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Craniosacral therapy
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Craniosacral therapy - May 24, 2006 3:13:00 PM
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vt2c1ms
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I started a rotation where my CI is hugely into craniosacral therapy. I really sounds like voo-doo to me. I'm reading a book about it but I would like to gather other therapist opinions about it as well.
Thanks for your time and any input you might have.
Mark
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Re: Craniosacral therapy - May 24, 2006 3:17:00 PM
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TLB
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Ask him to provide some research articles not written by a witch or warlock.
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Todd
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Re: Craniosacral therapy - May 24, 2006 4:00:00 PM
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ginger
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refer to previous postings on the subjest of HOCUM
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Craniosacral therapy - May 24, 2006 4:39:00 PM
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Andrew M. Ball PT PhD
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I used to, and will soon again, teach a CEU course on Evidence-Based Pediatric Physical Therapy. It will be part lab, part critical apprasal of the techniques learned (CST, NDT, PWB-TT, SI, conductive ed, etc.). I plan to teach some of the CST techniques in the course CV-4, stillpoint induction, sphenoid release, etc . . . We'll get everyone feeling what they believe to the be te pulse. Then we'll examine the evidence for CST with respect to pediatrics . . .
CranioSacral Therapy is a gentle hands-on method of evaluating and enhancing the function of the … membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Therapists using CST claim to see improvements in tone, autistic behaviors, movement restricitons, hyperactivity, LD, etc.
PEDIATRIC CST STUDIES:
Rimland B. In CranioSacral Therapy by Upledger JE. Vredevoogd JD. 1983 Eastland Press: Ann Arbor) p123-4. Asks the question, "Do children with autism have greater membranous restriction to CS movement?" In this double-blind study, the CSR of 63 “severely disabled children” (CP, autism, seizure disordered, learning disabled) were assessed. 5 children had been diagnosed as autistic on the Rimand autism rating scale (e.g. score over 20). A positive correlation was registered between higher scores on the Rimland rating scale and Upledger’s ratings of membranous restriction.
Rogers JS, Witt PL, Gross MT, Hacke JD, Genova PA. Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrrater reliablity and rate comparisons. Phys Ther. 1998;78:1175-85. In this study of 28 adult subjects and 2 CS examiners, Craniosacral rates simultaneously palpated at the head and feet were different. (e.g. the two CSR examiners usually could not agree on the rate of the CS pulse).
What does this mean for us? CST depends upon normalizing a pulse that is too rapid, too slow, or assymetrical, so how can CST work if the two examiners can’t even agree on their evaluation of the pulse????
Green C. et al. A systematic review of craniosacral therapy: biological plausibility, assessment reliably and clinical effectiveness. Complement Ther Med. 1999;7:201-7. This one should be no surprise, “The available research on craniosacral treatment effeteness constitutes low-grade evidence conducted using inadequate research protocols.” Translation --- insufficient evidence to support CST.
Finally, my personal favorite, is the neuroanatomic research by Rodier, P.M., Ingram, J.L., Tisdale, B., Nelson, S., and Romano, J. Embryological origin for autism: Developmental anomalies of the cranial nerve motor nuclei. J. Comp. Neurol. 1996 370:247-261. It indirectly makes commentary upon the role of CST in the treatment of children with autism . . .
There is a small INCREASE in cranial mass and a large DECREASE in cerebellar and brainstem mass in the child with autism (net decrease in mass). The question begs asking, “Could this increase in cranial mass or decrease of cerebellar and brainstem mass cause the increase in craniosacral rhythm (from 6-8 beats per minute up to 24 beats per minute) or temporal bone impaction that Upledger describes in children with Autism?” Maybe, but it's not Likely. One would think that the amplitude of beat impulse would INCREASE not decrease; and that the frequency of the CSR would DECREASE not increase. Decreased of the brainstem and cerebellum should allow for greater movement, not less.
