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Re: Craniosacral therapy
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Re: Craniosacral therapy - May 31, 2006 12:50:00 PM
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nari
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Don't get off your soapbox too often, Sarah.
The PT world needs folk like you.
Nari
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Re: Craniosacral therapy - May 31, 2006 2:12:00 PM
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Andrew M. Ball PT PhD
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Sarah,
Don't misunderstand us either. I'm not at all saying that therapeutic touch isn't valuable --- nor that it's non-therapeutic (heck "therapuetic" is baked right in . . .). What I disagree with, is all of the rubbish used to sell CST, when in all evidence-based likelyhood, it has no better effect than simply the laying on of hands that you do, that I do, that Barrett teaches under the name Simple Contact. Proper touch helps the sympathetic system move toward a parasympathetic state. That's inarguable. In my opinion, that's all that CST, MFR, or strain-counterstrain do. The difference with Simple Contact, is that Barrett cuts right to it --- therapuetic touch yields neurodynamic release and a therapist induced progression from a sympathetic to parasympathtic state. No pseudoscience, no false theory. What he doesn't do, is dress it up as something it's not. Got to respect a guy like that!
I digress. The point is, we don't disagree.
I would, however, caution you against saying anything remotely like, "to the casual observer it may look like CST." While you are correct, and most of us know what you're saying, it may, to the lesser exerpienced, sound as though you're backing CST and the proposed physiology behind it.
You are not.
What you ARE doing, however, is arguing the same point as the rest of us on this thread --- that the TECHNIQUES of CST may have a therapeutic effect, but certainly not by the physiology proposed.
There is no antagonism, at least not from me.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Craniosacral therapy - June 3, 2006 9:47:00 AM
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srcase
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From: Michigan
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Drew,
My last post was not directed toward you at all. I agree that we are saying the same thing, and I appreciate you caution about any comparisons between Simple Contact and CST. I will caution you about calling it "laying on of hands", which has a definite religious connotation. So, what do you call it in your documentation and I'm assuming you bill it under manual therapy?? Just curious.
Sarah
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Re: Craniosacral therapy - June 4, 2006 2:58:00 AM
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Andrew M. Ball PT PhD
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If I do Simple Contact, which is rare, I'll call it a neurodynamic release. Usually, however, I don't do it for more than a few minutes (less than 8 minutes, including set-up time is NON BILLABLE). I find I use it more on patients with cervical spine issues more often than any other. So if do 10 minutes of cervical joint mobilizations, 8 minutes of simple contact, and 15 of stab exercises. That's only 33 minutes of care, and I can only bill 2 units, not 3. For billing purposes, I'd bill a manual therapy and either a therex or a neuromuscular re-ed depending on the type of stab exercise used.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Craniosacral therapy - June 4, 2006 8:41:00 AM
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UTDC
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Drew,
I was surprised by a couple of statements from your last post:
[QUOTE]Proper touch helps the sympathetic system move toward a parasympathetic state. That's inarguable. [/QUOTE] [QUOTE]therapuetic touch yields neurodynamic release and a therapist induced progression from a sympathetic to parasympathtic state. No pseudoscience, no false theory.[/QUOTE]You seem to be giving these theories (my opinion) a high degree of respect in reference to scientific principles. By the sounds of it, this tt, sympathetic mediation connection is a pillar of science in your opinion.
While certainly not an expert, I am not familiar with the research which would make such a construct "inarguable." If such evidence does exist, is there any indication that this produces anything other than a transient effect? Is it a different effect than stubbing one's toe? Does it improve pain outcome?
Jeff
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Re: Craniosacral therapy - June 6, 2006 3:53:00 PM
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Andrew M. Ball PT PhD
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Jeff,
Good points, but I think you misunderstand me a little bit. The word "toward" is operative in the first statement, not "inarguable" (which I meant in the clinical sense . . . not the academic/research sense). You'll note that I made no comment on the magnitude of that effect, nor did I make comment on clinical relevance.
