Art of Osteopathy (2021) Cranial Bone Mobility https://osteodoc.com/cranial-bone-mobility/ (Accessed 2021-11-28)
Good collection of references on Sutherlands core cranial concepts.
BCOHTA (1999) A systematic review and critical appraisal of the scientific evidence on craniosacral therapy. British Columbia Office of Health Technology Assessment
Cross reference with Green et al 1999
Białoszewski D, Bebelski M, Lewandowska M and Słupik A (2014) Utility of craniosacral therapy in treatment of patients with non-specific low back pain. Preliminary report. Ortop Traumatol Rehabil. 2014 Nov-Dec;16(6):605-15.
Conclusions: 1. Craniosacral therapy and trigger point therapy may effectively reduce the intensity and frequency of pain in patients with non-specific low back pain. 2. Craniosacral therapy, unlike trigger point therapy, reduces the resting tension of the multifidus muscle in patients with non-specific lumbosacral pain. The mechanism of these changes requires further research. 3. Craniosacral therapy and trigger point therapy may be clinically effective in the treatment of patients with non-specific lumbosacral spine pain. 4. The present findings represent a basis for conducting further and prospective studies of larger and randomized samples.
Bordoni B, Walkowski S, Ducoux B, Tobbi F (2020) The Cranial Bowl in the New Millennium and Sutherland's Legacy for Osteopathic Medicine: Part 1. Cureus 12(9)
'Cranial manual osteopathic medicine is very controversial, although it is commonly practiced, from the clinician to the nonmedical health worker. The article, divided into two parts, reviews the assumptions with which the cranial model was created, highlighting the scientific innovations and new anatomicalphysiological reflections. In the first part we will review the synthesis and movement of cerebrospinal fluid (CSF), the movement of the central and peripheral nervous system; we will highlight the mechanical characteristics of the meninges. The aim of the article is to highlight the need to renew the existing cranial model.'
Bordoni B, Walkowski S, Ducoux B, Tobbi F (2020) The Cranial Bowl in the New Millennium and Sutherland's Legacy for Osteopathic Medicine: Part 2. Cureus 12(9)
'In the first part we reviewed the role of the meninges and cerebrospinal fluid (CSF), as well as we discussed some rhythms present in the central nervous system; these latter elements are the pillars to support the theoretical idea of the movement of the skull evaluated and palpated by the osteopath. In this second part we will review the mechanical characteristics of other structures that make up the cranial system, highlighting new perspectives for clinical practice, thanks to the most recent data derived from scientific research.'
Brough N, Lindenmeyer A, Thistlethwaite J, Lewith G, Stewart-Brown S (2015) Perspectives on the effects and mechanisms of craniosacral therapy: A qualitative study of users’ views. European Journal of Integrative Medicine 7 (2015) 172–183
Introduction: Craniosacral Therapy (CST) is a ‘body based’ complementary or alternative medical practice which aims to support natural healing mechanisms. There is limited evidence regarding its effectiveness or mechanisms of action.
Methods: Qualitative study based on constant comparative methods informed by grounded theory. Semi-structured interviews explored 29 participants’ experiences with CST. Inductive thematic analysis resulted in themes, concepts and illustrative quotes.
Castejón-Castejóna M et al (2019) Effectiveness of craniosacral therapy in the treatment of infantile colic. A randomized controlled trial. Complementary Therapies in Medicine. Vol 47, Dec 2019, 102164
•CST helps in reducing crying hours and colic severity in infantile colic.
•CST helps to increase the sleep hours in infants dealing with infantile colic.
•It would be interesting to perform a RCT with long-term follow up.
This randomized controlled trial was conducted on 58 infants, aged 0–84 days, diagnosed with infantile colic. The babies received a 30–40 minute CST session once a week (experimental group) or no treatment (control group). Babies in the CST group received either 1, 2 or 3 CST sessions over a 14-day period. Data were collected at 4 different times over the 24-day period, day 0 (baseline), day 7, day 14 and day 24. Crying (primary outcome) and sleep (secondary outcome) were evaluated using a crying and sleep diary, and colic severity was measured using the Infant Colic Severity Questionnaire (secondary outcome).
Castro-Sanchez AM et al (2016) Benefits of Craniosacral Therapy in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine Vol 00, No 0, 2016, pp. 1–8
Conclusions: Ten sessions of craniosacral therapy resulted in a statistically greater improvement in pain intensity, hemoglobin oxygen saturation, systolic blood pressure, serum potassium, and magnesium level than did 10 sessions of classic massage in patients with low back pain.