The problem, personally, that I have with most CST therapists is not that they use the technique. Lack of evidence isn't the same thing as lack of an effect --- and simply TOUCHING a patient may have a positive therapeutic effect --- e.g. the patient's headache goes away simply due to the therapist's therapeutic touch, having nothing to do at all with the KIND of touch used. The problem I have is that too many have self-deluded themselves into thinking that what they are doing "works" for the reasons taught by the "guru" and then pass on these half-truths or falsehoods onto unsuspecting patients without having so much as an AWARENESS of the aforementioned articles, much less a reasonable counter-argument. Look a little closer, and more often than not you'll find a clinician grasping to a niche technique that makes him or her unique in their clinic . . . but lacking in broad clinical technique or clinical problem solving abilities. You're not, for example, going to find many PT's that are both Maitland and CST certified . . . .
Dr. Andrew M. Ball, PT, DPT, PhD
Physical Therapist
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Craniosacral therapy - May 24, 2006 5:01:00 PM
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nari
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Well said!
Nari
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Re: Craniosacral therapy - May 25, 2006 4:36:00 AM
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ehanso
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It is unfortunate that a student has been placed in a setting where the CI is to single minded in the approach to patient care.
I use CST on selected patients who have experienced facial trauma and with migraines. The results have been very good. Would just light touch be as effective? I am not sure. I agree with Dr. Ball's summary. Evidence based, probably not. Effective for certain situations, yes. Cure all and the only way to treat all maladies, no.
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Re: Craniosacral therapy - May 25, 2006 5:03:00 AM
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proud
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Bogus and should not be billed under the umbrella "Physiotherapy"...YES.
If you want to float your hands around a patient and think this is effective...go ahead. Just don't associate yourself with our great profession please.
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Re: Craniosacral therapy - May 25, 2006 7:55:00 AM
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JLS_PT_OCS
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There are many aspects of the clinical encounter during CST (light touch, relaxation, possible reduction of sympathetic expression, possible facilitation of ideomotor movement) that are readily explained with our current understanding of human/pain physiology. The pulse has nothing to do with it.
But calling it CST implies that the theory matches the treatment.
Once again, practitioners are led astray by failure to use a deep model to explain the effects.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Craniosacral therapy - May 25, 2006 9:23:00 AM
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Andrew M. Ball PT PhD
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Jason, I agree entirely. I agree that any positive effect seen is more likely the result of either therapeutic touch or ideomotor facilitation than craniosacral stillpoint induction.
Proud, while I agree with you in theory, be careful about hard and fast statements like that. How many PT's would consider the heating effects of continuous US bogus? I'm not talking about functional outcomes (which is a different story), just deep heating. The fact is that several studies have found that 10 to 20 minutes of continuous US at intensities greater than 2.0 W/cmsquared, 1.0 MHz were effective in increasing musucle temperature and blood flow, but at at lower intensities, and for shorter durations, either no change or inconsistent changes in heat and/or blood flow were noted. That doesn't mean that US is, or isn't, effective for deep heating --- just that it's rarely applied in the clinic at durations or intensities powerful enough to achieve the effect that the PT is selling to the patient.
So what the generic "you" (and any other orthoPT attacking CST) must consider, is by providing continuous US for heating effects at 1.5 W/cmsquared for 5 to 8, or even 10 minutes, and then telling the patient that you're providing the modality for heating effects . . . "you" may . . . no, you ARE doing EXACTLY the same thing . . . billing as physical therapy a modality that is BOGUS for the effects being claimed. What's REALLY sad is that most PT's don't know it, and what's sadder is that the research has been out there for at least 20 years.
Sobering ain't it? I agree that CST therapists have quite a bit to answer for, but let's not cast stones --- more of us than you think are living blissfully unaware in our glass houses . . .
References:
Paul ED, Imig CJ. Temperature and blood flow studies after ultrasonic irradiation. Am J Phys Med 34:370, 1955.
Abramson DI, et al. Changes in blood flow, oxygen uptake and tissue tempertures produced by theraputic physical agents. Effect of ultrasound. Am J Phys Med 39:51, 1960.
