Craniosacral therapy (CST) is a form of light touch manual therapy practiced by osteopaths, chiropractors, massage therapists, and physical therapists, that involves applying gentle pressure to the patient’s head and neck to treat various conditions. The theory and philosophy behind CST has raised a few eyebrows among skeptical healthcare practitioners, but people continue to seek this treatment.
In this article, we will go through the basics of CST, the claims made by its practitioners, and most importantly, the scientific evidence for it.
The Theory And Philosophy Of Craniosacral Therapy
Craniosacral therapy was developed by John Upledger, D.O., through the late 70s and early 80s after “extensive scientific studies” (18). In his own words, Upledger describes his treatment as such:
“CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system. By complementing the body's natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction…” (18).
Craniosacral therapists propose that various health conditions are related to altered cerebrospinal fluid rhythm or restrictions in the “craniosacral system.” These restrictions can be found and corrected with gentle massage. Akin to heart rate or breathing rate, craniosacral rate is proposed to go through 8-12 cycles per minute and can be assessed by feeling the movement of the patient’s cranial bones (11).
For reasons that will become clear later, you shouldn’t think too much into this description.
What Is Craniosacral Therapy Supposed To Be Helpful For?
CST practitioners essentially claim to help any person with any problem. CST has been proposed to be helpful for:
- musculoskeletal issues: acute or chronic pain, post-surgical conditions, arthritis
- neurological disorders: traumatic brain injuries, concussions, and spinal cord injuries
- psychological conditions: dementia, Alzheimer’s disease, and PTSD
- pediatric disorders: autism, colic, and cerebral palsy
- conditions that are hard to treat: fibromyalgia and chronic fatigue syndrome(18)
There are plenty of claims from CST practitioners, but is there any research to back them up?
Is Craniosacral Therapy Even Plausible?
Let’s start with some of the basic claims that would be central to CST.
Can craniosacral rhythm really be detected?
- There’s no evidence craniosacral rhythm is a real phenomenon. Studies investigating our ability to determine the rhythm have shown that two examiners cannot agree on the rhythm of a given patient.
- “Craniosacral motion may not exist and might be imagined by the evaluator” (20).
- “Another possibility is that craniosacral motion may be an artifact of the examiners' imagination rather than a measurable phenomenon” (17).
- “This study demonstrated that a single examiner could palpate what was believed by the examiner to be the CSR consistently. However, the palpations of the CSR by two examiners were inconsistent…it is possible that the perception of CSR is illusory” (11).
Can cranial bones really move?
- There’s no evidence that cranial bones move.
- In a study on rabbits, forces of 5, 10, 15, and 20 grams were applied to the bones of the head, none of which produced any movement. “These results suggest that a different biological basis for craniosacral therapy should be explored” (5).
- If they can move, it is probably of a magnitude that is small enough to be irrelevant, and it can’t be done with a massage technique (9).
Is there any connection between craniosacral rhythm, cranial bone movement, and any health condition that CST is proposed to treat?
- There are no studies correlating an altered “craniosacral system” with any conditions at all.
- “Missing from the causal chain are evidential links to show that different cranial bones positions produce different cerebrospinal fluid flow patterns and that such different cerebrospinal fluid flow patterns produce different health outcomes” (9).
The most basic elements of CST have no scientific support at all, but reports of success with this treatment suggest something of interest may be happening during a CST session. Next, we will take a look at some research focused on clinical outcomes. Even though we have reasonable doubts about the mechanism of CST, do people that get it actually get better?
Does It Help With Neck Or Back Problems?
Let’s start with the “best” quality study on CST. In 2015, investigators looked at CST versus light touch sham therapy for patients with neck pain, and measured pain, function, among other things, after eight treatments. The patients and statisticians were blinded as to which group each patient was in.
They found that those in the CST group improved more than those in the sham group (10). However, the difference between the amount of improvement in each group was relatively small and of debatable clinical importance. Despite being a study clearly in favor of CST over sham, it does not validate the proposed mechanisms of CST.
Another study in 2016 looked at the effects of CST versus classic massage for patients with low back pain, and measured pain, disability, and fear of movement. The research design was adequate; patients were randomly assigned to CST and massage groups, and the person administering the tests of effectiveness was blinded as to what group each patient was in. Both are key features of a good study to help eliminate any bias.
After 10 sessions of treatment there were no differences for the main outcome measures, but some slight differences in favor of the CST group (2). However, they did not control for total treatment time. The CST sessions lasted for 50 minutes and the massage sessions lasted only for 30 minutes.
A study from 2013 looked at the effects of CST plus standard treatment (consisting of advice, education and exercise) versus standard treatment alone for pregnant patients with pelvic pain. They used pain in the morning and night, as well as number of sick days taken as primary outcome measures. Disability was measured as a secondary outcome measure.
There were no differences between groups after two months except for morning pain and disability, where the group that got CST had slightly better scores (6).This study only provides weak evidence that patients with pelvic pain may feel a bit better after getting CST, but there was not a valid placebo group.
For patients with neck or back pain, there is poor quality evidence that CST treatments are associated with a reduction in symptoms. However, these small improvements were not much better than placebo or standard treatments.
Does It Help With Fibromyalgia?
