Authors' objectives:

The objective of this report, was to gather and critically appraise the scientific basis of craniosacral therapy as a therapeutic intervention.

Authors' results and conclusions: Craniosacral treatment effectiveness Seven studies of craniosacral therapy effectiveness were identified, retrieved and critically appraised. Study designs were retrospective case control, retrospective case series, before-after and case reports. Using the Canadian Task Force on Preventive Health Care grades of evidence, all identified studies can be classified as level 3 - the lowest grade of evidence. Therefore the benefits of craniosacral therapy on health outcomes have not been demonstrated using research with sufficiently strong study designs and protocols. Not only is there an absence of efficacy evidence, the available research is of methodologically poor quality. Finally, adverse effects were reported when craniosacral therapy was used in brain injured outpatients. Agreement by practitioners on craniosacral assessment findings Five studies provided primary data on the assessment of craniosacral dysfunction by craniosacral therapy practitioners. These studies have found that assessment of craniosacral dysfunction by this group of practitioners is unreliable; that is, two or more assessors do not agree to the extent required by scientific measures. Pathophysiology of craniosacral dysfunction 1. The potential association between health and craniosacral mobility restrictions Three studies directly examined the association between craniosacral mobility and cerebrospinal fluid flow, and health. The quality of the available research is however poor, and therefore the reliance that can be placed on the reported results is limited. These studies provide very weak evidence of a causal relationship between restrictions or misalignments in the movement of cranial bones, and health. Other researchers have conducted studies that contribute evidence on the links in the causal chain potentially connecting craniosacral mobility restrictions to health outcomes. They investigated: 1) the existence of movement between cranial bones; and 2) the existence of rhythmic flow patterns in cerebrospinal fluid. Proponents use this literature to support craniosacral system theory. Sceptics meanwhile deny the existence of any significant bone movement or the influx of craniosacral flow. 2. Motion/fusion between cranial bones Nine studies reported on mobility or fusion at cranial sutures in adults. Although incomplete, the research evidence reviewed supports the theory that the adult cranium is not always solidly fused, and that minute movements between cranial bones may be possible. However, no research demonstrated that movement at cranial sutures can actually be achieved through manual manipulation. 3. Cerebrospinal fluid rhythmic flow patterns Eleven studies reported primary data on the motion of cerebrospinal fluid. None of these studies contributed to the knowledge of craniosacral therapy. This set of studies provides evidence on the pathophysiologic mechanisms pertaining to CSF motion for diagnosis, treatment and monitoring of brain injury and other neurological disorders. The retrieved studies verify that CSF movement and pulsation is a clearly observable phenomenon measurable by encephalogram, mylogram, magnetic resonance imaging and intracranial and intraspinal pressure monitoring. Furthermore, the research evidence supports the contention that there is a cranial 'pulse' or 'rhythm' distinct from cardiac or respiratory activity. However, changes in CSF due primarily to brain injury are not linked to health outcomes.

Authors' recommendations: This systematic review and critical appraisal did not find valid scientific evidence that craniosacral therapy provides a benefit to patients. Research methods are available which could conclusively evaluate craniosacral therapy effectiveness. They have not been used to date. The available health outcome research consists of low grade of evidence derived from weak study designs. Studies conducted in the 1970s reporting acceptable interrater reliability scores for assessment measures used by craniosacral therapy practitioners have not been verified by more recent research using stronger study protocols. This casts doubt on the existence of the underlying phenomenon being measured, or on practitioners' ability to measure it. Adverse events have been reported in head-injured patients following craniosacral therapy.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.chspr.ubc.ca/bcohta/

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: British Columbia Office of Health Technology Assessment

Contact Address: B. C. Office of Health Technology Assessment, Centre for Health Services and Policy Research, S-184 Koerner Pavilion, 2211 Wesbrook Mall, The University of British Columbia, Vancouver, B. C., V6T 1Z3, Canada.

Copyright: BCOHTA