My second statement was more in reference to techniques such as Craniosacral Therapy, or Strain-Counterstrain that offer techniques that MAY yield positive clinical result (but clearly do not work via the mechanisms taught), versus techniques such as Simple Contact that, while similarly unproven, at least offer plausable theory based upon plausable evidence of positive effect due specifically to the mechanism offered. This is in contrast to CST and SCS that ascribe effect to physiologic constructs proven incorrect long ago. For example, with respect to CST, Rodgers et al. showed that the CS pulse could not be reliably palpated between two examiners, prior to that H-wave testing proved that while gamma-bias exists in cats, in human muscle contractions, alpha motor neurons fire before gammas --- in other words, there is no such thing as a human gamma motor bias in non-pathologic human muscle. As such, SCS may have useful technique to offer, but it doesn't work via the mechanism that the Jones Institute sold last time I took a look at them. That may have changed in the last 10 years, but no user of SCS has ever lead me to believe that there has been any evolution to date. The point I was making was simply that Simple Contact and therapeutic touch techniques make claims on the basis of plausable (unproven) theory --- as opposed to theory since proven false.
As such, it is my position that those PT's who use Simple Contact or therapuetic touch (while kooky looking) are actually more evidence-based clinicians than those using CST or SCS.
Clinical outcomes, and longevity of effect is a different discussion.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Craniosacral therapy - August 21, 2006 1:37:00 PM
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Karie
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From: Wisconsin
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Dr. Andrew Ball,
You make a broad statement that PT's who use CST are not evidence based clinicians, please refer me to the study that states those findings.
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Re: Craniosacral therapy - August 21, 2006 1:41:00 PM
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Karie
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From: Wisconsin
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By the way Dr. Ball, I hope the study you refer to that prooved that CST, Rodgers et al wasn't the one that was done by 2 guys taken CST 1 and had someone palpating at the head and someone at the feet with a curtain between and published in the APTA journal. That one was so flawed on many levels, it was laughable. If it's a different one, please site the location so I can review it.
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Re: Craniosacral therapy - August 21, 2006 2:25:00 PM
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Jon Newman
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Just a quick clarification. Therapeutic touch does not actually involve touch although I suppose there are no rules against it. It relies on "energy medicine" and the therapist moves their hands over the patient's energy field. Here's a reality biased source
[URL=http://skepdic.com/tt.html]Therapeutic touch[/URL]
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Craniosacral therapy - August 21, 2006 3:01:00 PM
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tucker
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From: Texas
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Yes Kari..The study by Rogers and colleagues is the one you are thinking of. How was it flawed? In my experience with the PT journal's peer-review process, it would be difficult to get any flaw past them.
Here is another study on the interexaminer reliability palpating the 'rhythm':
Moran RW, Gibbons P. Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):183-90.
CONCLUSIONS: The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.
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Re: Craniosacral therapy - August 21, 2006 3:40:00 PM
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Karie
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Thanks Tucker, I will look that one up. :-)
Your right about the APTA journal, I was totally shocked that they let that that one be published. I am wondering if any of the pre-viewers had any training in CST principles.
There are many flaws Tucker, and I would have to get it back out again to give it to you verbatim, but the basic premise of the study was flawed from the start.
Cranial Sacral Rhythm would not necessarily be palpable the same at the head and the feet, and never has been in anyone that I have treated, because it is a "reflected" rhythm through the tissue. Any tissue restrictions at any layer will change the pattern palpated. In fact, that is part of the assessment methods. Therefore, someone palpating at the head and someone at the feet will not palpate equally and at the same time because as far as I know, there is not a human alive that doesn't have a restriction in tissue somewhere. If they had used someone with more broadbased knowledge of the "theory" and yes I use "theory" than 1st level course takers, this flaw would have been established from the get go. I know for a fact Upledger sent an extensive followup to that study to the APTA reviewers of our journal, and as of this date, I do not know of any response from them printed or feedback to Upledger. Many of us PT's were waiting for that response, that treat with CST. If anyone knows of a response, I would gratefully like to see it.
I am happy to review literature regarding this method and have been approached by a well respected researcher in our state about a possible study regarding this treatment with a good investigative study plan. If this research is performed (those of you doing research know all the parameters that have to be put in place to do a study), I will be happy to share with all, no matter what the outcome.
