Periodically some articles appear with almost evangelic fervour on the merits
of Craniosacral Therapy, yet the science behind this 'body, mind, spirit'
practice is seriously lacking. Here is a formal introduction to this form of
therapy from the following website, which bears the rather esoteric title of
"Craniosacral Therapy and SomatoEmotional Release":
INTRODUCTION TO CRANIOSACRAL THERAPY
<http://www.oz.net/~circle/cst.html>
"CranioSacral Therapy is light, non-invasive hands-on technique that helps
detect and correct imbalances in the CranioSacral system. These imbalances
may be the cause of sensory, motor or intellectual dysfunctions such as
headaches, neck and back pain, TMJ dysfunction, chronic fatigue, motor
coordination difficulties, eye problems, endogenous depression, hyperactivity
and central nervous system disorders.
" Any experience initially strikes the human body through the electrical
system (regardless whether the experience is easily perceived or not). The
impact immediately, almost simultaneously, shifts and translates into the
nervous system and routes itself throughout the nervous system appropriately
as it begins its identification and experience process, and continues its
impact into the CSF. The brain is impacted by both the nervous system
activity and the CSF pulse response to the impact. The cranial bones must
respond accordingly to accommodate this two pronged impact.
The range of bone movement will be affected; they run the risk of jamming or
misaligning. This is when so much of head pain associated with expanded
experience comes up. CranioSacral Therapy may be necessary for a short time
for the bones to properly adjust to and move in a more expanded range of
experience with ease, accuracy, and efficiency."
It continues thus:
"SomatoEmotional Release (SMR) is a therapeutic process that helps rid the
mind and body of residual
effects of past trauma and associated negative emotional experiences.Dr.John
Upledger and
biophysicist Dr. Zvi Karni research showed that body often retains (rather
than dissipates) physical
forces as the result of an accident, injury, or emotional trauma.Such area is
isolated, becomes
dysfunctional and an "energy cyst" is created. ...... CranioSacral Therapy
with SomatoEmotional Release will support your healing and spiritual
expansion by re-connecting your body, mind and spirit, and learning how they
work together for good health and wholeness "
*** While the aims of healing are most laudable, the manner in which
hypotheses, beliefs and placebos is being foisted on a world desperate for
relief from pain and suffering is rather questionable, especially if one
notes the remarkable lack of scientific evidence or even empirical data which
precludes the possibility of placebo effects or healing processes which have
nothing to do with cranial therapeutic touch.
The world of alternative healing is replete with the use of pseudoscientific
jargon, such as the misapplication of "energy fields", "bioenergetics" and
"psychic energy", and now we have "energy cysts" to add to the list. It
would be most interesting to read peer-reviewed research by the
above-mentioned physicist.
Before I proceed any further, let me state clearly that my article does not
posit that craniosacral therapy does not "work". On the contrary, there are
numerous similar apparently illogical, shamanistic, uncorroborated
therapeutic methods which regularly yield some definite benefits. What is of
concern is the dearth of any valid objective evidence based upon double blind
or similarly rigorous studies. Often the success of a given therapy is
attributed to factors which may have nothing much to do with the problem at
all, this being a very common issue in the world of therapy.
After all, many scientific articles have deduced that the placebo effect may
be a dominant factor in resolving in excess of 30 percent of all cases of
pathology. This is not even confined to the world of complementary healing,
since bogus cardiac bypass surgery (which simply made surgical chest
incisions suggestive of cardiac surgery) has been shown to enjoy comparable
healing effects to genuine bypass surgery. Thus, it is certainly possible
that a great deal of the apparent success of craniosacral therapy may be
associated with a placebo effect.
The beneficial effects of light touch or gentleness of approach is well know
in massage therapy, so such a statement should not be dismissed out of hand.
It would be very interesting to see uncommercialised objective research into
the spectacular claims of craniosacral healing in resolving a huge range of
physical and mental disorders (see the Table of applications below).
MORE INFORMATION SOURCES
Here is the official site of John Upledger, the osteopath who has been most
prominent in promoting craniosacral therapy:
http://upledger.com/index.html
For those who wish to delve somewhat deeper:
Craniosacral References and Articles
<http://iahe.com/magnet.htm>
The Journal of the Craniosacral Therapy Association of the UK
<http://www.craniosacral.co.uk/articles.htm>
Here is a quotation from Upledger's section warning that magnets may actually
be harmful as a from of therapy:
<http://iahe.com/magnet.htm>:
<In some cases large amounts of external heat may enter a living system.
