Craniosacral therapy

Craniosacral therapy (CST) is a form of bodywork or alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. It is based on fundamental misconceptions about the physiology of the human skull and is promoted as a cure-all for a variety of health conditions.[1][2][3]

Craniosacral therapy (CST)
cranial-sacral therapy,
cranial osteopathy,
cranial therapy
Craniosacral therapy
Alternative therapy
NCCIH ClassificationManipulation and body-based

CST therapy was invented in the 1970s by John Upledger, an osteopathic physician, as an offshoot of cranial osteopathy, which had been devised in the 1930s by William Garner Sutherland.[2][4]

CST is a pseudoscience, and its practice has been characterized as quackery.[5][6] Medical research has found no good evidence that either CST or cranial osteopathy confers any health benefit, and they can be harmful, particularly if used on children or infants.[2][7][8] The basic assumptions of CST are not true, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients.[9]

Effectiveness and safety

Practitioners of CST claim it is effective in treating a wide range of conditions, sometimes claiming it is a cancer cure, or a cure-all.[1][3][8] Practitioners particularly advocate the use of CST on children.[3] The American Cancer Society caution that CST should never be used on children under age two.[2] Pediatricians have expressed concern at the harm CST can cause to children and infants.[8]

CST is potentially harmful.[10] There have been cases of people with head injuries suffering further injury as a result of CST.[2] If used as an alternative for legitimate therapy for a serious condition, choosing CST can have serious adverse consequences.[2]

According to the American Cancer Society, although CST may relieve the symptoms of stress or tension, "available scientific evidence does not support claims that craniosacral therapy helps in treating cancer or any other disease".[2] Cranial osteopathy has received a similar assessment, with one 1990 paper finding there was no scientific basis for any of the practitioners' claims the paper examined.[7]

In October 2012 Edzard Ernst conducted a systematic review of randomized clinical trials of craniosacral therapy. He concluded that "the notion that CST is associated with more than non-specific effects is not based on evidence from rigorous randomised clinical trials."[11] Commenting specifically on this conclusion, Ernst wrote on his blog that he had chosen the wording as "a polite and scientific way of saying that CST is bogus."[3] Ernst also remarked that the quality of five of the six trials he had reviewed was "deplorably poor", a sentiment that echoed an August 2012 review that noted the "moderate methodological quality of the included studies."[12]

Ernst criticized a 2011 systematic review performed by Jakel and von Hauenschild for inclusion of observational studies and including studies with healthy volunteers.[11] This review concluded that the evidence base surrounding craniosacral therapy and its efficacy was sparse and composed of studies with heterogeneous design. The authors of this review stated that currently available evidence was insufficient to draw conclusions.[13]

The evidence base for CST is sparse and lacks a demonstrated biologically plausible mechanism. In the absence of rigorous, well-designed randomized controlled trials,[14][15] it is a pseudoscience,[6] and its practice quackery.[5] Tests show that CST practitioners cannot in fact identify the purported craniosacral pulse, and different practitioners will get different results for the same patient.[16] The idea of a craniosacral rhythm cannot be scientifically supported.[17]


Edzard Ernt writes that in 2005 in the United Kingdom, a foundation of the Prince of Wales issued a booklet listing CST as one of several popular alternative therapies, but admitting that the therapy was unregulated and lacked either a defined training program or the oversight of a professional body. Ernst writes that this makes the therapists practising CST "less regulated than publicans".[18]


The therapist lightly palpates the patient's body, and focuses intently on the communicated movements. A practitioner's feeling of being in tune with a patient is described as entrainment.[19]

History and conceptual basis

The fundamental concepts of cranial osteopathy and CST are inconsistent with the known anatomy and physiology of the human skull, brain and spine.[2] Edzard Ernst has written "to anyone understanding a bit of physiology, anatomy etc. [CST] looks like pure nonsense".[3]

In common with many other varieties of alternative medicine, CST practitioners believe all illness is caused by energy or fluid blockages which can be released by physical manipulation.[8] They believe that the bones of the skull move in a rhythmic pattern which they can detect and correct.[8]

Cranial osteopathy, a forerunner of CST, was originated by osteopath William Sutherland (1873–1954) in 1898–1900. While looking at a disarticulated skull, Sutherland was struck by the idea that the cranial sutures of the temporal bones where they meet the parietal bones were "beveled, like the gills of a fish, indicating articular mobility for a respiratory mechanism."[12]

John Upledger devised CST. Comparing it to cranial osteopathy he wrote: "Dr. Sutherland's discovery regarding the flexibility of skull sutures led to the early research behind CranioSacral Therapy  and both approaches affect the cranium, sacrum and coccyx  the similarities end there."[20] However, modern day cranial osteopaths largely consider the two practices to be the same, but that cranial osteopathy has "been taught to non-osteopaths under the name CranialSacro therapy."[21]

Practitioners of both cranial osteopathy and craniosacral therapy assert that there are small, rhythmic motions of the cranial bones attributed to cerebrospinal fluid pressure or arterial pressure. The premise of CST is that palpation of the cranium can be used to detect this rhythmic movement of the cranial bones and selective pressures may be used to manipulate the cranial bones to achieve a therapeutic result.[22] However, there is no evidence that the bones of the human skull can be moved by such manipulations.[23]

From 1975 to 1983, Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at Michigan State University as clinical researchers and professors. They assembled a research team to investigate the purported pulse and further study Sutherland's theory of cranial bone movement. Upledger and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement, and the concept of a cranial rhythm.[24][25][26] Later independent reviews of these studies concluded that they presented no good evidence for the effectiveness of craniosacral therapy or the existence of the proposed cranial bone movement.[23]


