Craniosacral therapy-- does it work?

Great Debates
61

[QUOTE=The Asbestos Mango]
You do realize that what all of you are saying is "personal experience (a/k/a empirical evidence) counts for nothing, give us evidence from a double blind study for something the very nature of which a double blind study is impossible.
Or, OK, we do a double blind study for a touch-based modality. One group was actually touched, the other group was told they were being touched, but actually weren’t. Compare results.

Err, yeah.

In other words, if the only available means of gathering evidence is to ask the practitioners and clients, “OK, what happened to you?” and they tell you, then you just up and say, “Nope, sorry, I don’t think that could have happened, therefore it didn’t, your mind is playing tricks on you”.

[QUOTE]

The placebo effect is real and effects all of us, albeit not all the time. The ability of the brain to provide sensations that it thinks ought to be there is real. And that it does it all the time. Empirical evidence is not just what you percieve.

If the only available means of collecting evidence is subjective reports, then one needs to particularly careful do so in a careful manner. Controls are usually possible. Yes, ask. But ask both those who had the procedure in question and those who did not but think they had something similar that they were led to believe would be effective. And the person who asks cannot know who is who, either.

In some cases controls are difficult to perform … the ethics of a surgical sham procedure with real anesthesia (and risks) and real incisions, have been an issue of much debate, for example. But when possible and ethical double blinded controls are needed before an approach is accepted as efficacious. And again, the more extraordinary the claim, the more extraordinary the evidence must be. Your claim of having dramatically felt a movement that should be below the threshold of human perception, while expecting it to occur, scarcely qualifies.

62

“Did the sutures move?” isn’t the question a scientist would focus on.

Nor would he ask, “Did the individual’s acne improve measurably?”

He would ask, for starters, “What is the mechanism whereby moving sutures affect acne?”, or “Where is the controlled experiment, where within X level of confidence Y percent of acne sufferers improved by Z%?”

Ie, the fluid pulsing under the skull squirts out through the skin softening the sebum and opening the pores, so the pimples empty themselves. That would be a mechanism, if it happened, which it doesn’t.

Or, we double-blind tested 1000 adolescents, 500 of them controls, and of the CST-treated 300 had the number of pimples reduced by 50%, 100 had the number change by plus-or-minus 10%, and 100 had the number of pimples increase by more than 10%. Of the controls, the numbers were etc.

Evidently the meta-study didn’t find anything reliable resembling that prior paragraph.

63

It isn’t the personal question as to whether one believes one particular witness. We all make daily decisions, and important decisions, on that basis, but not in science.

In science, a personal observation might trigger a scientific investigation to see what is really going on there.

If science is going to build on prior knowledge, the knowledge has to be tested beyond reasonable doubt.

And after a study is done, with the best competency by the ones testing, it is carefully written up and published. Before the journal lets it see the light of day, it is “peer-reviewed”, gone over by other scientists, experienced ones, who check for gaps or errors.

And after it’s published, it’s fair game for others to attack and disprove, if they can. Anything that can survive all that is probably something you can depend on.
As another issue, insurance companies don’t seem to want to pay cash out for treatments that don’t do the patient any more good than a placebo does.

64

Goodness-- let’s all play nice.

Anyway, I’m going to Vanderbilt this week (probably Thursday) in order to read the original studies cited in the BCC meta-study. That’s the only library that carries these medical journals in Nashville. That is also the only way I can see to try to get any more reliable information on this issue, since the BCC study itself said that the kind of double-blind studies that have been mentioned need to be done and are yet to be done. Nonetheless, I would like to examine the nature of the studies that have been done for myself. I am trying to find out what is really going on with the whole issue of craniosacral therapy, and I can’t be responsible for how anybody chooses to interpret what I have said (such as odd comments about it being “worrisome,” et. al.) I am not planning to suddenly spring some kind of intelligent-design type of argument on everybody (“HA HA!! I’m actually going to convince all of you that this exists through long-distance hypnosis, and then I’m going to make sure it’s taught in public schools!!!”) I am trying to find out the truth as it is currently known, and everybody else can do and think exactly as they choose.

65

I did not see this mentioned previously, but the study Anise apparently has been referencing (a systematic review of craniosacral therapy by Green et al, Complementary Therapy in Medicine, December 1999) does NOT flatly say that there is a “cranial rhythm”, contrary to what was stated in the OP.