This heat may be stored as energy within the system, creating an imbalance
(dysequilibrium). This storage of external energy with its secondary
dysequilibrium may continue for an extended period of time, often years. The
system in question may become
hypersensitive due to the internally stored external energy. A very small
stimulus can then produce an inordinately large energetic response from the
living system without the release of heat. >
***The implication that heat can be "stored" in a system which is open to the
environment is absurd, unless, of course, he is referring to a body whose
temperature is the same as its surroundings or of the body has some perfect
insulators preventing heat transfer in and out of the body.
Here are other dubious statements which others may care to analyse:
<Calcium and magnesium, for example, are frequently involved in enzymatic
reactions that are millions of times stronger than the weak electromagnetic
field on the cell membrane surface. The heat release at the time
of the reaction, if present at all, is certainly not proportional to the
amount of energy in the enzymatic reactions. It seems quite reasonable that
magnetic fields may have a significant influence upon these nonheat-producing
reactions. In turn, these reactions may influence the magnetic environment.>
<From a biochemical perspective, I do think that it is possible that changes
in the magnetic field might cause the internal homeostatic mechanism of a
living system to work harder to maintain appropriate body pH. When proteins
are destructed, pH has to be affected, and a change in body pH can cause a
myriad of physiological dysfunctions.>
WHAT CRANIOSACRAL THERAPY CAN DO
What is Craniosacral Therapy?
<http://www.craniosacral.co.uk/whatiscst.htm>
The following is a list of some of the common conditions which craniosacral
therapy claims to resolve:
Arthritis Insomnia
Asthma Lethargy
Autism Menstrual pain, PMS
Back pain Migraine
Birth trauma Post-operative
Bronchitis Problems during and after pregnancy
Cancer Reintegration after accidents
Cerebral Palsy Fall or injury
Colic Sciatica
Depression Sinusitis
Digestive problems Spinal curvatures
Drug withdrawal Sports injuries
Dyslexia Stress related illnesses
Exhaustion Tinnitus and middle ear problems
Frozen shoulder TMJ (jaw) disorders
Hormonal imbalances Visual disturbances
Hyperactivity Whiplash injuries
Immune system disorders
-------------------------------------------------
THE EVIDENCE?
It is surprising that a form of therapy which seems to have gained such
evangelistic support has not assembled a host of properly controlled
scientific studies. After all, modern technology has, for some years, been
able to monitor the intracranial pressure and waveforms in the cerebrospinal
fluid. Genuine medical research in some of these articles shows how
susceptible these intracranial measures are to a host of factors, including
nutrition, degree of hydration, position of head, posture, use of
pharmacological agents, disease states and temperature, so one wonders how a
cranio expert by some almost parapsychological means is able to discern which
single problem is manifesting itself in some miniscule cranial change.
Several years ago, a colleague of mine at the Medical School where I was
conducting research decided to scientifically analyse the claims of
reflexologists in being able to diagnose disease by examination of foot
points. He removed all medical "bed letters" of case histories in a general
ward, used a sheet to cover every patient except for the feet, and then asked
the several reflexologists separately to diagnose the condition for which the
patients had been admitted. The result was a resounding failure by all seven
reflexologists for all 20 patients.
It would be interesting to conduct a similar study using genuine craniosacral
techniques in patients who did not describe their conditions to the therapist
or have any typical therapist-patient contact to both diagnose and treat
various subjects. The control therapists would be some massage therapists
who apply typical nerve stroking and gentle techniques which they frequently
use for general "relaxation" and "destressing". It would be most intriguing
to ascertain if there would be any significant difference between general
massage techniques and "craniosacral" techniques. Has anyone seen research
along the lines which I have suggested?
Here are some peer-reviewed articles on measurement of intracranial pressures
and pulsations.
--------------------------------------------------
SCIENTIFIC ARTICLES ON INTRACRANIAL PROCESSES
J Neurosci Nurs 2000 Oct;32(5):271-7
Intracranial pressure waveform analysis: clinical and research implications.
