Craniosacral therapy (2004-09-24)

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An educational email circulated at our hospital during Pain Awareness Week has two interesting questions that draw a sharp contrast between traditional medicine and alternative medicine.

2. Which of the following is a subjective pain assessment tool that has been validated for assessment of pain in children between the ages of 2 months and 7 years of  age?
A. IPS (Infant Pain Scale)
B. FLACC (Faces,Legs,Activity,Cry and Consolability)
C. Faces
D. VAS (Visual or Verbal Analogue Scale)

The FLACC (Face, Legs, Activity, Cry and Consolability) Scale is a behavioral scale that has been validated for assessment of pain in children. A score is obtained by reviewing the descriptions of behavior and selecting the number that most closely matches the observed behavior. Source: American Medical Association. Available at

4. Craniosacral therapy can best be described as;

A. Gentle stimulation of the cranium to promote healing
B. A hands-on approach that involves "listening with the fingers"
C. A technique in which patients are trained to improve health by using signals from their bodies
D. A treatment modality using an altered state of consciousness

Craniosacral therapy is a hands-on approach that involves "listening with the fingers" to the body's subtle rhythms and any patterns of inertia and congestions. The emphasis of treatment is to encourage and enhance the body's own self-healing and self-regulating capabilities, even in the most acute resistance and pathologies. Source: Kern,Michael; "What is Craniosacral Therapy?

It is interesting to note that both the FLACC scale and Craniosacral therapy have undergone extensive testing for reliability. While FLACC has been shown to have a very good level of reliability, Craniosacral therapy has been shown to have no reliability. I can't include a comprehensive review of either FLACC or Craniosacral therapy, but two articles with full free text on the web are worth looking at:

Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Suraseranivongse S, Santawat U, Kraiprasit K, Petcharatana S, Prakkamodom S, Muntraporn N. Br J Anaesth 2001: 87(3); 400-5. [Medline] [Abstract] [Full text] [PDF]

Craniosacral therapy is not medicine. Hartman SE, Norton JM. Phys Ther 2002: 82(11); 1146-7. [Medline] [Full text]

Why is it that we are so demanding of measures of infant pain that we subject them to intense research, but when alternative medicine mentions subtle energy fields, we accept these claims uncritically?

Craniosacral therapy also has problems because of the nonspecific nature of symptoms that it claims to help with.

Impingement of cranial nerves or spinal nerves, left-right imbalances, head injuries, confusion, feelings of compression or pressure, anxiety, depression, circulatory disorders, organ dysfunctions, learning difficulties, neuro-endocrine problems, TMJ and dental problems, and trauma of all kinds birth, falls, accidents and other injuries, physical, sexual or emotional abuse, PTSD, loss/grief, surgery, anesthesia all are good indicators that a visit to your craniosacral therapist will be helpful. --

Some conditions that commonly respond well to treatment include:


Specificity is one the criteria that Sir Austin Bradford Hill used to identify causal relationships. An exposure that affects a single disease provides more credible evidence than an exposure that affects a broad range of diseases. Applying this to claims about therapy, the conclusion would be that a therapy that claims to cure everything probably cures nothing. Stated less extremely, you should use greater caution and demand a greater level of evidence for any therapy that makes overly broad claims of efficacy.

Specificity is, by itself, not a perfect indicator of causality. Certain exposures, such as cigarette smoking cause a very broad and non-specific set of diseases. Certain drugs, such as aspirin, are effective for a wide range of illnesses.

You should not discount the possible benefits of a therapy just because it is nonspecific. Just be cautious and the broader the claims the more caution you should use.