No one can deny that craniosacral therapy is relaxing. But, then again, so is a nap. And a nap is cheaper. Does Craniosacral Therapy Work? Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility SHOW SUMMARY

Craniosacral therapy ( CST ) doesn’t look like much: light holding of the skull and sacrum and some barely detectable manipulations. Indeed, the action of craniosacral therapy is so gentle and slight that it is the best example of the so-called “subtle” manual therapies, which claim to achieve profound health benefits with minor and safe hands-on tinkering. Practitioners believe that the tiny manipulations of CST affect the pressure and circulation of cerebrospinal fluid, the fluid that surrounds and cushions the brain and spinal cord.

The modern founder of CST, John Upledger, an osteopath,1 is one of the more famous personalities in complementary and alternative medicine. He built on much older ideas.2 Mr. Upledger says that CST “works with natural and unique rhythms of our different body systems to pinpoint and correct source problems.”

Does craniosacral therapy work as advertised?

Skeptics have always had several concerns about craniosacral therapy (here’s a good CST reading list from EBM-First.com):

CST is an alleged solution in search of a problem. CSF circulation doesn’t need to be manipulated or stimulated, because it isn’t ever meaningfully “stagnant” in the first place. There are no common or relatively minor problems that are attributed to it by any expert, and so CST is a solution to a problem that doesn’t exist.4 There is good, recent scientific evidence that the most important and basic assumption about how CST works is just not true: craniosacral therapists cannot actually move the bones of the skull enough to affect the pressure or circulation of the fluid surrounding the brain and spinal column.5 Although CST fluid does circulate, we know that it’s pumped almost entirely by respiration,6 not skull movement. The cranial bones do not even move to relieve the pressure of dangerous swelling in the cranium, so they are probably not going to move for therapist’s fingers either.7 There is both old and new evidence that CST therapists produce conflicting diagnoses of the same patients.89 That is, when asked to assess a patient the CST way, they come to mutually exclusive conclusions. Any effect that CST has on people must be a complex and subtle one, since it cannot be measured. Subtle effects of manual therapy probably do exist — just because it can’t be measured doesn’t mean it isn’t there — but it seems unlikely that any therapist is wise and knowing enough to reliably produce a therapeutic effect by leveraging a phenomenon so subtle that it can’t be measured. And there just aren’t any good quality studies showing that CST does anything to CSF circulation or helps patients. The closest is probably a 2015 study comparing CST to light touch for neck pain: it claimed to find evidence of a minor benefit, but it was quite flawed and probably got it wrong.10

Despite more than 50 years of investigation & the promotion of CST by some practitioners, there remains a void in credible evidence supporting the ability of these techniques to alter the movement of the cranial sutures or improve patient-centered outcomes. … The time is past due for advocates of CST to contribute well-designed studies evaluating the efficacy of these techniques to the peer-reviewed literature. The challenge is clear: prove that it works, or move on. ~ Flynn et al, 2006, Journal of Orthopaedic & Sports Physical Therapy

CST is guilty by association with the prevalent pseudoscientific claim of “increasing circulation”

The idea that craniosacral therapy increases the circulation of cerebrospinal fluid is transparently riffing on a much more quotidian myth about massage: the belief that it meaningfully increases the circulation of blood, and that this is one of the main mechanisms of helping patients. Most massage therapists claim to increase the circulation of blood; CST practitioners up the ante by claiming to increase a much more subtle and exotic type of circulation.

Massage therapy supposedly “increases circulation,” and this is one of the main mechanisms of helping patients. Although massage probably does sometimes modestly boost circulation in some ways, the scientific evidence shows that it’s too little to matter. Because the circulatory system is closed and blood volume is constant, circulation can only “increase” in an area at the expense of another. Also, the relaxation that we expect from any decent massage actually shunts blood into the core, away from the muscles, a robust effect that likely dominates the equation. Most importantly, light exercise is clearly a much stronger driver of circulation.

For more information, see Does Massage Increase Circulation? Probably not, and definitely not as much as a little exercise.

“Circulation boosting” of all kinds is a common concept in alternative medicine, often touted and never validated. To the extent that it’s true in some contexts, it’s probably not very important; to the extent that circulation actually matters (and of course it does), it’s not something that any therapy has much power over.

Even if boosting blood circulation with massage is definitely a myth, of course it’s possible that CSF circulation could be significantly stimulated. They are entirely different things, after all. But they are based on a shared type of motivated reasoning: imprecise and self-serving attempts to explain a treatment effect that is assumed to be true.