Bickford RH, Duff RS. Influence of ultrasonic irradiation on temperature and blood flow in human skeletal muscle. Circ Res 1:534, 1953.
Wyper DJ, et al. Therapuetic ultrasound and muscle blood flow. Physiotherapy 64:321, 1978.
Paaske et al. Influence of therapeutic ultrasonic irradiation on blood flow in human cutaneous, subcutaneous and musclar tissues. Scand J Clin Lab Invest 31:389, 1973.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Craniosacral therapy - May 25, 2006 10:30:00 AM
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proud
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Andrew: I usually don't throw out blanket statements, so I agree with you on being careful. But on this one, I just can't help myself.
I actually never use ultrasound( perhaps in the case of calcific tendonitis---I don't know the study off hand but sound evidence was presented using pulsed ultrasound for 10-15mins).
In any case, at least with ultrasound there exists conflicting evidence about it's effects. Where in the case of CST, from what I gather, there is NO evidence( and I suspect never will be).
It is for this reason that I feel strongly about the potential negligence in applying this approach. I just feel that Physical Therapists that apply this technique are not doing our proud profession any favours.
Does it work? I don't know. But some people believe in the power of prayer...so can I bill for a prayer session with my patients?
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Re: Craniosacral therapy - May 26, 2006 3:37:00 AM
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Shill
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Ultrasound DOES elevate tissue temperature. CST does not change the flow/rhythm or pulse rate of CSF.
Lets be clear on intent, probability of effect, and plausability of claims. If US is done at correct parameters, it does have tissue elevating capabilitites.
Im with proud, CST is an easy approach to bash, based on its claims alone, NOT whether or not people feel good when someone does it to them.
Mark,
I would run. But seriously, this would be something to mention to your ACCE at your school, as future students should not be subjected to someone who bases all treatments on fanciful methods. Students need solid bases on which to develop their concrete clinical thought processes, and this does nothing but start them off on the WRONG foot.
Good Luck,
Steve
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Steve Hill PT
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Re: Craniosacral therapy - May 26, 2006 6:10:00 PM
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srcase
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From: Michigan
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I agree with Andrew, Falls, and Jason. I actually use some of the techniques on certain patients with perhaps a psychosomatic component and/or sympathetic dominence who can't tolerate more aggressive manual techniques. Works quite well, but I don't sell it to my patients as craniosacral per se. I explain to them the mechanism of pain and how touch affects the nervous system, and I also tell them the theory behind craniosacral and why I don't buy into it. That way, they can be educated if they seek treatment elsewhere. After a couple treatments with Simple Contact or any light touch techniques (I'm ecclectic), patients ask me if I am going to do my "voodoo" on them again. I think it's funny. But I tell them i'm not doing anything, they are.
Beware of any treatment philosophy that is based on the practitioner having some special skill that other people can't do, it plays to the ego and clouds ones ability to make objective clinical decisions. My hands aren't any more sensitive than anyone else's. I can't say that I've ever felt a CST pulse. I've felt subtle movements, but not a pulse.....except my own or the patient's arterial pulse!
Sarah
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Re: Craniosacral therapy - May 28, 2006 5:40:00 AM
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rwillcott
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Sarah,
You mentioned that you would use some of the CST techniques with a patient that is presenting with a psychosomatic component. Don't you think that this will feed into their pain cycle? I'm sure that this patient would score very highly on the Fear-Avoidance Beliefs Questionnaire. The last thing you would want to do with that patient is to have them lay on the bed and apply a passive technique with no evidnce to support it's effect. That person needs a more accepted treatment approach that includes a graded exercise program and possibly a referral to a Cognitive Behavioral Therapist. I know Waddell has completed a lot of work in this area.
Secondly, you mentioned that you explain to the patient the theory behind CST and that you don't buy into it! Why would you use the techniques then? Do you think the patient is going to feel confident in this treatment approach after you've explained that you don't buy into it? That's like a Dentist that is about to perform a root canal and then explains to me that their not sure the effects of the treatment. No thanks!
