="http://www.cranialacademy.org/" target="_blank">http://www.cranialacademy.org/</a> especially their book section.

    Here is Dr. Richard Feely DO FAAO?s website. He is a CCOM OMM instructor. He has compiled a number of online resources including a comprehensive bibliography of cranial osteopathy references, an abridged osteopathic dictionary, and an OMT abstract list (not comprehensive).

    <a href="http://www.drfeely.com/doctors/index_osteopathy.htm" target="_blank">http://www.drfeely.com/doctors/index_osteopathy.htm</a>

    Another good place to start on the web is the RESEARCH section of <a href="http://www.osteohome.com/" target="_blank">http://www.osteohome.com/</a>
    It?s about 3 or 4 years out of date but it references are a good starting place to start.

    DO NOT do a Google search of ?craniosacral therapy? and expect to find accurate information! You will get a lot of Upledger induced trash, Polarity Therapy and British Osteopathy, different stuff than OCF.

    There a are number of good print based introductions to OCF.

    Perhaps the most official introduction is in Chapter 64 ?Cranial Field? by Edna Lay in ?Foundations for Osteopathic Medicine? by Ward et al. This is the AOA?s official textbook for osteopathic medicine.

    <a href="http://www.amazon.com/exec/obidos/ASIN/0683087924/qid=1022006318/sr=1-1/ref=sr_1_1/103-9201794-6869421" target="_blank">http://www.amazon.com/exec/obidos/ASIN/0683087924/qid=1022006318/sr=1-1/ref=sr_1_1/103-9201794-6869421</a>

    I like ?Right in my own backyard? Chapter 2 in Andrew Weil?s Spontaneous Healing for both an easy introduction to OCF and OPP/OMM. It is written for a popular audience but I think that his narrative about Dr. Fulford is a beautiful articulation of the Osteopathic ideal.

    <a href="http://www.amazon.com/exec/obidos/ASIN/0804117942/qid=1022006784/sr=1-1/ref=sr_1_1/103-9201794-6869421" target="_blank">http://www.amazon.com/exec/obidos/ASIN/0804117942/qid=1022006784/sr=1-1/ref=sr_1_1/103-9201794-6869421</a>
     
  15. osteodoc13

    osteodoc13 Member

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    I'm sorry, but the list I have is about 10 pages, and I can't figure out where I found it on the web. I think it was a link from one of my professors, but I can't remember the source. If anyone wants to PM me with their email I will send the file.

    Here is a link from a recent study by NASA:
    <a href="http://spacephysiology.arc.nasa.gov/projects/icp.html" target="_blank">http://spacephysiology.arc.nasa.gov/projects/icp.html</a>

    The interesting thing about this study is in the following sentence:

    " Although the skull is often assumed to be a rigid container with a constant volume, many researchers (2-5,7) have demonstrated that the skull moves on the order of a few micro-meters in association with changes in ICP."

    This refutes the claim by critics that the sutures of the skull fuse at birth.
     
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  17. osteodoc13

    osteodoc13 Member

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    Dr. Feely's web site is great! A tremendous resource, as well as a site to send patients to for more research.
     
  18. Stillfocused

    Stillfocused Senior Member

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    Hey Brian,

    Could you send me your article list. My email is [email protected]

    Also, if anyone has a copy of this infamous article, please send it to me.

    Thanks,

    Josh
     
  19. Stillfocused

    Stillfocused Senior Member

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    i meant infamous email
     
  20. Stillfocused

    Stillfocused Senior Member

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    In term of OCF and Peds:

    Osteopathic Center for Children
    Viola M. Frymann D.O., F.A.A.O., F.C.A. Director

    <a href="http://www.osteopathiccenter.org/" target="_blank">http://www.osteopathiccenter.org/</a>
     
  21. Dr. Nick

    Dr. Nick Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by osteodoc13:
    <strong>I'm sorry, but the list I have is about 10 pages, and I can't figure out where I found it on the web. I think it was a link from one of my professors, but I can't remember the source. If anyone wants to PM me with their email I will send the file.

    Here is a link from a recent study by NASA:
    <a href="http://spacephysiology.arc.nasa.gov/projects/icp.html" target="_blank">http://spacephysiology.arc.nasa.gov/projects/icp.html</a>

    The interesting thing about this study is in the following sentence:

    " Although the skull is often assumed to be a rigid container with a constant volume, many researchers (2-5,7) have demonstrated that the skull moves on the order of a few micro-meters in association with changes in ICP."