Cook A (2015) Reply to: Arguments for and against movement at the spheno-occipital synostosis: Furthering the debate. Richard Starkey (2015) International Journal of Osteopathic Medicine 18(2) pp102-115. http://www.hummingbird-one.co.uk/resources2.html
Read alongside Starkey 2015. In-depth debate on movement between sphenoid and occiput.
CSTA (2021) Research studies www.craniosacral.co.uk (Accessed 2021-11-28)
Collection of research relevant to craniosacral therapy CST.
For original research by the CSTA (Craniosacral Therapy Association UK) check Brough 2015.
Dreha-Kulaczewski S, Joseph AA, Merboldt KD, Ludwig HC, Gärtner J, and Frahm J (2017) Identification of the Upward Movement of Human CSF In Vivo and its Relation to the Brain Venous System. The Journal of Neuroscience, March 1, 2017 37(9):2395–2402
'CSF moved upward toward the head in response to forced inspiration. Concomitant analysis of brain venous blood flow indicated that CSF and venous flux act as closely communicating systems.'
Ernst E (2012) Craniosacral therapy: a systematic review of the clinical evidence. Focus on Alternative and Complementary Therapies December 2012 17(4)
Abstract Aim Craniosacral therapy (CST) is a popular treatment for a wide range of conditions. This systematic review evaluates the evidence of effectiveness for CST for any human condition.
Method An electronic search for relevant studies was conducted across three databases; this was complemented by extensive hand-searching of departmental files and bibliographies. Articles were included if they reported RCTs of CST for any human condition. Data were extracted according to predefined criteria and trial quality was determined using the Jadad score.
Results Six studies were included. Except for one, all were associated with a high risk of bias. Low quality studies suggested positive effects, while the high-quality trial failed to demonstrate effectiveness.
Conclusion The notion that CST is associated with more than non-specific effects is not based on evidence from rigorous RCTs.
Green C, Martin CW, Bassett K, Kazanjian A (1999) A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complementary Therapies in Medicine (I 999), 7, 201-207
Cross reference with BCOHTA 1999
'This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.'
Grubb S and Lauritzen M (2019) Deep sleep drives brain fluid oscillations. Science 1 Nov 2019 Vol 366 Issue 6465 sciencemag.org
'CSF (cerebrospinal fluid) is produced by the choroid plexuses and flows from the lateral ventricles into the third ventricle and then to the fourth. CSF then passes into the subarachnoid space surrounding the brain and spinal cord; there, it normally moves along the brain convexity to the top of the brain, where it is absorbed in the arachnoid granulations of the dural venous sinuses. Fultz et al. describe reversal of the direction of CSF flow during SWS (slow wave sleep). Most likely, CSF flows from the subarachnoid space to the fourth and third ventricle. The waves of CSF inflow were generated by the slow electrical brain oscillations and the corresponding fluctuations in blood flow and cerebral blood volume. CSF flow mediates mixing of brain fluids, facilitates signaling through volume transmission of neuromodulators, and increases the disposal of potentially harmful substances.'
Haller H, Lauche R, Sundberg T, Dobos G and Cramer H (2020) Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders Vol 21, Article number: 1 (2020)
'In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months.'
Jinich-Diamant A, Garland E, Baumgartner J, Gonzalez N, Riegner G, Birenbaum J, Case L and Zeidan F (2020) Neurophysiological Mechanisms Supporting Mindfulness Meditation–Based Pain Relief: an Updated Review. Current Pain and Headache Reports (2020) 24:56
Kratz SV and Kratz DJ (2021) Effects of CranioSacral therapy upon symptoms of post-acute concussion and Post-Concussion Syndrome: A pilot study. Journal of Bodywork and Movement Therapies. Vol 27, Jul 2021, 667-675
Objective: The purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences.
Conclusions: Patient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.
Defn Craniosacral Therapy: CST includes examination of the craniosacral system through gentle palpation at multiple sites, including the cranium, the thoracic and lumbar spine, the sacrum, and the feet. (Complementary Therapies for Physical Therapy, 2008)
Kratz SV et al (2016) The use of CranioSacral therapy for Autism Spectrum Disorders: Benefits from the viewpoints of parents, clients, and therapists. Journal of Bodywork & Movement Therapies (2016) http://dx.doi.org/10.1016/ j.jbmt.2016.06.006
Mann J et al (2012) P02.55. Craniosacral therapy for migraine: a feasibility study BMC Complementary and Alternative Medicine 2012, 12(Suppl 1):P111
Conclusion: Our results show that conducting a randomized clinical trial of CST for migraine using a standardized protocol is feasible and that adjunctive CST may reduce headaches in those with severe migraine. Protocol modifications may enhance future investigations of CST for migraine.
