Head cases

If you live in a big city and are the parent of an under-five, you’ve probably heard of craniosacral therapy (CST).

CST is described by its advocates as ‘a gentle but profound form of treatment that works at the deepest level of the human system’. CS therapists claim that the bones of the skull are designed to accommodate movement, and are in constant motion in response to a pulsation known as the ‘craniosacral rhythm’ – a rhythm different and more subtle than that caused by breathing or heartbeat.

The ‘craniosacral system’ – made up of the central nervous system, cerebrospinal fluid, dural membranes, skull bones and the sacral vertebrae at the base of the spine – is said to contain our primary life force, which it distributes around the body. And apparently, if your ‘craniosacral rhythm’ is disturbed, your sense of wellbeing is undermined and you start to feel unwell.

It’s not surprising that some parents are attracted to CST. Bringing up a baby can be an anxious time, and when your baby develops something like colic – which can seem impossible to get rid of – a therapy that claims to target the supposed core of our entire physical wellbeing can seem attractive.

Indeed, some midwives, GPs and health visitors actively promote CST to new mothers. CS therapists suggest that all babies – irrespective of the type of delivery (vaginal, instrumental or Caesarean section) – should have a CST check-up soon after birth, ‘to ensure there are no residual problems that might compromise future healthy growth’. A centre in Bristol in the UK is offering free check-ups to babies under six weeks old, while recommending check-ups every three months for babies, and every six months for children. One London clinic encourages mothers and babies to have CST together, and offers a price discount as an incentive.

The question is, where is the evidence that CST works?

• What is CST?

There is no standard definition of CST. It was first described by William Garner Sutherland, an American osteopath, in the 1930s, but has now developed into a modality in its own right.

The description of CST, and the outline of its functions, can vary from one therapist to another. According to a conventional explanation, you have to ‘imagine a jellyfish expanding and contracting as it moves through the water. A similar, but far more subtle pulsation exists in human beings…. The cranial rhythm, as this pulsation has become known, arises out of the central nervous system and the cerebrospinal fluid that surrounds it. It can be felt throughout the body’s tissues and is fundamental to the healthy functioning of all the other body systems. When the rhythm becomes restricted or blocked, discomfort and, eventually, disease processes set in. Craniosacral therapy is a gentle way of working with the body that utilises the cranial rhythm in a diagnostic and therapeutic way’ (1).

Proponents of New Age theories talk up the benefits of CST in the language of ‘energy medicine’, a pseudoscientific concept. ‘Sutherland saw the craniosacral system…as containing our primary life force, which he called the “Breath of Life”‘, says therapist Matthew Appleton. ‘The fluctuation of the cerebrospinal fluid within the dural membranes, which surround the brain and spinal cord, takes up the vital energy or potency of the Breath of Life, distributing it throughout the rest of the body.’ (2)

William Garner Sutherland’s original description is also illuminative: ‘The fluctuation of the cerebrospinal fluid has a potency with an intelligence, as I found out. The potency is an invisible “fluid” within the cerebrospinal fluid. The potency of the Tide is what we have to consider….’ (3)

Over the past 20 years, osteopathy, from which CST originated, has shifted its emphasis from correcting structural lesions towards only energetic and emotional ‘dimensions’. Like much complementary and alternative medicine, CST is more prevalent in the USA than in the UK – but it is rapidly gaining a foothold in Britain. There are clinics and schools in London and Bristol, and the fact that some CST practitioners come from professional health backgrounds, and continue to practice as nurses, midwives, dentists and physiotherapists, is positively advertised.

• What do CS therapists do?

CS therapists graduate after one year’s training – they don’t need to be qualified as osteopaths or chiropractors. They do not diagnose patients’ ills in a conventional way or treat specific conditions, but listen, via their hands placed on the person’s head, sacrum or any other appropriate part of the body, to what the body is ‘saying’.

Through very gentle touch, the therapist claims to be able to detect subtle patterns of motion – rhythms, pulls and pulsations – that emanate from deep within the body’s core structures. ‘The touch does not so much manipulate or massage’, says Appleton, ‘as simulate the potency of the system into action by reflecting its pattern of holding, rather like a counsellor brings awareness to their client verbally’ (4).