Kirkness CJ, Mitchell PH, Burr RL, March KS, Newell DW
Assessment of intracranial adaptive capacity is vital in critically ill
individuals with acute brain injury because there is the potential that
nursing care activities and environmental stimuli to result in clinically
significant increases in intracranial pressure (ICP) in a subset of
individuals with decreased intracranial adaptive capacity. ICP waveform
analysis provides information about intracranial dynamics that can help
identify individuals who have decreased adaptive capacity and are at risk for
increases in ICP and decreases in cerebral perfusion pressure, which may
contribute to secondary brain injury and have a negative impact on neurologic
outcome. The ability to identify high-risk individuals allows nurses to
initiate interventions targeted at decreasing adaptive demand or increasing
adaptive capacity in these individuals.
Changes in the ICP waveform occur under various physiologic and
pathophysiologic conditions and may provide valuable information about
intracranial adaptive capacity. Simple visual assessment of the ICP waveform
for increased amplitude and P2 elevation is clinically relevant and has been
found to provide a rough indicator of decreased adaptive capacity. Advanced
ICP waveform analysis techniques warrant further study as a means of
dynamically assessing intracranial adaptive capacity.
-----------------------------------------
Isr J Med Sci 1977 Sep; 13(9):881-6
Effect of routine bedside procedures on intracranial pressure.
Shalit MN, Umansky F
The effect on intracranial pressure (ICP) of routine bedside procedures, such
as changing the patient's position, suction, rotation, flexion or extension
of the head, was investigated in 21 comatose patients with brain edema.
Simple maneuvers, which under physiological conditions have no effect on ICP,
often led to significant changes in the ICP in these patients. It is
suggested that monitoring of ICP and adjustment of body position in
accordance with the level of ICP become a standard procedure in neurosurgical
wards.
--------------------------------------------------
J Clin Monit 1992 Jan;8(1):81-90
Analysis of intracranial pressure.
Doyle DJ, Mark PW
Methods for the acqusition and analysis of intracranial pressure (ICP)
signals are reviewed from clinical and technical perspectives. The clinical
importance of ICP monitoring is presented, and methods for ICP transduction
are briefly discussed. These methods include intraventricular catheters,
subarachnoid screws, epidural techniques, and the new fiberoptic ICP
measurement systems. Approaches to the visual analysis of the ICP waveform
are presented, with special emphasis on the relationship between the ICP
waveform and the arterial blood pressure signal. Methods of computer-based
ICP analysis are also reviewed, including histogram and "systems analysis"
methods. Methods to predict ICP pressure rises and to estimate intracranial
compliance are also discussed. Finally, ICP monitoring is reviewed from the
point of view of patient outcome. It is concluded that advanced ICP waveform
analysis methods warrant further clinical evaluation to demonstrate their
clinical usefulness.
-------------------------------------
Br J Neurosurg 1998 Jun;12(3):223-7
A clinical evaluation of the Codman MicroSensor for intracranial pressure
monitoring.
Signorini DF, Shad A, Piper IR, Statham PF
The strain-gauge Codman MicroSensor intracranial pressure (ICP) transducer
has shown consistently good laboratory performance. To assess the practical
performance of the system in patients following acute brain injury, 10
patients were fitted with a MicroSensor and a second ICP monitor. In five
cases this was a fibre-optic transducer and in five cases an intraventricular
fluid-filled device. Paired ICP values were recorded every 5 min. ICP values
ranged from 0 to 31 mmHg. Altman-Bland plots showed that individual readings
could differ by as much as 9 mmHg. Further analysis showed that much of this
disagreement could be explained by a constant offset on each occasion.
Comparison traces of ICP in individual patients show high agreement in timing
and size of changes. The unexplained constant offset leads to uncertainty
about the true ICP. Treatment decisions are often based upon absolute levels
of ICP and patient care may therefore differ depending upon the monitor used.
-----------------------------------------------
Surg Neurol 1984 Jan;21(1):67-74
Epidural pulse waveform as an indicator of intracranial pressure dynamics.
Hirai O, Handa H, Ishikawa M, Kim SH
With an increase in intracranial pressure during epidural balloon inflation,
epidural pulse waveform, which is polyphasic under normal conditions, becomes
monotonous at about 30 mmHg. This change in waveform is considered closely
related to the apparent increase in arterial driving pressure to the brain
and to a disturbance of venous outflow. When cerebral vasodilatation is
prominent, the waveform becomes monotonous at a significantly lower
intracranial pressure. These findings correlate well with the results of
spectral analysis of the pulse wave. The usefulness of change in epidural
pulse waveform, which can indicate an alteration of intracranial pressure
dynamics in a relatively low pressure range, is discussed with comparison to
other techniques used to determine intracranial pressure dynamics.
