Why Cranial Therapy Is Silly
Stephen Barrett, M.D.
Craniosacral therapy (CST) is one of many terms used to describe a various methods based on fanciful claims that:
- The human brain makes rhythmic movements at a rate of 10 to 14 cycles per minute, a periodicity unrelated to breathing or heart rate.
- Small cranial pulsations can be felt with the fingertips.
- Restriction of movement of the cranial sutures (where the skull bones meet) interfere with the normal flow of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) and cause disease.
- Diseases can be diagnosed by detecting aberrations in this rhythm.
- Pain (especially of the jaw joint) and many other ailments can be remedied by pressing on the skull bones.
Most practitioners are osteopaths, massage therapists, chiropractors, dentists, or physical therapists. The other terms used to describe what they do include cranial osteopathy, cranial therapy, bio cranial therapy, and two chiropractic variants called craniopathy and sacro occipital technique (SOT).
Osteopaths assert that CST was originated by osteopath William G. Sutherland, who published his first article on this subject in the early 1930s. Today's leading proponent is John Upledger, DO, who founded the Upledger Institute of Palm Beach Gardens, Florida. Various Institute publications have claimed:
CranioSacral Therapy is a gentle, noninvasive manipulative technique. Seldom does the therapist apply pressure that exceeds five grams or the equivalent weight of a nickel. Examination is done by testing for movement in various parts of the system. Often, when movement testing is completed, the restriction has been removed and the system is able to self-correct .
The rhythm of the craniosacral system can be detected in much the same way as the rhythms of the cardiovascular and respiratory systems. But unlike those body systems, both evaluation and correction of the craniosacral system can be accomplished through palpation. CranioSacral Therapy is used for a myriad of health problems, including headaches, neck and back pain, TMJ dysfunction, chronic fatigue, motor-coordination difficulties, eye problems, endogenous depression, hyperactivity, attention deficit disorder, central nervous system disorders, and many other conditions .
Practitioners today rely on CranioSacral Therapy to improve the functioning of the central nervous system, eliminate the negative effects of stress, strengthen resistance to disease, and enhance overall health .
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, including: migraine headaches; chronic neck and back pain; motor-coordination impairments; colic; autism; central nervous system disorders; orthopedic problems; traumatic brain and spinal cord injuries; scoliosis; infantile disorders; learning disabilities; chronic fatigue; emotional difficulties; stress and tension-related problems; fibromyalgia and other connective-tissue disorders; temporomandibular joint syndrome (TMJ); neurovascular or immune disorders; post-traumatic stress disorder; post-surgical dysfunction .
The Upledger Institute has also advocated and taught "visceral manipulation," a bizarre treatment system whose practitioners are claimed to detect "rhythmic motions" of the intestines and other internal organs and to manipulate them to "improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body."  Upledger died in October 2012, but the institute will perpetuate his teachings.
Some chiropractors claim that Nephi Cottam, D.C. introduced "cranial adjusting" (craniopathy) to the chiropractic world in 1929, several months before Sutherland publicly presented his methods. During the 1980s, a brochure distributed by his son Calvin Cottam, D.C., claimed that cranial adjustments had relieved "insanity, insomnia, paralysis . . . spoken aphasia, headache . . . trigeminal neuralgia, pain between the shoulders, pain in the stomach (apparently from ulcers), indurated empyema. . ." 
Some of Upledger's beliefs are among the strangest I have ever encountered. Chapter 2 of his book, CranoSacral Therapy: Touchstone of Natural Healing, describes how he discovered and communicates with what he calls the patient's "Inner Physician":
By connecting deeply with a patient while doing CranioSacral Therapy, it was possible in most cases to solicit contact with the patient's Inner Physician. It also became clear that the Inner Physician could take any for m the patient could imagine —an image, a voice or a feeling. Usually once the image of the Inner Physician appeared, it was ready to dialog with me and answer questions about the underlying causes of the patient's health problems and what can be done to resolve them. It also became clear that when the conversation with the Inner Physician was authentic, the craniosacral system went into a holding pattern .
The chapter goes on to describe Upledger's care of a four-month-old French baby who was "as floppy as a rag doll." Although the baby had never been exposed to English, Upledger decided to see whether the baby's "Inner Physician" would communicate with him via the craniosacral system:
I requested aloud in English that the craniosacral rhythm stop if the answer to a question was "yes" and not stop if the answer was "no." The rhythm stopped for about ten seconds. I took this as an indication that I was being understood. I then asked if it was possible during this session for the rhythm to stop only in response to my question and not for other reasons, such as body position, etc., The rhythm stopped again. I was feeling more confident. I proceeded .
Using "yes-no answers," Upledger says, he pinpointed the problem as "a toxin that was inhaled by the mother . . . over a period of about two-and-a-half hours while cleaning the grease off an antique automobile engine" during the fourth month of pregnancy. After "asking many particulars" about what he should do, Upledger was told to "pump the parietal bones that form a large part of the roof of the skull, and to pass a lot of my energy through the brain from the back of the skull to the front." As he did this, Upledger frequently checked with the baby's "Inner Physician." After about an hour, Upledger says, the baby began to move normally .