In the process of detecting disturbances in the cranial rhythm, the therapist builds up a holographic image of underlying trauma patterns, and facilitates their release. This ‘release’ is sometimes accompanied by emotional outbursts, and therapists claim that memories connected with the trauma or injury can also arise and be expelled. The therapist then stimulates the rhythm in a way that encourages a return to normal functioning.

Treatment is comforting and pleasant, creating a sense of ease and wellbeing. Babies can be treated while cradled in their mother’s arms and even while asleep. And it isn’t necessary to undress for a treatment because the craniosacral patterns can apparently be felt through clothing and nappies.

CS therapists claim that people of all ages, but especially children, can benefit from CST. They believe that prenatal events, the birth process and childhood experiences can have a profound effect on babies, sometimes resulting in physical or emotional traumas. If these traumas aren’t resolved, CS therapists claim, they can last into adulthood, and may result in conditions like arthritis, autism, cerebral palsy, dyslexia, epilepsy, headaches, hyperactivity, impotence, jaw disorders, learning difficulties, stress-related conditions and visual disturbances.

Take this CS case study: a 15-year-old boy began to develop a ‘pigeon chest’, so an orthopaedic specialist considered applying a brace to stop it getting worse. But in the course of CS therapy, the boy reported that he felt vulnerable, choked up and constricted in his throat – and he used defensive gestures, such as drawing his neck down into his shoulder and raising his right shoulder while twisting it forward. He claimed frequently to dream that he could not breathe and that he was drowning.

The CS therapist discovered that the boy was born with his umbilical cord wrapped around his neck and suggested that, whatever other factors were involved in the development of his pigeon chest, ‘the initial birth trauma was clearly a major influence’ – claiming that ‘the protective reflex that he expressed in therapy had been active in his tissues from that time directing the shape that his body was taking’ (5).

The boy moved away after a few sessions of CST, and he is not thought to have pursued the therapy any further.

• Is there any basis to CST?

A basic knowledge of anatomy – including knowing that the bones of the skull (cranium) fuse during infancy – should be enough to refute CS therapy. But, as is often the case with complementary and alternative medicines, well-established scientific facts are disputed or even refuted, and there is little compulsion to provide scientific evidence to support the alternative theory. So flying in the face of scientific fact, CS therapists believe that the cranium does not fuse or ossify its sutures until well into later life, suggesting that through the manual manipulation of individual cranial bones they can influence health or disease.

It is of course true that a baby’s head is compressed during the birth process. The skull, however, is designed to adapt to the pressure exerted on it during birth and remoulds into its normal shape in a child’s early months and years. It is also true that some babies suffer brain injuries while still in the womb or while being born, but this is rare. While we can know these things for sure, evidence that CST can positively influence the outcome of any trauma caused before, during or after birth simply doesn’t exist (6).

CS therapists also believe that the brain pulsates and that there is a rhythm to the ‘cranio-sacral system’ (primary respiration) independent of other measurable physiological body rhythms (heart rate or respiration). Yet studies have failed to provide valid evidence for this.

There has been little scientific research into CST, and no valid scientific trials demonstrating its effectiveness have been held. A systematic review of the available evidence was undertaken in 1999, where the reviewers reported that the quality of the literature available was of poor methodological quality, was highly variable, lacked consistency and did not allow any logical ‘positive’ conclusions regarding craniosacral therapy. They concluded that ‘there is insufficient scientific evidence to recommend craniosacral therapy to patients, practitioners or third party payers for any clinical condition’ (7).

A report published in autumn 2001 on the effectiveness of chiropractic spinal manipulation found that spinal manipulation had no appreciable effect on babies suffering from colic in comparison with babies who receive a placebo (tender loving care) under controlled conditions (8).

Like many alternative therapists, CST advocates believe that scientific proof of efficacy should not be required for alternative therapies – suggesting instead that ‘positive patient outcomes as a result of CST 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’ (9).