Important points from the review:

  1. The existing studies on craniosacral therapy (i.e. showing a benefit) are “poor” - of the lowest quality available.

  2. There is no evidence that movement can be achieved manually at cranial sutures.

  3. There is some support for the idea that such motion is possible, and some support for the concept of rhythmic pulsation of cerebrospinal fluid (CSF). What has NOT been shown is that there is any connection between the two, or that alterations in CSF pulsation are related to behavioral or other disorders, or that there is ANY reliable evidence whatsoever that craniosacral manipulation has a positive effect on disease states.

This, again, is in a journal dedicated to reviewing complementary/alternative medicine, not some staid publication like the New England Journal of Medicine.
The skepticism should ring loud and clear.

I have no doubt that if someone goes back and looks at the original studies dating back 20 years or more, and ignores evidence of poor study design, the conclusions could look appealing.

You’d have to want badly to believe.

66

Actually, I know it is, because I just verified it experimentally. I used a playing card (a 52 card deck is just under 1 1/16 inch thick, so I figure that that would be a fairly good approximation), a ruler (hence the measurement) and a memo cube filler pad.

I could easily feel the card sliding under the paper up to 1/8 inch, and could no longer feel it just shy of the 1/4 inch mark. Human skin averages from 1-2 mm thick (according to Wickipedia), which is slightly less than 1/8 inch.

Shodan, a moment’s thought would reveal why your proposed experiment would be useless. A cadaver skull does not have living skin, muscle and fascia over it, or CS fluid flowing in and out of it. It would probably be just as useful to make up a construction of wood and ballistics gel, with a hydraulic pump to push water in and out.

I think ybeafy has a more workable idea. Of course, it would involve taking two groups of people unfamiliar with CST, teaching half of them the correct technique, and the other half incorrect technique, with neither group knowing whether they were doing it properly, and two groups of clients also unfamiliar with CST, with their eyes covered and their ears plugged so they couldn’t pick up any inflection of the therapist’s voice or facial expression, and hope they didn’t pick up on any subtle hesitation in the therapist’s touch, because the therapist may have doubts about what they’re doing because they don’t know if they are in the group that was taught the correct technique or the wrong one (the only way I can see around this would be to tell both groups they were learning the proper technique, and that would bring up ethical considerations).

67

1/8th, or even 1/16th of an inch is a FAR cry from 1/100th of an inch.

68

We cannot reasonably be held responsible for not grasping a point you can not state clearly. If you intended to express through hyperbole that the movement was dramatic, you should have used a phrase that was clear hyperbole. “two inches” is not clear hyperbole. This is especially true in a thread concerned with such things as the placebo effect.

Re Your Experiment

What you describe was not even a single blind experiment.

69

um, go back and, like, actually read my post, then reply to it, OK?

70

I said, “it felt like a couple of inches” (not “two inches” as I have been repeatedly misquoted as saying), regarding a situation where the movement could not have possibly been more than a tiny fraction of an inch. If that’s not clear hyperbole, I don’t know what is.

Because double-blind is the only possible valid experiment. :rolleyes: I did what I could with the equipment and personnel I had at hand. But, oh, wait, direct empirical evidence is really only the placebo effect/my mind playing tricks on me, and is therefore not valid.

Ya know, if we were discussing anything other than alternative/natural therapies, anybody reading this would accept this as a valid experiment that was easily duplicateable, and anyone wishing to test it would grab the nearest playing/business/index card and notebook/memo pad, and I’d be getting responses ranging from “I couldn’t feel the card sliding under when I got past three sheets of paper” to “I could feel it through an entire ream” and everyone would agree that while YMMV, it is possible to feel a movement of 1/100 inch through at least a few sheets of paper.

71

Sorry for neglecting this thread. I didn’t think it was a placebo effect because of all the previous work that she had done, with no effect. It’s very conspicuous cause and effect for serious pain to disappear due to her treatment.

On the other topic being discussed, I would say that even 1/16th of an inch wouldn’t be distinguishable from the compressibility of your own fingertips. Also, it might be hard to tell the “rhythm of the cerebro-spinal fluid” from your own pulse through your fingertips.

72

I see Anise proposes to do a meta-study.