Two Deaths Reported
Relying on CST instead of effective treatment can be dangerous. Moreover, its practice indicates poor judgement that may harm patients in other ways. At least two deaths associated with craniosacral therapy have been reported:
- In 2003, a Pennsylvania chiropractor (Joann A. Gallagher) was convicted of insurance fraud in connection with the death of a 30-year-old epileptic woman whom she treated with cranial therapy. Court documents indicated that the patient died of severe seizures after following the chiropractor's advice to stop taking her anticonvulsive medication. The fraud involved submitting insurance claims falsely describing Upledger's "meningeal balancing" as spinal manipulation .
- In 2012, a Missouri dentist (Joseph H. Kerwin) had his license revoked for contributing to the death of a 2-day-old infant who had been brought to him because of a high fever. Records in the case indicate that instead of referring the parents to a medical facility, he manipulated the child's skull and applied a vibrating machine to his sacrum. The boy died 12 hours later, and the autopsy showed that he died from complications of a subdual hematoma (a blood clot that compressed his brain). The medical examiner concluded that the hematoma could have been present at birth but was more likely caused by the skull manipulation. The dental board concluded that Kerwin had acted outside the scope of dentistry .
British osteopath Robert Boyd, who developed a variant he calls Bio Cranial Therapy, which—according to the International Bio Cranial Web site—is "extremely helpful" for "chronic fatigue syndrome (CFS); varicosity and varicose ulcers; tinnitus; bladder prolapse; prostate disorders; Meniere's syndrome; cardiovascular disturbances including hypertension, angina; skin disorders (psoriasis, eczema, acne etc); female disorders (dysmenorrhoea, PMS (PMT), menorrhagia etc); arthritis and rheumatic disorders; fibromyalgia and heel spurs; gastric disorders (hiatus hernia, ulceration, colitis); asthma and a range of bronchial disorders including bronchiectasis and emphysema." 
Sacro-occiptal technique (SOT) combines theories about spinal fluid pressure with chiropractic theories about spinal "nerve pressure" as a cause of ill health. Chiropractors who advocate SOT claim to detect "blockages" by feeling the skull and spine and measuring leg lengths .
The Scientific Viewpoint
I do not believe that CST has any therapeutic value. Its underlying theory is false because the bones of the skull fuse by the end of adolescence and no research has ever demonstrated that manual manipulation can move the individual cranial bones . Nor do I believe that "the rhythms of the craniosacral system can be felt as clearly as the rhythms of the cardiovascular and respiratory systems," as is claimed by another Upledger Institute brochure . The brain does pulsate, but this is exclusively related to the cardiovascular system , and no relationship between brain pulsation and general health has been demonstrated.
A few years ago, three physical therapists who examined the same 12 patients diagnosed significantly different "craniosacral rates," which is the expected outcome of measuring a nonexistent phenomenon . Another study compared the "craniosacral rate" measured at the head and feet of 28 adults by two examiners and found that the results were highly inconsistent .
In 1999, after doing a comprehensive review of published studies, the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that the theory is invalid and that practitioners cannot reliably measure what they claim to be modifying. The 68-page report concludes that "there is insufficient evidence to recommend craniosacral therapy to patients, practitioners, or third party payers." 
In 2011, the Archives of Disease in Childhood published the results of a well-designed randomized, controlled study of 142 children ages 5-12 with cerebral palsy. About half received cranial therapy (up to six sessions) and the others were placed on a "waiting list." After six months, the researers found no difference between the treatment and no-treatment groups in gross motor function or the child's quality of life .
In 2002, two basic science professors at the University of New England College of Osteopathic Medicine concluded:
Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. Since no properly randomized, blinded, and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations .
I certainly agree! In fact, I believe that most practitioners of craniosacral therapy have such poor judgment that they should be delicensed.
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therapy illustrates an exercise proposed
for skeptics to develop critical thinking and a better understanding of human psychology. Skeptical Inquirer, May/June 2003.
- Barrett S. Some notes on Viola Frymann, D.O. Quackwatch, Jan 26, 2003.
As a physical therapist and exercise physiologist, I'd like to thank you for your article on "craniosacral therapy". Too many patients and therapists have been duped by this so-called therapy. If these therapist were ever to suggest to any self-respecting neurosurgeon, that they could move the sutures of the skull with ounces of force, they would get laughed right out of the room. I have personally witnessed how saws and drills are needed (with more than a few ounces of force) to alter the structure of the adult skull. To tell patients that you have the ability to analyze the cerebral spinal fluid flow with your fingertips and then "normalize" it by mobilizing the cranial sutures is not just quackery but malpractice. They should lose their license.
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- For serious education in complementary care . . . come to the source. Brochure for course, Upledger Institute, Aug 2001.
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- Findings of fact, conclusions of law, and disciplinary order. Missouri Dental Board v Joseph H. Kerwin, D.D.S.. Cause No. 01-1073 DB, June 22, 2009.
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This article was revised on October 30, 2012.