Mataran-Penarrocha GA et al (2009) Influence of Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia. Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 178769, 9 pages
McPartland JM and Skinner E (2005) The Biodynamic Model of Osteopathy in the Cranial Field. Explore January 2005, Vol. 1, No. 1
"The forces of embryogenesis become the forces of healing after birth."
Muñoz-Gómez et al (2022) Effect of a Craniosacral Therapy Protocol in People with Migraine: A Randomized Controlled Trial. J. Clin. Med. 2022, 11(3), 759
Conclusions: A protocol based on craniosacral therapy is effective in improving pain, frequency of episodes, functional and overall disability, and medication intake in migraineurs. This protocol may be considered as a therapeutic approach in migraine patients.
Nelson KE, Sergueef N, Glonek T (2006) The effect of an alternative medical procedure upon low-frequency oscillations in cutaneous blood flow velocity. JMPT Vol 29, No 8
'This study showed that CV-4 has an effect on the Traube-Hering frequency component of blood flow velocity. The practitioners of cranial manipulation who participated in this study affected their subjects in a quantifiable manner with the application of the CV-4 procedure.'
Osteopathic Cranial Academy (2021) Research - News Highlights www.cranialacademy.org (Accessed 2021-11-28)
The Osteopathic Cranial Academy is a professional membership organization dedicated to the teaching and support of post-graduate training in osteopathy.
Their research news highlights page is a useful collection of news relevant to the cranial concept.
Raith et al (2016) General Movements in preterm infants undergoing craniosacral therapy: a randomised controlled pilot-trial. BMC Complementary and Alternative Medicine 16:12
'craniosacral therapy seems to be safe in preterm infants.'
Rao K and Khatri S (2017) Effectiveness of craniosacral therapy in cervicogenic headache. MOJ Yoga & Physical Therapy, Vol 2 Issue 4 - 2017
Conclusion: Craniosacral therapy is an effective treatment strategy for patients of Cervicogenic Headache as measured on HIT-6 during a 3week treatment program.
Rasmussena TR and Meulengrach KC (2021) Direct measurement of the rhythmic motions of the human head identifies a third rhythm. JMBT 26 (2021) 24-29
Introduction: Central to the osteopathic cranial field, and at the same time controversial, is the concept of a unique rhythmic movement believed to originate from a primary respiratory mechanism (PRM). Further, the PRM is reported to manifest as a cranial rhythmic impulse (CRI) on the living human skull. This study explores the rhythmic oscillations of the human head measured directly as physical movements. The aim is to investigate the existence of a third rhythm distinct from the head movementscaused by respiratory breathing and arterial pulsing, in an objective and purely experimental study.
Experimental: In 50 healthy individuals, rhythmic oscillations of the head were measured in real-time for 42 min in a supine resting state without any intervention. A newly developed machine for tracking rhythmic movements was used for measurements.
Results: In all individuals, a third rhythm was distinguished as separate from the arterial and respiratory rhythm at all times. The third rhythm was observed as a dynamic physiological phenomenon with anarrow range in resting healthy individuals with a mean of 6.16 cycles/minute (4.25-7.07). The significant contribution to the amplitude of the measured movements was the respiratory breathing and this third rhythm, whereas the contribution from the arterial pulsing were minor.
Conclusion: The present study demonstrates the existence, and normative range of a third physical rhythm detected on the human head. Having developed an objective approach to studying this third rhythm might form the future basis for clinical and physiological studies of craniosacral function and dysfunction.
Rogers JS, Witt PI (1997) The Controversy of Cranial Bone Motion. JOSPT Volume 26 Number 2 Literature Review
Conclusion: Anatomic studies on sutural union provide evidence that sutures may not fuse until late in life and perhaps not at all in some cases. Biomechanical evidence clearly shows that adult human suture has properties very distinct from that of cranial bone, making it highly improbable that sutures are completely ossified as some authorities have contended.
Research on cranial bone motion has shown that cranial sutures may play a significant role in cranial compliance to increases in intracranial pressure in adult humans and animals, indicating the need for revisiting the concept of a physiologically rigid cranium. Therefore, a small magnitude of motion may be possible between the bones of the cranium.
However, a number of those published studies supporting cranial bone motion lacked evidence of scientific rigor. Physical therapists should carefully scrutinize the literature presented as evidence for cranial bone motion.
Further research is needed to resolve this controversy. Outcomes research, however, is needed to validate cranial bone mobilization as an effective treatment.
Seimetz CN, Kemper AR and Duma SM (2012) An investigation of cranial motion through a review of biomechanically based skull deformation literature. International Journal of Osteopathic Medicine (2012) 15, 152-165
'The review of literature regarding cranial motion illustrated that both externally applied forces and increases in intracranial pressure result in measurable motion across the cranial sutures in adolescent and adult mammalian species, and measurable changes in cranial vault diameter in post-mortem and living adult human skulls.'
