Natural Standard
An international research collaboration that systematically reviews (and limits its focus to) scientific evidence on complementary and alternative medicine (CAM). Founded in 2000, Natural Standard assigns a grade to each CAM therapy, reflecting the level of available scientific data for or against the use of each therapy for a specific medical condition.
Natural Standard is subscription-based, and each of the database’s monographs aggregates data from other resources like AMED, CANCERLIT, CINAHL, CISCOM, the Cochrane Library, EMBASE, HerbMed, International Pharmaceutical Abstracts, Medline and NAPRALERT – and 20 additional journals. Data analysis is performed by healthcare professionals conducting clinical work and/or research at academic centers, using standardized instruments pertaining to each monograph section
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Statistically significant evidence of benefit from >2 properly randomized trials (RCTs), OR evidence from one properly conducted RCT AND one properly conducted meta-analysis, OR evidence from multiple RCTs with a clear majority of the properly conducted trials showing statistically significant evidence of benefit AND with supporting evidence in basic science, animal studies, or theory.
Statistically significant evidence of benefit from 1-2 properly randomized trials, OR evidence of benefit from >1 properly conducted meta-analysis OR evidence of benefit from >1 cohort/case-control/non-randomized trials AND with supporting evidence in basic science, animal studies, or theory. This grade applies to situations in which a well designed randomized controlled trial reports negative results but stands in contrast to the positive efficacy results of multiple other less well designed trials or a well designed meta-analysis, while awaiting confirmatory evidence from an additional well designed randomized controlled trial.
Evidence of benefit from >1 small RCT(s) without adequate size, power, statistical significance, or quality of design by objective criteria,* OR conflicting evidence from multiple RCTs without a clear majority of the properly conducted trials showing evidence of benefit or ineffectiveness, OR evidence of benefit from >1 cohort/case-control/non-randomized trials AND without supporting evidence in basic science, animal studies, or theory, OR evidence of efficacy only from basic science, animal studies, or theory.
Statistically significant negative evidence (i.e., lack of evidence of benefit) from cohort/case-control/non-randomized trials, AND evidence in basic science, animal studies, or theory suggesting a lack of benefit.This grade also applies to situations in which >1 well designed randomized controlled trial reports negative results, notwithstanding the existence of positive efficacy results reported from other less well designed trials or a meta-analysis. (Note: if there is >1 negative randomized controlled trials that are well designed and highly compelling, this will result in a grade of "F" notwithstanding positive results from other less well designed studies.)
Statistically significant negative evidence (i.e. lack of evidence of benefit) from >1 properly randomized adequately powered trial(s) of high-quality design by objective criteria.*
In the early 1900s, the osteopathic doctor William Sutherand developed a theory that the relationships and motions of the bones of the skull (cranium), the fluid that flows through the brain and spinal column (cerebrospinal fluid), the membranes around the brain and spinal cord (meninges), and the bones of the lower back (sacrum) lie at the core of the body's functioning and vital energy.
A series of techniques grew out of these concepts, which were further developed in the 1970s by John Upledger, also an osteopathic doctor. Dr. Upledger coined the term craniosacral therapy, which refers to a form of therapeutic manipulation that is oriented to tissue, fluid, membranes, and energy.
Cranial manipulation has reportedly been practiced in India for centuries. In the 18th Century, a philosopher and scientist named Emmanuel Swedenborg claimed that the brain moves with regular cycles of expansion and contraction.
Craniosacral therapy has been suggested as a treatment for various conditions, including asthma, cerebral palsy in children, headache, labor and delivery, low back pain, and torticollis in infants. However, there is a lack of scientific data on the safety and effectiveness of the therapy.
Skeptics have raised various criticisms about craniosacral therapy. For example, some argue that scientific evidence does not support the theories for cranial bone movement since the cranial bones fuse during adolescence. Others argue that the cerebrospinal fluid pulsation is caused by the functioning of the cardiovascular system and not by the craniosacral system.
Craniosacral therapy practitioners touch areas of their patients lightly to sense the cranial rhythm impulse of the cerebrospinal fluid (CSF), which is said to be similar to feeling the pulse of blood vessels. Practitioners then use subtle manipulations over the skull and other areas with the aim of restoring balance by removing restrictions to CSF movement. This process is proposed to help the body heal itself and improve a wide range of conditions. Treatment sessions usually last between 30 and 60 minutes.
There are many individual reports about treatment benefits, although scientific data on its safety and effectiveness are lacking. Craniosacral therapy may be practiced by osteopathic doctors, chiropractors, naturopathic doctors, or massage therapists. This technique is sometimes called cranio-occipital technique or cranial osteopathy (when practiced by osteopathic doctors), although it is controversial whether there are subtle differences between these approaches.
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The grades A-F ascribed to the specific health conditions below have a very specific meaning. i.e., a "C" can still mean evidence of benefit from a small randomized trial, etc. Read about what each grade actually means.
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Grade
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Asthma
Early research suggests that craniosacral therapy may help improve pulmonary function and improve quality of life in patients with asthma. More studies are needed before a conclusion can be made.
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C
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Cerebral palsy (in children)
There is not enough evidence to support the use of craniosacral therapy in the treatment of cerebral palsy in children.
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C
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Headache (tension, migraine)
A review of several studies did not find compelling evidence of benefit for craniosacral therapy in patients with tension-type headaches. Additional study is needed.
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C
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Labor and delivery
Early studies suggest that craniosacral therapy may not offer added benefits during labor and delivery. Pregnant women considering the use of craniosacral therapy should first consult their qualified obstetricians.