Basically, I have been using this technique for more than 10 years, (I am certified in technique) along with using a wide variety of other methods and treatment techniques/exercise. If someone can tell me what I am doing with it that is causing my patients to have significant success and it's not what Upledger proposes or others such as Michigan State Osteopathic College, then I am happy to learn differently.
CST and other methods are just tissue release with different methods of assessing the area of restriction. It's not magic, it's just anatomy and the inter-relationship of the whole tissue system of the body. There's no magic fingers, anyone can do it, I've taught patient family members to treat each other.
This treatment approach isn't for every therapist though, and that's perfectly okay.
The start of this post was from a student that was in a clinical where the PT clinician was apparently mainly using CST methods and the student was uncertain of being taught this method and felt uncomfortable.
I don't recommend that CI's use methods such as this to teach entry level students in the field. It and other methods are for those who are solid in their therapy treatments/evidence and then can go on and make critical decisions regarding other therapy applications.
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Re: Craniosacral therapy - August 21, 2006 4:22:00 PM
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dfjpt
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I think what makes people be turned off this approach is the weird and unsupportable construct that comes embedded with the training of where to put the hands and how lightly to hold and long to wait there. The physicality of the technique is non-noxious, placeboic even, in the very best Patrick Wall sense of the word; "Placebo is not something that is administered to a patient, it is something that is elicited from a patient." The pleasant relaxation the technique brings on is worth a lot more than the theoretical construct sold with it, which is nothing more than perceptual fantasy based on conceptual hallucination.
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Re: Craniosacral therapy - August 21, 2006 4:46:00 PM
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Karie
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I truly respect your thoughts dfjpt, but as I said there are too many significant changes that I have seen over the years treating with it to throw it to the wayside because we have yet found good ways to effectively assess it to the satisfaction of peer reveiewed research. It is due to more than just the relaxation response. I have a long history with biofeedback and relaxation, and this clinical response has more depth and long lasting effects than just doing relaxation training procedures. I do understand where you might get that initial perception, however.
Again, as I said before if it's not based on the "theory" of what is put forth, I am happy to be shown what it is I am doing. Until then, it makes sense to me based on the fascial constructs and interconnectedness of all body systems.
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Re: Craniosacral therapy - August 21, 2006 5:11:00 PM
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tucker
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Good reply Kari and I do see your point with that study. My only experience with CST was when a CST therapist was trying to show me how to palpate the rhythm at the back of the skull many years back. I could not feel anything and questioned the concept of the skull moving due to this flow...and how it could be 'reset' if it was off.
A few years later, I asked a neurosurgeon and he knew nothing about it..So if neurosurgeons do not detect this movement or rhythm during surgeries, how can a therapist palpate it?
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Re: Craniosacral therapy - August 21, 2006 5:12:00 PM
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dfjpt
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Karie, don't discount the neurology. The nervous system can change with new input that it prefers. It loves to have non-noxious interaction with another nervous system. Hands-on is kinesthetic, but it's also dermo-neuromodulatory. A better explanation for treatment effects besides getting lost in fascial constructs would be to give the nervous system of the patient credit for being able to learn new ways to self-regulate, from cortex to hindbrain.
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Re: Craniosacral therapy - August 21, 2006 5:28:00 PM
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srcase
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From: Michigan
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Karie,
dfjpt always has a more eloquent way of putting things, but I agree. The results you are getting with CST are more likely from the brain and nervous system self-regulating, with shifts in the autonomic state and psychoneuroimmune responses, than with fascia (an inert structure) or cerebrospinal fluid. Scientifically, we are much more aware of this "mind-body" connection than any proof of tiny cranial rhythms. Being a natural skeptic, I never could buy into that one.
Sarah
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Re: Craniosacral therapy - August 21, 2006 6:09:00 PM
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Karie
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From: Wisconsin
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Very good information everyone, I really like your responses and it is giving me more information to ponder; psychoneuroimmune response I am familiar with.
Sarah C., (or anyone) give me more information to delve into regarding what I am feeling with my hands, the tissue shifts etc., because there is definately a pattern under my hands, and when upon a restriction, the tissue feels like what I describe as a "stacking" feel before the release. I get the same feel with visceral release.