-----------------------------------------------
Neurol Res 1986 Jun; 8(2):93-6
Non-invasive measurement in intracranial pressure and analysis of the pulse
waveform.
Kuramoto S, Moritaka K, Hayashi T, Honda E, Shojima T
Non-invasive measurement of the intracranial pressure (ICP) via the anterior
fontanelle by using an applanation transducer has been performed. Recently, a
new fontanometer using an applanation transducer has been developed in our
department by improving the conventional Statham transducer, P-50 which is
currently accepted for its high reliability. In this study, by analysing
patterns of the ICP pulse waves obtained from this new fontanometer, its
clinical evaluation has been made in 27 neonates and infants in intracranial
pathologies. Analysing the ICP waveforms, the first peak (P1) was divided by
the following second peak (P2) and the changes in P1/P2 were examined. A
differential amplifier, a dP/dt detector, was also used to make it easier to
identify the turning point on the pulse waves. The results obtained
demonstrated that the waveforms of ICP in neonates as well as infants are
influenced by not only the intracranial constituents but compliance of the
container such as the scalp, cranium and the meninges.
-----------------------------------------------
Br J Anaesth 1991 Apr;66(4):476-82
Systems analysis applied to intracranial pressure waveforms and correlation
with clinical status in head injured patients.
Lin ES, Poon W, Hutchinson RC, Oh TE
Intracranial pressure waveforms (ICPWF) in head injured patients vary with
the nature and severity of injury. Clinical interpretation of ICPWF shape is
not defined. Spectral analysis provides an objective method of measuring
changes in waveform shape, but the indices most suitable for clinical use
remain unknown. Spectral analysis has been applied to ICPWF recorded from 30
patients with head injury, classified on clinical grounds into good, poor and
intermediate groups. Normalized indices derived from ratios of certain
characteristics of the ICP waveform to those of the arterial pressure (AP)
waveform, were different (P less than 0.05) in all groups. A simple index
examined was the harmonic count ratio (Nc:Na) which decreased with
increasing severity of injury. ICP/AP harmonic transfer functions were
derived, and demonstrated a peaked response in the range 10-12 Hz. Increasing
attenuation of this peaked response occurred with increasing severity of
injury. These results suggest that transfer unctions may be a clinically
useful index of intracranial conditions.
----------------------------------------------------------
J Neurosci Methods 1995 Mar;57(1):15-25
Intracranial pressure waveform indices in transient and refractory
intracranial hypertension.
Contant CF Jr, Robertson CS, Crouch J, Gopinath SP, Narayan RK, Grossman RG
Analysis of data obtained by continuous computerized monitoring of
intracranial pressure (ICP) in 109 adult patients with severe head trauma was
performed to examine the pattern of change in indices of the ICP waveform.
Indices derived from direct measurement of the ICP wave and obtained from a
Fast Fourier Transform (FFT) were examined. Concurrent physiologic
measurements were made. Two types of intracranial hypertension (ICH) were
defined for comparison. 'Transient intracranial hypertension' occurred when
an abrupt rise in ICP was followed by a return to below 25 mm Hg (n = 63).
Increases in ICP that were progressive and led to neurologic deterioration
and death were termed 'refractory intracranial hypertension' (n = 18). During
transient ICH heart rate, arterial pressure, end-tidal carbon dioxide and
jugular venous oxygen saturation all increased, while these measures either
were unchanged or decreased during refractory ICH. The pulse amplitude of the
ICP wave increased in both types of ICHtn. Other changes in the waveform
indices were consistent with this change in pulse amplitude. HFC responded
differently to the two types of changes, with an increase during the
transient changes and a decrease during the refractory changes.
The differences in changes in physiologic measurements as ICH occurred in the
2 groups suggest that in refractory ICH cerebral blood flow is maintained
against the mounting ICP, while in transient ICH the hypertension is caused
by an increase in cerebral blood flow. The waveform indices do not
discriminate between the two types of changes.
-----------------------------------------------------
Neurochirurgia (Stuttg) 1978 Mar;21(2):43-53
The analysis of the intracranial pressure by the concept of the driving
pressure from the vascular system.