    This refutes the claim by critics that the sutures of the skull fuse at birth.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Osteodoc,

    You do realize that a micro-meter is 1/1000 of a millimeter, correct? We're talking about the size of bacteria here. In fact, the average bacteria is about 1 micrometer long.

    I don't think that this refutes any claims about the fusion of the skull. The inherent elasticity of the material, i.e. the bone, could quite easily explain movement of the skull of several bacteria in length. Such fantastically minute movements need not be explained by articulations.

    OK, guys, i'm out for a few days. Have fun and i'll see ya later.

    Cheers
     
  22. Stillfocused

    Stillfocused Senior Member

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    This article definitively addresses the "give" felt in the living crainium (also important in OCF) and sutural movement.

    The Monroe-Kellie doctorine is dead. The skull in not a ridgid case.

    Am J Phys Anthropol 2000 Aug;112(4):575-93

    Strain in the braincase and its sutures during function.

    Herring SW, Teng S.

    Department of Orthodontics, University of Washington, Seattle, Washington 98195, USA. [email protected]

    The skull is distinguished from other parts of the skeleton by its composite construction. The sutures between bony elements provide for interstitial growth of the cranium, but at the same time they alter the transmission of stress and strain through the skull. Strain gages were bonded to the frontal and parietal bones of miniature pigs and across the interfrontal, interparietal and coronal sutures. Strains were recorded 1) during natural mastication in conjunction with electromyographic activity from the jaw muscles and 2) during stimulation of various cranial muscles in anesthetized animals. Vault sutures exhibited vastly higher strains than did the adjoining bones. Further, bone strain primarily reflected torsion of the braincase set up by asymmetrical muscle contraction; the tensile axis alternated between +45 degrees and -45 degrees depending on which diagonal masseter/temporalis pair was most active. However, suture strains were not related to overall torsion but instead were responses to local muscle actions. Only the coronal suture showed significant strain (tension) during jaw opening; this was caused by the contraction of neck muscles. All sutures showed strain during jaw closing, but polarity depended on the pattern of muscle usage. For example, masseter contraction tensed the coronal suture and the anterior part of the interfrontal suture, whereas the temporalis caused compression in these locations. Peak tensile strains were larger than peak compressive strains. Histology suggested that the skull is bent at the sutures, with the ectocranial surface tensed and the endocranial surface predominantly compressed. Collectively, these results indicate that skulls with patent sutures should be analyzed as complexes of independent parts rather than solid structures.

    Copyright 2000 Wiley-Liss, Inc.
    PMID: 10918130 [PubMed - indexed for MEDLINE]
     
  23. Dr. Nick

    Dr. Nick Senior Member

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    Hi Guys,

    I'm very busy for the next few days but I just wanted to add something to the discussion really quickly.

    "This article definitively addresses the "give" felt in the living crainium (also important in OCF) and sutural movement.

    The Monroe-Kellie doctorine is dead. The skull in not a ridgid case."


    Stillfocused, I appreciate your enthusiasm for cranial manipulation, but don't let your eagerness to believe in something blind your objectivity.

    The article you posted discusses compression and tensile strains in sutures, not gross movement. These strains are also likely on the order of micrometers - see nasa article above, yet you so quickly rush to conclude that, "This article definitively addresses the "give" felt in the living crainium "

    Nowhere in this article does it address the "give" that can be felt in the living cranium - certainly nowhere does it definitively address any such thing.

    Is the skull rigid then? Yes, it is. Try this, invite your partner over and ask them to squeeze your head. Does it get smaller? Does it change shape? Maybe by a few micrometers. But can people actually feel that?

    I think these are valid questions. Certainly, I wouldn't rush to conclude that any theories are "dead" or have been "definitively addressed." Remember the ultimate goal here is to find the truth, not to validate any specific therapeutic modalities.

    OK, I really need to get back to work now.
     
  24. Stillfocused

    Stillfocused Senior Member

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    If an object is compressible then it is not completely rigid.

    No one has implied that cranial articulations have any form of "gross movement" only very subtle ones.

    The fact that sutural movement have been definitively measured in vivo does address, ie. support that claim that sutural movement could be felt in the living cranium.