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C
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Low back pain
There is not enough evidence to support the use of craniosacral therapy in the management of low back pain.
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C
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Torticollis (post-traumatic in infants)
There is currently not enough information available to support the use of craniosacral therapy in infants with post-traumatic torticollis.
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C
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The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Allergies, Alzheimer's disease, amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease), attention-deficit hyperactivity disorder (ADHD), autism, Bell's palsy, birth outcomes (trauma), brain damage (brain disorders), chronic bronchitis, chronic pain, colic, coma, congestive heart failure, coordination disorders, craniofacial pain, Crohn's disease, dental pain, depression, dermatitis, diabetes, dizziness, ear infection, ear pain (congestion), emotional disorders, epilepsy, eye disorders (strabismus, crossed eyes), frozen shoulder, hearing impairment, hormonal imbalances, hyperkinesis (a movement disorder), infertility, insomnia, joint diseases, joint pain, learning disabilities, lupus, Ménière's disease (an inner ear disorder), menstrual pain, migraine, multiple sclerosis, muscle aches, musculoskeletal disorders, neck pain, nerve damage, postoperative recovery, psychiatric disorders, Rett syndrome, sciatica, seizure, sinusitis, speech disorders (aphasia), spinal cord injury, spine problems (kyphosis, pain, scoliosis), sports injuries, stress-related conditions, stroke, temporomandibular joint disorder (TMJ), tinnitus (ringing in the ears), trauma, traumatic brain injury, trigeminal neuralgia (a nerve disorder), visual disturbances.
Safety data for craniosacral therapy is lacking in the available literature. Although the movements of this technique are usually gentle, there may be a small risk of stroke, nervous system damage, bleeding in the head, bulging in the blood vessels of the brain (called intracranial aneurysm), or increased pressure in the brain.
The following people should approach craniosacral therapy cautiously: those with recent head trauma or skull fracture, those with diseases that affect the brain or spinal cord, those with conditions in which a change in pressure in the brain would be dangerous, and those with blood clotting disorders. In theory, craniosacral therapy may make some existing symptoms worse. Side effects have been reported in patients with traumatic brain syndrome.
Diarrhea, headache, opisthotonus (muscle spasm in which the head, neck, and spine hyperextend), confusion, dizziness, double vision, loss of consciousness, trigeminal nerve damage, underactive pituitary gland, brainstem dysfunction, seizures, and increased anger have been reported after treatment. It has been proposed that craniosacral therapy may interact with agents used for diabetes, epilepsy, or psychiatric disorders, although scientific evidence is lacking.
Use cautiously before driving or operating heavy machinery, as craniosacral therapy may cause deep relaxation and light-headedness.
Based on secondary sources, avoid craniosacral therapy in children younger than two years old because the bones in the skull are not fully developed yet.
There is not enough evidence to determine if craniosacral therapy is safe during pregnancy or breastfeeding.
Craniosacral therapy should not be relied on as the sole treatment (instead of more proven approaches) for potentially severe conditions, and it should not delay consultation with an appropriate healthcare provider.
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. Selected references are listed below.
- Green C, Martin CW, Bassett K, et al. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med 1999;7(4):201-207. View Abstract
- Greenman PE, McPartland JM. Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopath Assoc 1995;95(3):182-188. View Abstract
- Hartman SE, Norton JM. Craniosacral therapy is not medicine. Phys Ther 2002;Nov, 82(11):1146-1147. View Abstract
- Hanten WP, Dawson DD, Iwata M, et al. Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. J Orthop Sports Phys Ther 1998;Mar, 27(3):213-218. View Abstract
- Hehir B. Head cases: an examination of craniosacral therapy. Midwives (Lond) 2003;Jan, 6(1):38-40. View Abstract
- Maher CG. Effective physical treatment for chronic low back pain. Orthop Clin North Am 2004;35(1):57-64. View Abstract
- McPartland JM, Mein EA. Entrainment and the cranial rhythmic impulse. Altern Ther Health Med 1997;Jan, 3(1):40-45. View Abstract
- Mehl-Madrona L, Kligler B, Silverman S, et al. The impact of acupuncture and craniosacral therapy interventions on clinical outcomes in adults with asthma. Explore (NY). 2007 Jan-Feb;3(1):28-36. View Abstract
- 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):183-190. View Abstract
- Phillips CJ, Meyer JJ. Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery. J Manipulative Physiol Ther. 1995 Oct;18(8):525-9. View Abstract
- Quaid A. Craniosacral controversy. Phys Ther 1995;Mar, 75(3):240. Comment in: Phys Ther 1994;Oct, 74(10):908-916. Discussion, 917-920. View Abstract
- Rogers JS, Witt PL, Gross MT, et al. Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons. Phys Ther 1998;Nov, 78(11):1175-1185. View Abstract
- Rogers JS, Witt PL. The controversy of cranial bone motion. J Orthop Sports Phys Ther 1997;Aug, 26(2):95-103. View Abstract
- Upledger JE. Craniosacral therapy. Phys Ther 1995;Apr, 75(4):328-330. Comment in: Phys Ther 1994;Oct, 74(10):908-916. Discussion, 917-920. View Abstract
- Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Phys Ther 1994;Oct, 74(10):908-916. Discussion, 917-920. Comment in: Phys Ther 1995;Apr, 75(4):328-330. Phys Ther 1995;Mar, 75(3):240. View Abstract