Ikeyama A, Maeda S, Ito A, Banno K, Nagai H, Furuse M
In order to understand the pathogenesis of intracranial hypertension, the
intracranial pressure (ICP) has usually been studied with the concept of
volumetric pressure. In other words, the ICP is held to derive from the
volume of the intracranial elements (e.g., brain, blood and cerebrospinal
fluid). In this paper, the authors propose a new concept of the so-called
driving pressure and apply it to both clinical and experimental studies. The
driving pressure (DP) consists of the combined pressure continuously exerted
on the ICP by the arterial pressure (ADP) and venous pressure (VP) systems.
------------------------------------------
Aust J Adv Nurs 1994 Dec-1995 Feb;12(2):32-9
The effects of patient repositioning on intracranial pressure.
Jones B
This study was designed to describe changes in intracranial pressure during
74 nurse-initiated repositionings of 30 patients with potential for, or
raised intracranial pressure. Measures were recorded of intracranial
pressure, body position, heart rate and mean arterial blood pressure prior
to, during, and five minutes after repositioning. Grouped data showed that a
rise in mean intracranial pressure occurred during each of the position
changes and that the mean pressure was close to or below the baseline
observation five minutes after each position change. Despite fluctuations in
heart rate and mean arterial blood pressure, cerebral perfusion pressures
were always at or above 53 mmHg which indicated that cerebral perfusion was
adequate. Nursing implications of the results are discussed.
-------------------------------------------
Anaesthesist 1994 Jul;43(7):421-30
[Opioids, cerebral circulation and intracranial pressure].
Schregel W, Weyerer W, Cunitz G
The effects of the opioids alfentanil (A), fentanyl (F), and sufentanil (S)
on cerebral blood flow (CBF) and intracranial pressure (ICP) have been
discussed in several recent publications. The purpose of this review is to
describe the results of studies in animals, healthy volunteers, and patients
with and without intracranial diseases. Clinical relevance and mechanisms of
the reported ICP and CBF increases are analysed. METHODS. Approximately 70
original articles and abstracts were retrieved by a systematic literature
search using the key word list at the end of this abstract. The cited studies
came from computerised database systems like Silver Platter and DIMDI, the
SNACC reference list, and the bibliographies of pertinent articles and books.
These studies were classified into three groups: significant increase of ICP
and/or CBF; no significant or clinically relevant alterations; and
significant decreases of ICP and/or CBF.
RESULTS. The numerical relationship was 6:7:3 for A, 7:16:9 for F, and 5:11:8
for S. Increases of previously normal or only slightly elevated ICP were
registered in some studies in connection with a decrease in mean arterial
pressure (MAP). On the other hand, in patients with brain injury and elevated
ICP opioids did not further increase ICP despite MAP decreases. In studies
monitoring ICP and/or CBF continuously, transient and moderate increases of
questionable clinical relevance became apparent a few minutes after bolus
injection of opioids. Alterations of systemic and cerebral haemodynamics
observed after bolus application were not registered during continuous
infusion of A and S.
DISCUSSION AND CONCLUSIONS. The cerebral effects of opioids are dependent on
several factors, e.g., age, species, ventilation, anaesthesia before and
during measurements, systemic haemodynamics, and underlying diseases. The
probable mechanism of ICP increase during decreasing MAP is cerebral
vasodilatation due to maintained autoregulation. With increasing severity of
the cerebral lesion autoregulation is often disturbed. Therefore, ICP often
remains unaltered despite MAP decreases. However, the resulting decrease in
cerebral perfusion pressure makes such patients more susceptible to develop
ischaemic neurological deficits. Induction of somatic rigidity or (with high
doses) convulsions, exceeding the upper limit of autoregulation, histamine
release, cerebral vasodilatation, increased cerebral oxygen consumption, or
carbon dioxide accumulation during spontaneous breathing were discussed as
mechanisms for transient ICP/CBF increases.
It is concluded that opioids are often beneficial and not generally
contraindicated for patients with cerebral diseases and compromised
intracranial compliance. However, since negative side effects cannot be
excluded, opioid effects and side effects should be monitored (MAP, ICP,
cerebrovenous oxygen saturation, transcranial Doppler sonography) in patients
at risk. It has to be stressed that opioids should be administered only to
patients with stable haemodynamic situations and preferably in well-titrated,
continuous infusions.
----------------------------------------
Any comments on this controversial topic?
Dr Mel C Siff
Denver, USA
http://www.egroups.com/group/supertraining
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