    Dr Nick, don't let your eagerness to believe in "objectivity" blind your logic.
     
  25. bones

    bones Osteopathic Physician
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    The "give" that is claimed by cranial people is on the order of +/- 2.2 millimeters, not micrometers. I have trouble imagining that this is the case for adults, but I will keep an open mind until I can generate some proof to the contrary. They claim that this movement is due to folding in the sutures -specifically around the sphenoid, temporals, and occiput, and some movement around the sphenobasilar synchondrosis.
    In babies? Yes- you can probably even get a lot MORE movement than 2.2 millimeters if you so desire- you just better darn well know what you?re doing! To add strangeness to the matter, one of the OMM docs at my school has made a bit of a reputation for himself by getting an audible pop out of his patient?s craniums when he works on them (I didn?t believe the rumor until I saw it for myself when I was shadowing him). Something along the lines of cranial HVLA? Interesting?
    The case that I was watching was a baby. It wasn?t particularly loud and I don?t think the mother noticed- but I sure did (and so did the kid, by her expression!). Anyhow, the child was set on the table screaming and left with a big smile on its face. There?s that subjective thing again?

    bones
     
  26. Dr. Nick

    Dr. Nick Senior Member

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    Originally posted by Stillfocused:

    "If an object is compressible then it is not completely rigid."

    Well, that's interesting.

    According to your definition, there is no such thing as a completely rigid object! Stillfocused, everything is compressible to some degree - particularly when you start measuring on microscopic levels.

    That's the problem with using subjective terms in a scientific debate.

    How can I argue with logic like that?
     
  27. osteodoc13

    osteodoc13 Member

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    I wonder if anyone here has found a good way to explain to people like Dr. Nick how it is possible to feel the subtle changes in body texture or position that we osteopaths utilize?

    The best way I can do it is to demonstrate on a person, and hopefully they are sensitive enough to their own body to feel the changes as well.
     
  28. Stillfocused

    Stillfocused Senior Member

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    If we want to understand this [physiological] mechanism, we have to understand and feel how it functions in both a state of health and a state of illness. We have to learn through it; we must function as it functions; we must think as it thinks; and we have to experience it with our hands. We have to experience it in terms of its living function, understanding the way this body would act if it were in good health. We must not only explore symptoms; we have to look around, everywhere, across this living body, and find what it would like to be and how it would like to live.

    I feel very strongly that we have the opportunity to go deeper into the study of stillness.... I am trying to bring into focus a way... of using the stillness objectively and subjectively in the diagnosis and treatment of our cases.... It is a treatment program in which health is related to a return to the freedom of interchange between body physiology and stillness.

    -ROLLIN E. BECKER, D.O.

    Have you ever had a thought strike you? I have told many times of the thought that struck me before I graduated from the American School of Osteopathy. [In trying] to prove that motion between cranial bones in the living adult is impossible....I gained knowledge not only of the articular mobility of the skull but also of the Tide and something within that I call the "Breath of Life." I do not consider this contribution of thought mine--I call it a guiding thought.

    The goal with your patients is to find the way to healthy function within the mechanism that they bring to you. Study the Lfe principle and come closer to understanding what I mean by the "Breath of Life." To the digger who will take time to dream and the dreamer who will wake up and dig, the science of osteopathy will unfold into a magnitude equal to that of the heavens.

    -William C. Sutherland, D.O.
     
  29. Dr. Nick

    Dr. Nick Senior Member

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    stillness? is that a reference to dr. still?
     
  30. Stillfocused

    Stillfocused Senior Member

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    Nope.

    Have you done any of the reading I assigned you Dr. Nick?
     
  31. Doc Oc

    Doc Oc Senior Member

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    The petition was not started by "some students from Maine". I go to UNECOM, the osteopathic school in Maine, and I assure you that most of my classmates are disappointed by this motion - which was started by two basic science professors here. They presented it to our curriculum committee, and a copy of their proposal was emailed to us. Until I read this thread, I had no idea that this went beyond our school. I thought the proposal was to eliminate it from UNECOM.
     
  32. blondarb

    blondarb PGY-4 Neuro

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    Here are a few interesting links dealing with CS teachings.