Starkey R (2015) Arguments for and against movement at the spheno-occipital synostosis: Furthering the debate. International Journal of Osteopathic Medicine (2015) 18, 102-115
Great, in-depth, discussion on movement at the junction between the sphenoid and occiput
Background: The junction between the sphenoid and occipital bones fully ossifies by age 18, forming the spheno-occipital synostosis. William Sutherland and most subsequent craniosacral authors hold that, in adults, cranial motion is, in part, enabled by movement of the synostosis.
Objectives: To review arguments for and against movement at the synostosis, and the extent to which statements by craniosacral authors regarding the synostosis accord with the mainstream anatomical understanding of their day.
Stub T et al (2020) Combining psychotherapy with craniosacral therapy for severe traumatized patients: A qualitative study from an outpatient clinic in Norway. Complementary Therapies in Medicine.
Conclusion: According to data from this qualitative study, patients with complex traumas including PTSD benefit from being treated holistically, with a mixture of different treatment modalities, including a bodily oriented modality such as craniosacral therapy. According to the study participants, this modality was particularly beneficial for patients who did not benefit from psychotherapy due to physical complaints. However, in order to prevent harm to patients, craniosacral therapy for severely traumatized patients should only be provided in cooperation with psychotherapists, or other highly qualified health personnel working in professional institutions. Routines for documenting adverse effects are recommended.
Tobey et al (2019) Effect of Osteopathic Cranial Manipulative Medicine on an Aged Rat Model of Alzheimer Disease. Journal of Osteopathic Medicine
Discussion: The majority of osteopathic physicians practice as primary care physicians and provide medical care for older patients. Osteopathic physicians who practice OMM use these techniques to improve the symptoms of various disorders. Although clinically effective, the underlying mechanism for the effect of OCMM (Osteopathic Cranial Manipulative Medicine) is not well understood. The knowledge on glymphatic and meningeal lymphatic systems in the brain lends credence to the theory that OCMM improves CNS fluid circulation. However, there remains a void in scientific evidence supporting the capability of OCMM techniques to alter fluid dynamics and lymphatic circulation in the brain or other underlying mechanisms of improved clinical outcomes. If OCMM is capable of improving CNS fluid circulation, it could represent a minimally invasive means to take advantage of the CNS glymphatic system to overcome the age-related deficits in cerebrovascular fluid circulation and metabolic exchange that may be contributing to AD.
Manipulation-induced skull deflections have been extensively studied in live nonhuman primates, dogs,cats, rabbits, and unembalmed human cadaver heads. These studies have revealed that a mechanical pressure can cause cranial deflections up to 910 μm based on the region of the skull.45 These cranial deflections may influence fluid circulation through the glymphatic periarterial influx and meningeal lymphatic perivenous efflux pathways that run close to the cranial bones. The function of glymphatic and meningeal lymphatic pathways is largely regulated by the water channels (AQP4) expressed in the perivascular astrocyte end-foot processes. This is in agreement with a significant increase in AQP4 protein expression in the OCMM-treated rats compared with UT rats (Figure 3H). This finding, combined with the other biochemical and behavioral changes we reported, supports the notion that OCMM-induced cranial bone deflections can potentially improve fluid circulat
Wen-Bin J et al (2023) Effectiveness of craniosacral therapy in the human suboccipital region on hamstring muscle: A meta-analysis based on current evidence. Medicine 102(5):p e32744, February 3, 2023
'Conclusion: CST could change the flexibility of the hamstring muscles. CST had a better curative effect when compared to proprioceptive neuromuscular facilitation technique on the hamstring muscles.'
Wetzler G, Roland M, Fryer-Dietz S and Dettmann-Ahern D (2017) CranioSacral Therapy and Visceral Manipulation: A New Treatment Intervention for Concussion Recovery. Medical Acupuncture Vol 29, No 4, 2017 Mary Ann Liebert, Inc. DOI: 10.1089/acu.2017.1222
Conclusions: Ten sessions of specific CranioSacral Therapy (CST), Visceral Manipulation (VM), and Neural Manipulation (NM) therapy resulted in statistically greater improvements in pain intensity, ROM, memory, cognition, and sleep in concussed patients.
Yildiz S, Grinstead J, Hildebrand A, Oshinski J, Rooney WD, Lim MM, Oken B (2022) Immediate impact of yogic breathing on pulsatile cerebrospinal fluid dynamics. Sci Rep. 2022 Jun 28;12(1):10894.
"In examinations of 18 healthy participants, we observed immediate increase in cranially-directed velocities of instantaneous-CSF ... during four breathing patterns compared to spontaneous breathing, with the greatest changes during deep abdominal breathing."