So in short, CST advocates seem to argue that evidence that CST works should be dervied from generalising from the experience of observing a number of patients, rather than from objective and scientific proof.

• So what’s wrong with CST?

Despite the dearth of evidence for the efficacy of CST, CS therapists continue to promote its use for people of all ages and babies in particular. This is disingenuous. Patients are being taken for a ride by people who, while being scornful of scientific medicine, seduce patients into believing they need to have sessions of a worthless therapy for their wellbeing.

And it’s a cheap psychological ploy. Parents can be vulnerable when it comes to their newborn babies, and will try any number of therapies, either to help an existing problem or to prevent one from occurring, ‘just in case’. The notion that any type of delivery can cause a potential ‘craniosacral imbalance’, which ‘may in turn inhibit full and proper growth and development’ (10) can panic parents into believing that their babies must see a CS therapist. And offering free sessions to small babies suggests an urgency to the treatment that doesn’t exist.

The promotion of cheap, free and ‘urgent’ sessions also ensures more and more new recruits to CST. As increasing numbers of CS and CAM practitioners are being trained, they end up competing with each other for patients. As one chiropractor and outspoken critic of the profession said of the developing field of paediatrics in chiropractics: ‘You push heavy with the pediatrics because no one wants anything to happen to their kids.’ (11)

CST literature claims that children with special needs, such as autism and cerebral palsy, respond well to CST – even going so far as to suggest that conditions like autism and asthma ‘often have their roots in birth trauma’ (12). So parents of autistic children, who are already desperate and hopeful for some kind of ‘cure’, now have yet another implausible causative theory and improbable cure to look into.

CS therapists like to promote themselves as alternative and holistic – but they tend to associate themselves opportunistically with real scientific medicine. ‘CST system represents a bridge between conventional anatomy and physiology and pure energy medicine’, says Appleton (13). There may be no evidence for the existence of a ‘human energy field’, but still pseudo-science is used to give CST some much-needed legitimacy.

When promoted by health professionals, as is increasingly the case, CST is granted such undeserved legitimacy. This might be beneficial to CS therapists, but it is not good for parents or patients. And that it helps to undermine and discredit scientific medicine should be cause for concern to health professionals everywhere.

It is time that health professionals, and the public, took a long, hard look at CST and exposed it for what it really is – medieval mysticism dressed up in quasi-scientific garb.

Bríd Hehir is a contributor to Alternative Medicine: Should We Swallow It? (Hodder & Stoughton, 2002). Buy this book from Amazon (UK).

Read on:

Put alternative medicine back in its box, by Dr Michael Fitzpatrick

The rise and rise of CAM, by Bríd Hehir

Watered-down science, by Howard Fienberg

Touching a nerve, by Sarah Glazer

(1) The Bristol Centre for Craniosacral Therapy website

(2) The Bristol Centre for Craniosacral Therapy website

(3) Institute of Craniosacral Studies website

(4) The mind/body connection in craniosacral therapy on the Bristol Centre for Craniosacral Therapy website

(5) The Bristol Centre for Craniosacral Therapy website

(6) Articles on cranio-sacral therapy, by Thomas Attlee, on the College of Craniosacral Therapy website

(7) ‘A systematic review and critical appraisal of the scientific evidence on craniosacral therapy’, A Kazanjian et al, British Columbia Office of Health Technology Assessment 1999

(8) ‘Randomised controlled trial of infantile colic treated with spinal manipulation’, E Olafsdottir E et al, Archive of Disease in Childhood 2001; 84: 138-141

(9) ‘A systematic review and critical appraisal of the scientific evidence on craniosacral therapy’, A Kazanjian et al, British Columbia Office of Health Technology Assessment 1999

(10) Articles on Cranio-Sacral Therapy, by Thomas Attlee, on the College of Craniosacral Therapy website

(11) Comments made by Dr Charles DuVall, an Ohio-based chiropractor. Quoted in ‘Do chiropractors treat anything?’, by Paul Benedetti, 13 November 2001, on the Canoe website

(12) The Bristol Centre for Craniosacral Therapy website
(13) The Bristol Centre for Craniosacral Therapy website