    <a href="http://www.quackwatch.com/01QuackeryRelatedTopics/cranial.html" target="_blank"> This one is from quackwatch</a> and does not take a very positive view of cranial therapy. However, there are a few references cited that might make good reading.

    <a href="http://www.chspr.ubc.ca/bcohta/pdf/cranio.PDF" target="_blank"> Here is another one </a> which is taken from "A systematic review and critical appraisal of the scientific eficence on craniosacral therapy" which was published by theBritish Columbia Office of Health Technology Assessment. The entire article is pretty good and definetly worth a read for "believers and non-believers" alike. The discussion and conclusion states :

    "This systematic review found there is insufficient scientific evidence to recommend craniosacral therapy to patients, practitioners or third party payers for any clinical condition.

    The literature suggests that the adult cranium does not obliterate, fuse or ossify its sutures until well into late life. There is also some evidence (albeit of variable research quality) that there is potential movement at these suture sites in earlier life. Questions remain as to whether such ?movement? is detectable by human palpation or whether mobility has any influence on health or disease.

    The authors of this review also note that, in accord with a basic tenet of craniosacral therapy,
    there is evidence for a craniosacral rhythm, impulse or ?primary respiration? independent of other measurable body rhythms (heart rate, or respiration). Avezaat & Eijndhoven ?86 (40) and Feinberg & Mark ?87 (46) used sophisticated technology to gain an understanding of the phenomenon. However, these and other studies do not provide any valid evidence that such a craniosacral ?rhythm? or ?pulse? can be reliably perceived by an examiner. Our review does not suggest any reasonable data that would allow such a conclusion. The influence of this craniosacral rhythm on health or disease states is completely unknown.

    Clinicians require a reliable means of assessment for decision making. Craniosacral assessment
    has not been shown to be reliable.

    The literature on craniosacral therapy does not include any high grade evidence, such as random controlled trials, of its effects on health outcomes. (20) The evidence that is available is of poor methodological quality, is highly variable, lacks consistency and does not allow any logical ?positive? conclusions regarding craniosacral therapy.

    Upledger (?95), osteopath and founder of the Institute of Craniosacral Integration, argues that: ?[P]ositive patient outcomes as a result of CranioSacral Therapy should weigh greater than data from designed research protocols involving human subjects, as it is not possible to control all of the variables of such studies. (56)

    This point of view has successfully been countered by groups such as the Quantitative Methods Working Group of the U.S. National Institutes of Health Office of Alternative Medicine,(57) as well as the Cochrane Collaboration on Complementary and Alternative Medicine.(58) Many validated measures of a variety of health outcomes exist to measure ?positive patient outcomes?. Complex
    complementary medical systems can be studied as ?gestalts? (integrated wholes) for the purpose of evaluation from within an intervention/trials framework. Claims that the scientific methods
    currently available are not suitable for evaluating the therapies variously categorized as ?nontraditional?, ?alternative?, or ?complementary? are not valid.

    The issue is not that craniosacral therapy is a ?non mainstream? entity.(59) Rigorous and
    scientifically defensible studies are clearly possible on all its aspects. If undertaken, such research would be of great value in providing the necessary direction for administrators, practitioners and patients alike."

    **soapbox**
    IMO: Good research is needed in the cranial and general osteopathic manipulation field. We need to be willing to accept both positive and negative findings and change osteopathy correspondingly. I strongly encourage all DOs and DO students to become involved in some sort of research project. Don't sit and complain about or peddle the benefits of osteopathy without good evidence to support either viewpoint.
    Read all the primary sources you can and then make informed decisions. Do not accept statements made by anyone blindly.
    **off of soapbox**

    s
     
  33. acurarte

    acurarte Member

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    Craniosacral teachings embarrass me as an osteopathic physician and I consider myself an open minded person. Just my opinion, but I am not alone, get rid of it!
     
  34. Sweaty Paul

    Sweaty Paul Senior Member

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    I have actually read the entire article that blondarb posted (a classmate sent it out) I have to say that given this article and the huge number of sources and studies that were consulted and reviewed in the generation of the article I think that the Cranial portion of OTM should be removed from the curriculums of all schools until some 'quality' research is done. Schools could offer a cranial course as an elective, however, it should not be part of the mainstream osteopathic curriculum.