CST has been proposed as a treatment for fibromyalgia, a condition associated with severe widespread pain, and a host of other symptoms. In 2014, researchers looked at the effects of CST versus sham magnet therapy over the course of 20 weeks. They found that those that had CST had significant reductions in painful tender points as compared to those that had sham magnet therapy (3).
Another study compared CST to sham ultrasound therapy, looking at the effects on anxiety, depression, pain, and physical function. The researchers found those that had CST had less pain, less anxiety, and physical function after the completion of treatment as compared to those that had sham ultrasound (15).
However, both studies suffer from the same problem; the comparison groups used, magnet therapy and ultrasound therapy, were not good choices because they don’t appropriately mimic CST, a massage type therapy.
For patients with fibromyalgia, there is poor quality evidence from studies with inappropriate control groups that CST may improve pain, anxiety and depression.
Does It Help With Migraines or Headaches?
In 2013, researchers looked at the effects of CST on migraines, using the HIT-6 questionnaire, which quantifies how much migraines are impacting a person’s daily life. 19 people divided into two groups received CST. Each group was assigned a different schedule for when they received the treatment and when to complete their questionnaires.
The researchers found that the scores on the HIT-6 improved for both groups. They write “the effect of migraines on the lives of the individuals in the research had been reduced during the overall study period from being “serious” down to “considerable” (1). So people with migraines got better...but there were no comparison groups to assess if there were placebo effects or contextual effects in play. This study provides very weak evidence that patients that got CST had improvements.
In 2017, researchers looked at the effects of CST on 49 subjects with cervicogenic headaches (headaches which have originated from the bones in your neck), and measured its effects via the HIT-6 again. Each subject received 9 CST sessions over the course of 3 weeks and kept headache diaries documenting the frequency and severity of their headaches.
The researchers found that the average HIT-6 score improved from pre-treatment to post-treatment and thus concluded “this study revealed that craniosacral therapy is an effective treatment strategy for patients of Cervicogenic headache as measured by HIT-6” (16). This conclusion is overstated because there was no comparison group receiving a placebo treatment or a control treatment. The researchers are not warranted to say that CST is effective, only that CST was associated with symptom reduction.
For patients with migraines or headaches, there is poor-quality evidence that there is symptom reduction associated with CST treatments.
Does It Help With Autism?
Despite significant uncertainty in the cause and treatment of autism, many have suggested CST can help. According to Tad Wanveer, a Licensed Massage Therapist associated with Mr. Upledger, CST may help with autism by “enhancing balanced motion” of the layers of tissue and fluid around the brain, as well as areas of the body that “do not show normal response to the craniosacral rhythm” (19).
There are no published and peer-reviewed trials investigating the effects of CST on patients with autism. There is one research article that looked at the benefits of CST from the perspective of clients, therapists, and parents of children with autism. Participants from the Upledger institute, social media sites for CST, and support networks for parents completed informal interviews and surveys.
Unsurprisingly, all three groups reported positive outcomes associated with CST (14). This cannot count as evidence, since all three groups will be biased in favor of CST, and subjective reports of experiences with CST do not carry the same explanatory weight as a controlled experiment would.
There are no proper experiments looking at CST for autism or any plausible mechanisms by which CST could work. We have no reason to believe it can be effective beyond the effects of gentle massage.
Does It Help With Infant Colic?
Infant colic is excessive crying thought to be due to gastrointestinal discomfort. Since infant colic is associated with significant distress for both baby and parents alike, many have sought effective treatments. In 2006, researchers looked at the effects of CST on infant colic versus no treatment and found that on average, the babies that received the treatment cried 63% less and slept 11% more over a period of 4 weeks.
The babies that did not receive the treatment cried 23% less and slept 2% more (12). But again, the researchers did not use a good comparison, as we might expect the extra handling time that occured during CST may have made the difference.
For infants with colic, there is weak preliminary evidence from a study without a comparison group that CST is associated with small reductions in symptoms.
Is Craniosacral Therapy Safe?
Craniosacral therapy sessions are physically safe and unlikely to cause injury. CST is simply a gentle head massage, and is thus as safe as any massage would be. I did not read any study that reported adverse events after CST treatments. However, while the sessions themselves are not likely to cause injury, choosing to get CST instead of real medical care is not advisable because it may result in further injury or disability.
Craniosacral Therapy Is Pseudoscience
Craniosacral therapy is a perfect example of an alternative medicine treatment. CST is not plausible, its mechanisms are not backed by science, and it has not had strong support from clinical trials, despite many practitioners and patients claiming to have success with it. Some research does show CST has benefits, likely due to the pleasantness of a head massage. But the studies that do so are poorly designed, biased, and do not let us conclude that CST is effective.
Multiple in-depth reviews and commentaries have suggested that CST has simply failed on the scientific front (4, 7, 8, 9, 13). Craniosacral therapy does not work, and educators, clinicians, and patients should leave it in the graveyard of dead medical ideas.
- CST is essentially gentle head massage and helps as much as a massage would.
- The theory behind CST is not plausible and has been debunked.
- The existing research is poorly designed, biased, or shows small effects of debatable value.
- The research from the Upledger Institute should be interpreted with caution, as there is a clear conflict of interest.
- There is no strong evidence that CST is helpful for any condition. If you have a medical problem you should seek professional care from a doctor, and craniosacral therapy cannot be recommended.
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