For example, I can be being working with newborns that have trouble with colic or sucking, for example; and when I release the cranial base or vomer, colic goes away and they can suck instantly with Mom or bottle (and they weren't successful prior to start of CST treatment), respectively, after just a 15 minute treatment at times. Is this a neuro correction as dfjpt suggests? I truly am proposing the question?
I treat all ages for various issues, but pediatrics I tend to see the fastest changes with regards to the CST methods.
In fact I was contacted tonight that a general surgeon is bringing in their 5 week old baby tommorrow with sucking and feeding problems. La Leche specialist has been already attempting changes, but no luck, and pediatrician can't find any reason to explain the problem.
So, I guess what I am saying is that I have respect from the medical field for what I do, long history in this community with treating their patients successfully. I don't consider myself as having any "magical hands."
Thanks for all your help and any reading suggestions would be most appreciated. My kids are going off to college, just one left at home in high school, and I feel like I have more time to delve into these areas more in depth.
Thanks all for great discussion!!!!!!
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Re: Craniosacral therapy - August 21, 2006 6:26:00 PM
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Jon Newman
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[QUOTE] There are many flaws...and I would have to get it back out again to give it to you verbatim, but the basic premise of the study was flawed from the start.[/QUOTE]Karie, please do this when you find time.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Craniosacral therapy - August 21, 2006 6:34:00 PM
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dfjpt
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[QUOTE]the tissue feels like what I describe as a "stacking" feel before the release. I get the same feel with visceral release.
For example, I can be being working with newborns that have trouble with colic or sucking, for example; and when I release the cranial base or vomer, colic goes away and they can suck instantly with Mom or bottle (and they weren't successful prior to start of CST treatment), respectively, after just a 15 minute treatment at times. Is this a neuro correction as dfjpt suggests? I truly am proposing the question?[/QUOTE]Karie, I'd like to see the nervous system rulled out as an operator first, before I'd ever entertain any other possible mechanisms in any sort of manual therapy, including 'mobilipulation'. Without the nervous system (an ectodermal derivative) enlivening them, the mesodermal derivatives (muscles, fascia) are just dead meat.
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Re: Craniosacral therapy - August 21, 2006 7:13:00 PM
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Karie
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Jon, I will do that and I'll see if I can get ahold of Upledger's response to it as well. It was quite awhile ago, and I'll have to do some digging... :-)
dfjpt,
I know I reference fascia alot when I have been posting, but definately yes the neuro system has to be involved. In fact, my undergrad studies were heavy in neuro, and sometimes with all the talk about spinal mobilization I wonder if some of it is being taught anymore, LOL.
Are you familiar with Valerie Hunt's work out of UCLA, she is a PT, but has a whole list of other credentials now behind her name. She is researching alot in the field of the biochemical electrical interactions in body tissues. One of her books, "Infinite Mind." is a fascinating read and references many studies.
Candace Pert, Phd...... also is doing work in the field of biochemistry out of Georgetown University and has found the mapping for neurotransmitters that were originally thought to be only found in the brain and nervous system located in the viscera and other body tissues as well. It is here where one finds some of the scientific basis for "emotional components" that happen sometimes with soft tissue releases of various kinds, including plain old stretching. She stumbled on it when she was doing research at NIH looking at binding sites for opiates etc.
So yes, there is a nuero component, but exactly what is a good question.
As a side note, it seems people are thinking, I may be misunderstanding, that CST is about palpating the Cranial Sacral Rhythm directly from the cerebrospinal fluid. We in fact are palpating the "reflective" inherent rhythm as perceived through flexion extension patterns of tissue. It is here where one gets into "theory" as to the flexion/extension patterns and axis of motions that various bones, viscera, etc go through in response to the Cranial Sacral Rhythm. (Sutherland defined alot of these axes of motion using the sphenobasilar junction as his reference point). Is there a Cranial Sacral Rhythm? John did research out of Michigan State that measured it with a physicist as his partner. Others have attempted to since, it seems, and there you find disagreement in the research. Although, I have to check into Tuckers article he referenced yet.
Great stuff, everyone....Thank You!!!
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