    I realize that some of you will disagree. Some will argue, but, what if after research it proves to be beneficial? The simplistic argument is What if it proves to be ineffective? However, the more sophisticated reply is that most things taught in medical school have a grounding in science and solid research that has come before. There has been no solid research demonstrating inter-examiner reliability in the palpation of the cranial bowl (as shown by the Journal article blondarb posted), subsequently, diagnosis of cranial problems cannot really be done. Most diagnoses, including those who's mechanisms allude us, follow specific well documented patterns that have been noted by multiple examiners. This is not the case with cranial manipulation despite what the proponents say, the various studies that have been done, by not showning inter-examiner reliability actually demonstrate clearly why we, as physicians, cannot diagnose cranial dysfunction; because, we can't fulfill the most basic requirement of the scietific method, reproducibility.

    Without reproducibility we can't establish patterns of palpable dysfunction, and without that we cannot establish criteria for diagnoses. Therefore, as I stated above, cranial manipulation should be removed from the required curriculum and the COMLEX until such time that quality research, demonstrating interexaminer reliability and specific palpable patterns of dysfunction have been performed.

    Personally I think manipulation is a wonderful tool. However, I think cranial manipulation on adults is a tool that will never realize the promise that so many hope will come from it.

    Sweaty Paul
     
  35. Mr. happy clown guy

    Mr. happy clown guy Senior Member

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    Once again I whole heartedly agree with Sweaty Paul...there is no place for craniosacral on medical licensure exams such as COMLEX. When I took step 1 and 2, I laughed out loud when I saw those terrible, terrible questions.
    Personally, I believe craniosacral should be left to fellowship work...there is no room in an already cramped medical student schedule for the bizarre beliefs of craniosacral teaching...I would have loved further time for something entirely more useful.
     
  36. osteodoc13

    osteodoc13 Member

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    This has been brought up time and time again in different threads, but if we are going to eliminate any teaching that doesn't have a firm scientific basis, we would have to eliminate a large percentage of the pharmacology curriculum as well. Look in a pharm book and see how many drugs say "Mechanism of action unknown." Most psychiatric medications are used only because they have shown to be efficacious, not because their use is based in solid fact.

    I understand that not every osteopathic student is going to be able to use cranial, and I also know that some are going to disagree with it's use. But we need to expose all students to as many areas of Osteopathy as we can, and to spend two years teaching how to treat the body without ever teaching how to treat the head would be ridiculous.

    BTW: the majority of the references in those two links are from PT journals and from the Upledger Institute. Those of us who know our history will know that Upledger was basically "excommunicated" from the osteopathic community, and the "cranial-sacral" therapy he teaches to non-physicians is a dumbed down version that doesn't include lectures in anatomy or any type of diagnosis.
     
  37. Sweaty Paul

    Sweaty Paul Senior Member

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    Osteodoc,

    I would disagree with your comment that we have to eliminate half of our pharmacologic armamentarium. Yes, Metformin, Isoniazid, and many psychotropic drugs, for example, have mechanisms we don't fully understand. However, in all cases we know their chemical makeup, the characteristics of that chemistry and in most cases we know what receptors they are working against. The main problem, esp. with the psychotropic drugs is that we don't understand all of the anatomy and physiology occuring between the receptors. However, this is a far cry from not having any scientific basis. Furthermore, all of the drugs you question have reliably shown efficacy between multiple studies that demonstrate reproducible effects unlike cranial manipulation.

    The article by the British Columbia group states that studies indicate that the cranial bones do move. They only stated there is no inter-examiner reliablity or solid proof that cranial manipulation actually worked. In addition to Upledger they analyzed Viola Frymann's research and came to the conclusion that it too was sub-standard in its controls and reporting.

    I would continue to argue that until we have solid evidence about interexaminer reliability that schools suspend the teaching of cranial manipulation as part of a body of 'required' coursework. As for leaving the 'head' out after two years of medical school, I would point to efflerauge OA/AA interactions as areas that are considered part of the head that can indeed help pts.

    Just my two cents.

    Back to board study

    Sweaty Paul
     
  38. Stillfocused

    Stillfocused Senior Member

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    OCF is NOT CranioSacral Therapy!

    Osteodoc made an essential point about OCF, CranioSacral Therapy (Registered Trademark) and the available inter-rater reliability research.

    I want to reiterate it.

