Craniosacral Therapy

***Disclaimer: This blog is not meant to be used as legal or medical advice.  It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

Today on The Integrated Pharmacist Podcast, we're talking about Craniosacral Therapy.  This is a branch of medicine closely associated with Osteopathy.  It involves the gentle manipulation of the skull and spine to induce self-healing.  Dr. William Garner Sutherland developed this modality as an extension of osteopathy.  He studied the human skull as his life's work.  Although he had been taught that the bones of the skull were fused, his experience lead him to develop his theory of the Primary Respiratory Mechanism.  This theory describes the flow of cerebro-spinal fluid, the slight movements of the skull and the involuntary movement of the sacrum.  This mechanism is called primary because of its central role in the body and its ability to heal.  Respiratory refers to the influx and outflow that he sensed around the skull.  A skilled osteopathic physician trained in cranial therapy attempts to sense this ebb and flow and guide the body to work with this "respiration".  According to the Osteopathic Cranial Academy website, the physician should be able to sense and manipulate the respiration of the CNS by touching nearly any part of the body.

From my experience researching other modalities, I see a few challenges in creating a solid clinical trial to measure the effectiveness of craniosacral therapy.  This appears to be heavily dependent on the skill and sensitivity of the practitioner's touch.  This can vary widely among therapists who feel competent in their ability.  This modality also relies on the patient's body's ability to heal itself.  The primary focus is providing the ideal structural support to allow healing within the body.  Because of this, it may be difficult to measure an exact outcome.  Everyone's body might experience healing in different ways.  For example, a healthy patient undergoing craniosacral therapy may feel very tired afterward or they may feel quite energized.  Both outcomes appear to be a positive result of therapy, but they are contradictory measures.
Although I did not have full access to the more superior clinical trials regarding this therapy, I did find a meta-analysis that encompassed 6 randomized controlled trials regarding the efficacy of a specific craniosacral treatment called the compression of the fourth ventricle or CV4.  Using the Downs and Black measure for clinical trial quality, these six trials ranged from 17 to 24 out of a

maximum of 27 points.  The analysts concluded that this therapy might be beneficial for several functional problems; however, 5 of the 6 trials compared only healthy patients.  One significant finding was CV4 influence on pain for those suffering tension headaches.  This specific trial compared patients receiving CV4 with those who received a special osteopathic resting position and patients receiving no intervention.  I found this statistic interesting because of the relationship of therapy to the cause of tension headaches.  Although we often experience tension headaches somewhere around the face or scalp, most tension headaches are caused by strain of the muscles along the back of the skull and neck.  The CV4 technique manipulates the skull around these muscles.  I can see how this therapy would reduce headache pain by helping those muscles relax, but it could potentially be due to other adjustments of the musculoskeletal system.
In order to receive this treatment, a standard 1 hour treatment costs $150.  However, most craniosacral therapists require an introductory evaluation that costs $175.  Some insurance plans might cover this therapy, but it is unlikely.  Because of the price and the current trials, the best recommendation for craniosacral therapy would be for tension headache.  However, my personal experience would guide patients to cheaper therapies such as massage or a shower (that is if Tylenol wasn't an option).  To learn more including a list of clinical trials, please visit The Osteopathic Cranial Academy at cranialacademy.org.
That's it for today's episode.  Thank you once again for joining me.  For comments, questions, concerns or suggestions, please reach out at integratedpharmacist@gmail.com.  You can also find me on facebook and instagram as the Integrated Pharmacist.  Be sure to subscribe so you can join us again next week on The Integrated Pharmacist Podcast.
References:
McAree M, Dunn A, Furtado J, Timmerman C, Winchell Z, Rani R, Farah J, Crispino LJ. Osteopathic Cranial Manipulative Medicine and the Blood-Brain Barrier: A Mechanistic Approach to Alzheimer Prevention. J Am Osteopath Assoc 2019;119(6):e25–e28. doi: 10.7556/jaoa.2019.07