Before we decide to use fancy manual techniques we can't forget the foundation of our profession. Exercise. There are so many great studies supporting the effects of this long lost treatment.
Rob
Waddell et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear avoidance beliefs in chronic low back pain and disability. Pain. 1993 Feb; 52(2):157-168.
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Re: Craniosacral therapy - May 28, 2006 5:42:00 AM
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rwillcott
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Proud,
I prayed for you. Where do I send the bill?
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Re: Craniosacral therapy - May 28, 2006 2:49:00 PM
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ginger
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From: Melbourne Victoria
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Proud, I prayed for myself , then paid myself with a latte'and a coffee scroll.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Craniosacral therapy - May 28, 2006 4:57:00 PM
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proud
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RWILLCOTT,
I love the dentist example. As a profession, how can we expect and command respect when we have individuals...do treatments they don't even believe in???? Can you imagine going to a dentist who gives you that explanation? Your right...no thanks.
I went to a place called a university for my degree...where EBM/best practice was the foundation of our learning objectives. CST is so far removed from proper patient care that it is a shame it is even a topic on this discussion board.
Shill...my point exactly with US. I still don't use it much at all, but it has SOME evidence when applied with proper parameters.
Oh and RWillcott and Ginger, thanks for the prayers. You can send the bill to 654 CST BS Avenue...if you know what I mean.
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Re: Craniosacral therapy - May 28, 2006 6:06:00 PM
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srcase
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rwillcott,
You bring up some good points, but I also think you misread my post. I don't do craniosacral therapy as it is described by those who teach it. I don't sense the rhythm of cerebrospinal fluid, nor do I delude myself into thinking I can feel it or change it. However, I do touch patients at certain points and hang out there, which to an outside observer might seem like CST. Sometimes, patients come in wanting CST or physicians prescibe it, that is where the education comes in. But Jason is right, we shouldn't call what we do CST unless we buy into the theory behind it, which I don't.
There is a certain type of patient who responds well to this sort of light touch (not floating my hands over people) and, although I don't give my patients the FAB-Q (I am working on getting it approved for use at my facility), I don't think it feeds into fear-avoidance behavior. But that would be an interesting topic for research. Maybe "psychosomatic issue" wasn't the best choice of words. I will admit, I have limited experience with chronic pain patients, but it seems to work well for them, to allow them to get into an exercise program...kind of calms down the nervous system if you will and decreases muscle guarding to prepare them for movement. By no means, it is the only treatment I give either. So, I hope that clears things up a bit for you.
Sarah
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Re: Craniosacral therapy - May 29, 2006 3:17:00 AM
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TLB
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[QUOTE] However, I do touch patients at certain points and hang out there, which to an outside observer might seem like CST [/QUOTE] :confused:
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Todd
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Re: Craniosacral therapy - May 31, 2006 12:14:00 PM
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nari
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Sarah
You're right - the physiology behind light touch is complex and often misunderstood, but behind it is rational and evidence-based thinking that is often abused and mislabelled such as the case of CST. Unfortunately there are so many who take a legitmate action such as touch and turn it into voodoo to attract unsuspecting PTs. CST and MFR seem to sit in that category.
It certainly calms down the CNS, and that applies to every step we take in treatment, whether it's labelled 'psychsomatic' (whatever that is) or not.
It is a treatment in itself, provided the PT understands the well-documented rationale behind its application.
Nari
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Re: Craniosacral therapy - May 31, 2006 12:45:00 PM
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srcase
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Thanks Nari,
When did this board become so antagonistic? I no longer feel like I'm having a discussion, but sitting on trial at times. It's quite discouraging. I'm all for EBM (heck, I'm pursuing my DScPT right now), but by definition, EBM includes the therapist's expertise and the patient's values, not just RCT's. Every technique has it's limitations, just as every study does. It's important to be open-minded yet skeptical, and most of all, humble in this profession or we are really not providing optimal care.
Ok, I'm off my soapbox.
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