    BTW: the majority of the references in those two links are from PT journals and from the Upledger Institute. Those of us who know our history will know that Upledger was basically "excommunicated" from the osteopathic community, and the "cranial-sacral" therapy he teaches to non-physicians is a dumbed down version that doesn't include lectures in anatomy or any type of diagnosis.

    James Norton PhD UNECOM professor and I assume author of the curriculum proposal to remove OCF also authored a small inter-rater reliability study. However, it was actually a test of "biodyanmic" techniques and a severely flawed study.

    Moreover, although IRR was low overall and especially low amongst inexperienced examiners, the correlation coefficient for highly experienced operators was &gt;+. 80.

    That is a great result when compared with other interpretive diagnostic test such as psychiatric diagnosis.

    Remember that both the systolic and the diastolic numbers in a blood pressure can vary up to +/- 10mmHg and still be considered accurate.

    All interpretations are unique by definition!

    Do not make "Objectivity" or "Evidence-Based Medicine" such a fetish that you forget the role of highly trained, deeply experienced clinical intuition.
     
  39. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    NIH is interested in conducting OMT and craniosacral research. In fact, they have trouble attracting quality scientific proposals to do such research. They literally have money ear-marked for these areas of research and are waiting for osteopathic clinical researchers to submit quality proposals. Look at this link:

    <a href="http://nccam.nih.gov/clinicaltrials/osteopathicmanipulation.htm" target="_blank">http://nccam.nih.gov/clinicaltrials/osteopathicmanipulation.htm</a>

    The real issue is that if DO's want quality OMT and cranial research, then it is OUR professional responsibility to train the osteopathic clinical researchers to do it. Those posting here lamenting the lack of evidence-based manipulative medicine all make good points. But, the real question still remains, "What have YOU done to advance evidence-based osteopathic research?" You're either part of the solution or part of the problem.
     
  40. osteodoc13

    osteodoc13 Member

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    Great post by Dr. Russo. I agree that we need to be more proactive in our studies of OCF.

    I wonder, though, who are we trying to prove to? Is it the allopathic world, with their addiction to "randomized, double-blind studies," or is it to the MD wannabes who come to DO school because they can't get in to MD school, then spend 4 years and a whole career ripping OMM?

    Any thoughts?
     
  41. Dr. Nick

    Dr. Nick Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by acurarte:
    <strong>Craniosacral teachings embarrass me as an osteopathic physician and I consider myself an open minded person. Just my opinion, but I am not alone, get rid of it!</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Well, you're not alone.

    Craniosacral manipulation embarasses me as an allopathic medical student. I think it is a poor reflection on the medical field, period.
     
  42. Dr. Nick

    Dr. Nick Senior Member

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    Has anyone else noticed hints of religious thinking in some of these threads on Osteopathy?

    All of the classic elements are there.

    #1, Reverence of "scriptures"

    i.e. the oft-mentioned practice of studying the writings of Still, Sutherland, etc.

    #2, Element of faith and the rejection of strictly rational thinking.

    For example, "Do not make "Objectivity" or "Evidence-Based Medicine" such a fetish that you forget the role of highly trained, deeply experienced clinical intuition."

    #3, Distinction between the "true believers" and the "non-believers."

    Just see the many reference to those who do not embrace osteopathy or those who are only here because they can't get into MD school, etc.
     
  43. Sweaty Paul

    Sweaty Paul Senior Member

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    Osteodoc,

    Just because I don't embrace Cranio-sacral therapy (which is what we call the course material at KCOM) doesn't mean:

    1) That I have spent 2 years complaining about OTM.

    2) That I see no value in OTM

    3) That I don't believe OTM has areas of great efficacy

    4) That I wish I was an MD student

    Dr. Nick is exactly correct in stating that many who believe in Cranio-sacral therapy take an almost religious point of view in arguing for it. The facts are there HAS NOT BEEN enough quality research done in the area of cranial therapy to make the claims that many practitioners state. That is a fact. Dr. Sutherlands early experiments of soaking dry beans in water in an empty skull does not show that skull bones move, it shows that the osmotic pressure of soaked beans exceeds the force that the sutures could provide to keep the skull whole.
    The fact is we don't really know that it works. Just because a patient says the 'feel better' doesn't mean that they are better or that we really have treated any underlying pathology. Certainly there are ways to test all of these variables, however, it hasn't been done and until it is I will be extremely skeptical.