  1. Crislip M (16 December 2011). "Alas poor Craniosacral. A SCAM of infinite jest, of most excellent fancy". Science-Based Medicine. In reality what do CST practitioners do? They lightly massage your head. To treat everything from Downs to headache to PMS. It is an all purpose diagnostic and therapeutic intervention, like all SCAMs.
  2. Russell J, Rovere A, eds. (2009). "Craniosacral Therapy". American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.). American Cancer Society. pp. 187–189. ISBN 9780944235713.CS1 maint: uses editors parameter (link)
  3. Ernst, Edzard (12 December 2012). "Up the garden path: craniosacral therapy".
  4. "Craniosacral Therapy". UPMC Center for Integrative Medicine. 2012. Retrieved 19 May 2013.
    • Aronoff, George R., ed. (1999). Evaluation and Treatment of Chronic Pain (3rd ed.). Lippincott Williams and Wilkins. p. 571. ISBN 978-0-683-30149-6.
    • Barrett, Stephen. "Why Cranial Therapy Is Silly". Quackwatch. Retrieved 16 December 2012.
    • Gorski D (23 June 2014). "Ketogenic diet does not 'beat chemo for almost all cancers'". Science-Based Medicine. it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark's "zapper," the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other "energy healing" therapy) are the rankest quackery
  5. Ferré, J. C.; Chevalier, C.; Lumineau, J. P.; Barbin, J. Y. (1990-09-01). "[Cranial osteopathy, delusion or reality?]". Actualités Odonto-Stomatologiques. 44 (171): 481–494. ISSN 0001-7817. PMID 2173359.
  6. Cassileth BR (2011). "Chapter 42: Craniosacral Therapy". The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals. World Scientific. pp. 247–250. ISBN 978-981-4335-16-4.
  7. "Craniosacral Therapy: Does it Work?". Cite journal requires |journal= (help)
  8. Pavone L, Ruggieri M (2005). "Chapter 9: The Problem of Alternative Therapies in Autism". In Coleman, M (ed.). Neurology of Autism. Oxford University Press. p. 189. According to our opinion and experience in the field of autism, there is no scientific justification for this approach. Furthermore, this method could be harmful.
  9. Ernst, Edzard (2012). "Craniosacral therapy: A systematic review of the clinical evidence". Focus on Alternative and Complementary Therapies. 17 (4): 197–201. doi:10.1111/j.2042-7166.2012.01174.x.
  10. Jäkel, Anne; Von Hauenschild, Philip (2012). "A systematic review to evaluate the clinical benefits of craniosacral therapy". Complementary Therapies in Medicine. 20 (6): 456–65. doi:10.1016/j.ctim.2012.07.009. PMID 23131379.
  11. Jäkel, Anne; Von Hauenschild, Phillip (2011). "Therapeutic Effects of Cranial Osteopathic Manipulative Medicine: A Systematic Review". The Journal of the American Osteopathic Association. 111 (12): 685–93. PMID 22182954.
  12. Agency for Healthcare Research and Quality (2012). "Best evidence statement (BESt). Craniosacral therapy for children with autism and/or sensory processing disorder". U.S. Department of Health & Human Services. Archived from the original on 7 October 2012. Retrieved 19 May 2013.
  13. "Craniosacral Therapy". Blue Cross Blue Shield of Tennessee Medical Policy Manual. Blue Cross Blue Shield of Tennessee. 2012. Archived from the original on 2008-09-22. Retrieved 19 May 2013.
  14. "Cranial therapy is just a hare-brained theory". Retrieved 2019-08-07.
  15. "People who opt for craniosacral therapy should have their head examined". Retrieved 2019-08-07.
  16. Ernst E, Rose LB (2008). "CAM and Politics". Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine. Societas Imprint Academic. pp. 102–3.
  17. McPartland, JM; Mein, EA (1997). "Entrainment and the cranial rhythmic impulse". Alternative Therapies in Health and Medicine. 3 (1): 40–5. PMID 8997803.
  18. Upledger, John E. (2002). "CranioSacral Therapy vs. Cranial Osteopathy: Differences Divide". Massage Today. 2 (10).
  19. Ferguson, A.J.; Upledger, John E.; McPartland, John M.; Collins, M.; Lever, R. (1998). "Cranial osteopathy and craniosacral therapy: current opinions". Journal of Bodywork and Movement Therapies. 2 (1): 28–37. doi:10.1016/s1360-8592(98)80044-2.
  20. Seimetz, Christina N.; Kemper, Andrew R.; Duma, Stefan M. (2012). "An investigation of cranial motion through a review of biomechanically based skull deformation literature". International Journal of Osteopathic Medicine. 15 (4): 152–65. doi:10.1016/j.ijosm.2012.05.001.
  21. Green, C.; Martin, C.W.; Bassett, K.; Kazanjian, A. (1999). "A systematic review of craniosacral therapy: Biological plausibility, assessment reliability and clinical effectiveness". Complementary Therapies in Medicine. 7 (4): 201–7. doi:10.1016/S0965-2299(99)80002-8. PMID 10709302.
  22. Upledger, John E (1995). "Craniosacral Therapy". Physical Therapy. 75 (4): 328–30. doi:10.1093/ptj/75.4.328. PMID 7899490.
  23. Upledger, JE (1978). "The relationship of craniosacral examination findings in grade school children with developmental problems". The Journal of the American Osteopathic Association. 77 (10): 760–76. PMID 659282.
  24. Upledger, JE; Karni, Z (1979). "Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment". The Journal of the American Osteopathic Association. 78 (11): 782–91. PMID 582820.
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