A Reader Question About Craniosacral Therapy

 A reader asked the following question:

How do you describe Craniosacral Therapy to a client who has never experienced it before and how do you promote it?

The simple, most straightforward answer is that I do not practice Craniosacral Therapy (CST) so I do not promote it. I've never had a client ask about it that I can recall. However, if a client were to ask about it, I'd probably answer something like this:

I had classes in Craniosacral Therapy many years ago from two different nationally known instructors. However, I never used it in my practice. I probably practiced some of the things learned in class shortly after I learned them, but abandoned it pretty quickly. 

For those readers not familiar with CST, I will explain a little about it. Its history has its roots in osteopathy. Practitioners believe that, by using gentle force on the skull, they can move the bones of the cranium and that the recipient derives some benefit from this. They are taught that there is a pulse in the cerebrospinal fluid (CSF) that they can palpate and that by manipulating the cranial bones, the flow of CSF can be manipulated and regulated. 

When I took these classes, in spite of having good palpation skills, I was never able to detect any pulse outside of the pulse of my own heart beating felt in my hands or the client's breathing. I thought at first I was somehow deficient. It turns out that this pulse cannot be detected with even the most sensitive instruments, so I don't feel so bad about that. 

In practice, CST consists of lying face up while the practitioner cradles the client's head in their hands and manipulates it very gently. It is soothing and relaxing and can feel quite nice. Many people feel that they derive benefit from it. However, do the claims of CST stand up when they are examined?

The bones of the skull are fused together and no evidence exists that they can be moved with human hands at the low levels of force used by CST practitioners. Experiments done decades ago by CST practitioners that claimed to demonstrate the ability to move cranial bones were poorly controlled. More recent studies have found that the forces that would be needed to move cranial bones would not be tolerated by any conscious person and would resemble Medieval torture. 

Another problem with CST is that there is very low inter-rater reliability. That is, when multiple CST practitioners assess the same person, they come up with very inconsistent diagnoses. Suppose three different people all listened to your heart with a stethescope at the same time and gave three entirely different answers as to what was your heart rate. You would conclude that at least two of them were wrong but you would have no way of knowing which, if any of them, were right.

If the claims of CST are contradicted by the evidence, how is it that people who receive CST report that they feel better? There's a very easy answer to that question. We know that focused attention and gentle human touch makes us feel better. That's very well established. Having one's head gently cradled in a caring person's hands is relaxing and when the body is relaxed, the brain will often turn down the volume on all sorts of pain problems or any other problems that might be aggravated by stress. 

My friend Paul Ingraham has written a well-researched article on CST which can be found at his website, PainScience.com. I recommend it for further reading. 

What is a CST practitioner to do in the face of evidence that contradicts what they have been taught? This is a dilemma that many massage therapists and manual therapists face as science demonstrates that many of the explanations we were taught turn out not to be true. One can still practice the modality. After all, the experience of relaxing while having one's head gently held is very pleasant and one may feel stresses, strains, tensions, and headaches melting away. There is nothing wrong with that! However, we should drop claims which we cannot support. When we learn that our explanations are flawed, we should give them up. 

I think that massage therapy has a lot to offer and it is not necessary for us to make unsupported claims. When we do that it holds us back. In the interest of personal and professional integrity, we should strive to understand how the body actually works, rather than hold on to our fantasies of how it works, and adapt our thinking to the preponderance of evidence. I think that this will help us move forward and assist us at becoming even more effective with our clients. 

Thanks for stopping by and for taking the time to ask your question. We really appreciate it!