At least craniosacral therapy is actually relaxing

I have experienced CST. It is truly, deeply comforting to have your head held for a long time by a craniosacral therapist with the best intentions to provide a soothing experience. Receiving craniosacral therapy is one of the most pleasant, sleepy experiences I have ever had on any massage table. That said, those experiences were not much different from any other soothing massage… or even just a good nap. I have been just as relaxed on my couch with my cat in my lap.

Also on the bright side, I have no doubt at all that there are emotional benefits to the touch therapy involved. And I am even happy to admit that there might be some “interesting” neurological effects, some of which may even be therapeutic — and which are probably not medically harmful. It is, after all, a gentle therapy.

Despite my own professional expertise, I do not begin to have the power to micro-manage such subtle and “interesting” neurological effects … assuming they exist at all. This is a simple matter of humility. Anyone who has studied physiology and neurology honestly must admit to profound ignorance. No one knows how that system really works. There are just too many blank areas on the map.

Yet, craniosacral therapists claim to “know” what is going on well enough to reliably deliver profound therapeutic effects. They believe it strongly enough to charge top dollar for it, too. That’s some serious overconfidence.

What do other osteopaths think?

Even Complementary Therapies in Medicine — a journal that is much friendlier to alternative therapies than mainstream scientific journals — published a review of the available research in 1999 and “found insufficient evidence to support craniosacral therapy.”11 Wouldn’t you expect such a journal to say just the opposite?

There hasn’t been any research supporting CST since then.

In 2006, craniosacral therapy was strongly questioned in yet another journal that you might expect to be friendlier to an alternative therapy, Chiropractic & Manual Therapies .12 Dr. Steve Hartman, a professor of anatomy at a college of osteopathic medicine, writes with much greater authority on this subject than I have:

Craniosacral therapy lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, “cranial” methods remain popular with many practitioners and patients. Until outcome studies show that these techniques produce a direct and positive clinical effect, they should be dropped from all academic curricula; insurance companies should stop paying for them (and their willingness to do so is not evidence that CST works13); and patients should invest their time, money, and health elsewhere. As a scientist in this age of evidence-based practice, I have grown frustrated in my dealings with the “cranial” faithful. As a group, evidence carries little weight with them. ~ Hartman, 2006, Chiropractic & Manual Therapies

Should patients buy craniosacral therapy?

Unproven therapies should never be sold to patients without acknowledging the uncertainties — it’s not ethical.14 More importantly, there’s a risk of harm: not from the therapy, but from belief in a non-existent pathology.15

I can imagine a health care professional who sells CST but strictly limits her therapeutic predictions and is conspicuously humble. Such a therapist might integrate CST as one component of treatment, a relaxing touch therapy, hoping that it might have some other subtle benefits, but not promising or overselling them. The uncertainty would have to be clear to the patient.

That would be a responsible use of CST — presented with a grain of salt, and offered as just one component of therapy, not the centerpiece.

How many CST therapists actually practice in this way? In my experience, CST practitioners like this are basically unheard of. Most seem to be “true believers,” ideologically committed to the modality, unaware of the substantial scientific evidence that CST is ineffective, and not interested in it either. They are also extremely likely to integrate other dubious methods into treatment, especially “energy” medicine, like therapeutic touch/Reiki — which is pure vitalism, and as ridiculous as astrology or psychic healing.

The good, the bad, and the ugly of craniosacral therapy

The good

medical harm is extremely unlikely

relaxing, pleasant, gentle

The bad

harm to your wallet is inevitable, because it doesn’t work

no plausible mechanism of action

practitioners can’t agree on diagnoses

The ugly

CST exists to solve a problem that doesn’t even exist

practitioners tend to be “true believers” whose faith in CST is the tip of an iceberg of pseudoscientific beliefs

About Paul Ingraham I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.

Related Reading

The major myths about massage therapy are:

The complete list of dubious ideas in massage therapy is much larger. See my general massage science article. Or you can listen to me talk about it for an hour (interview).

And massage is still awesome! It’s important to understand the myths, but there’s more to massage. Are you an ethical, progressive, science-loving massage therapist? Is all this debunking causing a crisis of faith in your profession? This one’s for you: Reassurance for Massage Therapists: How ethical, progressive, science-respecting massage therapists can thrive in a profession badly polluted with nonsense.

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