    As to following evidenced-based medicine with a 'blind fetish' I would caution anyone considering not following EBM as opening yourself to a series of litigations considering many therapies are based on series of guidelines that medical practioners agree upon and these are based on research and evidence (treatment of Diabetes, HTN, etc.).

    Lastly, I have been involved with research. I have helped classmates who are doing a study on the efficacy of rib-raising and I enrolled myself as a test-subject for another OTM study. If after vigourous research Cranio-sacral therapy proves to be efficacious, and if I am in a speciality in which my patients would benefit from that modality of therapy, I would happily take the appropriate course work to become proficient. However, as I stated above, I cannot 'believe' in the benefits of cranio-sacral therapy, and I am convinced that at this time the evidence for cranio-sacral therapy is dubious.

    By the way, this thread has been a lot of fun, it has demonstrated how SDN is supposed to be: a forum for open well-reasoned debate without personal attacks.

    Thanks,

    Sweaty Paul MS-II
    KCOM
     
  44. blondarb

    blondarb PGY-4 Neuro

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    For some reason I would rather think about Cranial Osteopathy studies than study for boards. :D

    I am curious if anyone can think of good sham techniques that could be used in a study on cranial. This might be difficult since it is my understanding that cranial manipulation is very gentle. How would you rule out an effect caused by a sham technique. Obviously you would also have to have a no touch control.

    Okay, I'm in trouble for procastinating again.
    s
     
  45. osteodoc13

    osteodoc13 Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by SubAtomicStringTheory:
    <strong>What is craniosacral therapy supposed to cure??????</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">First of all, as Stillfocused and Drusso have tried to state many times, craniosacral therapy is very different than OCF. CST is "practiced" by non-physicians after taking courses taught by a DO who was basically excommunicated from the osteopathic field.

    As far as what OCF cures, it doesn't cure anything. Oseopaths don't believe that they can perform cures on the body. We try to restore optimal structure to the body to allow it to function to its optimal level. If this leads to a "cure" of the patient's problem, then that is the work of the body, not our hands.

    If you want to know what OCF can help the body recover from, the answer is that it can help with any problem the patient comes in with, providing there are cranial lesions that are contributing to the problem. Fascial strains produced by cranial lesions can be reflected in any other part of the body, including the viscera. These fascial strains prevent fluids from reaching the affected areas, which can lead to "disease."
     
  46. Stillfocused

    Stillfocused Senior Member

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    See <a href="http://www.cranialacademy.org/" target="_blank">http://www.cranialacademy.org/</a>

    Common Problems
    Some common problems addressed by physicians proficient in Cranial Osteopathy are:

    Pediatric Problems
    Colic
    Sucking Difficulty
    Spitting Up
    Development Problems
    Otitis Media (ear infections)
    Birth Trauma
    Cerebral Palsy
    Learning Disorders
    Behavior Problems
    ADD, ADHD
    Somatic Pain

    Back Problems
    Neck Problems
    Back Pain
    Sciatica
    Joint Pain Syndrome
    Headaches
    Traumatic Injury
    Overuse Syndrome
    Pleurisy
    Extremity Problems
    Systemic Problems

    Edema
    Chronic Infectious Disease
    Fatigue
    Dental Problems

    Orthodontic Problems
    TMJ Syndrome
    Malocclusion
    Orthopedic Problems
    Scoliosis
    Neurologic Syndromes

    Head Trauma
    Seizures
    Post Concussion Syndrome
    Down Syndrome
    Genitourinary Problems

    Respiratory Illness

    Asthma
    Recurrent Sore Throats
    Allergies
    Frequent Colds
    Bronchitis
    Pregnancy

    Groin Pain
    Back Pain
    Prevention of Labor Problems
    Ear Nose Throat Problems

    Sinusitis
    Chronic Ear Infection
    Chronic Tonsillitis
    Digestive Problems

    Irritable Bowel Syndrome
    Constipation
    Nausea
     
  47. Dr. Nick

    Dr. Nick Senior Member

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    Wow! Quite the miracle cure!

    Back in the old days, didn't they sell some kind of snake oil that also addressed the dozens of complaints above?
     
  48. Stillfocused

    Stillfocused Senior Member

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    The list is of conditions that can be "addressed" with OCF, not cured.

    Manual medicine is a powerful treatment modality, Dr. Nick.

    Maybe you should actually experience it for yourself instead of issuing pompous, self-satisfied but nonetheless ignorant dismissals.
     
  49. Dr. Nick

    Dr. Nick Senior Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Stillfocused:
    <strong>The list is of conditions that can be "addressed" with OCF, not cured.

    Manual medicine is a powerful treatment modality, Dr. Nick.

    Maybe you should actually experience it for yourself instead of issuing pompous, self-satisfied but nonetheless ignorant dismissals.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I don't think it is "ignorant" to doubt the incredibly optimistic claims made on this website.

    I do think it is naive to take at face value the claims of the "cranial academy." A website that clearly states that "Its mission is to teach, advocate and advance osteopathy, specifically Cranial Osteopathy." Is probably not the most objective source of info on cranial osteopathy.

    I am always open to the possibility, however, that I may be wrong. Please feel free to post the scientific evidence backing up the ability of cranial to "address" these illnesses. Oh, I forgot..there is none.

    I'm sorry, I don't care what the "modality" is. If it looks like snake oil, smells like snake oil...

    See, "Dubious Aspects of Osteopathy" at:
    <a href="http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html" target="_blank">http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html</a>
     
  50. osteodoc13

    osteodoc13 Member

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    Dr. Nick

    If you had read my post (and done the reading that Stillfocused assigned to you) you would understand that Osteopaths don't "cure" anything with OMM. They simply try to remove the barriers to the body healing itself. If those barriers exist in the head, then OCF is indicated and may help the patient resolve the whole list of problems posted by Stillfocused.

    As far as Osteopaths treating Osteopathy like a religion, I don't see any difference between the esteem with which DOs hold writings of Still, Sutherland, et.al., and the esteem with which physicians hold texts like Harrisons or Robbins. They are all definative texts in the fields, and just as internists are likely to quote Harrisons when they lecture, Osteopaths are likely to quote Still in their speech.
     
  51. osteodoc13

    osteodoc13 Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Sweaty Paul:
    <strong>Osteodoc,

    Just because I don't embrace Cranio-sacral therapy (which is what we call the course material at KCOM) doesn't mean:

    1) That I have spent 2 years complaining about OTM.

    2) That I see no value in OTM

    3) That I don't believe OTM has areas of great efficacy

    4) That I wish I was an MD student

    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Sweaty:

    I think it's great that you are a proponent of OMM, and I also understand that you don't use OCF on your patients. My point is that we as students need to be exposed to this area of Osteopathy, just as we are exposed to HVLA, which many students also don't use on their patients. Lack of "randomized, single-blind" studies doesn't mean that the techniques don't work. In the hands of experienced practicioners (usually &gt;5 years of practice) OCF is a very powerful tool. I don't know if you have a required OMM rotation, but spend time with an Osteopath in your area. Talk to the patients who have had Osteopathic treatments, including cranial, and see if the work isn't effective. Try to have an open mind and develop your hands so you can feel the CRI (a developed palpatory sense helps in any technique you use, even HVLA)

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">
    <strong>By the way, this thread has been a lot of fun, it has demonstrated how SDN is supposed to be: a forum for open well-reasoned debate without personal attacks.
    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I agree wholeheartedly. A strong debate is good for the mind. It helps us solidify our thinking, as well as hopefully allowing us to hear the other side.
     
  52. Dr. Nick

    Dr. Nick Senior Member

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    Hi Osteodoc,

    I read your post and I believe I understood it. However, the evidence to support the claims of these "barriers" - particularly "barriers" that can be palpated and adjusted in the skull, simply doesn't exist.

    I think it's fair to say that the evidence of cranial "movement" is controversial at best. Certainly there is no evidence of palpable movements that can be adjusted to treat disease.

    As far as your comparison between Harrison's and the writings of Dr. Still, I think you are comparing apples and oranges here. Harrison's is not the collected writings of a man named Harrison. Harrison's is a textbook of internal medicine consisting of many chapters written and edited by dozens of medical professionals.

    The writings of Dr. Still are....well, the writings of Dr. Still. Speaking of which, is it true he claims in his autobiography, osteopathy's "definitive text," that he could, "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck.[1]"

    Cheers,
    Dr. Nick
     

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