Anise, tally up all the pages in the articles and the hours you spend to do this, and let us know, OK? It sounds like a lot of work, I’d like to know how much.

What standards did the BCC meta require, and are you going to use the same standards? If not, what are you going to use?

73

One more thing, I’m not making any arguments as to whether CST actually works. As far as I’m concerned, the jury is still out, and probably hung. I’m just saying that based on some experiences I’ve had in a classroom, and reading I’ve done, the principles behind it seem pretty sound.

Most of the arguments I’ve heard against alt therapies can also be applied to many, if not most, conventional therapies. Double-blind studies are very effective ways of testing things such as drugs or herbal remedies and nutritional supplements, but things can be pretty dicey when you’re talking about hands-on modalities, both conventional and alt. There are too many human-factor variables that have to be controlled for.

74

Ah, the old “read my post” non-response. Of course it totally ignores the fact that I WAS responding to your post. :rolleyes:

In which Askance said that such a such small distances were imperceptible to human touch. You claimed otherwise:

In which your experiment didn’t use moving the card distances anywhere near 1/100th of an inch. So your proof was not any sort of proof at all, but just silliness. I was merely pointing that out.

So explain that how feeling a card 1/200th of an inch thich through paper moving distances of 1/4 -1/8th of an inch somehow relates to being able to feel something move 1/100th of an inch. You see, I read the responses to your post, and they aren’t saying you can’t feel 1/100 of an inch difference in height through skin, they are saying you can’t feel something move 1/100th of an inch. (not that I necessarily believe that, but your “experiment” didn’t prove jack) Of course you could be deliberately trying to cleverly be dishonest by doing the old bait and switch, but that wouldn’t be intellectually honest, so I will assume you aren’t deliberately shifting your argument.

75

Actually, the scientific verdict is pretty unambiguous. No logical basis to the theory or valid supporting evidence. If you are waiting for a panel of distinguished scientists to announce publicly that CST is a crock, you’ll have a long wait, as there remains openness to any new findings. Until then, there is no justification for practicing or marketing CST.

Such as?

76

Why is it necessary to have skin over the skull and fluid flowing in and out to allow the plates to move?

What effect, in other words, do skin and fluid have on the mobility of the plates of the skull? You said earlier it was heat from the hands. Now you claim other factors. Why are those factors relevant?

Or is this simply a case of special pleading, where every time someone comes up with an experiment, you come up with a new reason to discount it - no skin over the skull, unbelievers in the room, wrong alignment of the planets, etc.

I am afraid that this is also false. You can perfectly well do double blind testing on CST and other touch modalities.

Ideally, you divide a group of patients into three groups, randomly. One group gets “standard” CST. Another group gets nothing. The third group gets something involving touch, but from someone who is plausible on the subject but does things unrelated to CST. As in -

"Hi, Mrs. Smith. Your case is tricky, but I have concluded that your energy flow is impeded. Lie down here, and I can release it. " Then give her a gentle neck rub, preferably with scented oils, all the while murmuring “yup, I can definitely feel the blockage here at your fourth chakra. This will help - just relax.” Then, at the end, you say cheerfully, “You will start feeling better shortly. See you next week!”

Then you compare the three groups. If there is no difference amidst the three groups, then by Occam’s Razor, a difference that makes no difference is no different, and CST has no clinical value.

Again, no offense, but did you see my first point? Post hoc cannot be assumed to be ergo propter hoc.

Regards,
Shodan

77

Well, I trekked down to Vanderbilt’s Biomed Library today, it being the only place in Nashville that carries all the medical journals, and was turned away at the door-- only Vandy or Meharry-affiliated allowed. They do have to let the plebians in at the other Vandy libraries, but not this one (and I’ll bet they wince at having to let in Meharry students.) So, I will now have to go the interlibrary loan route. You see, I’m really not kidding when I say that I will do what it takes to research issues thoroughly. I am not interested in third or fourth-hand versions of whatever it was these studies said, and whatever I have to do to find them, I will do. I am not interested in finding answers that give me a nice emotional feeling because they go well with whatever prejudices I already had. I know this may be hard to believe, because honestly, most people are not interested in going to this kind of trouble. But I am, and I will. Further updates as events warrant.

78

I was amazed to see the assertion that the various sections of the skull can actually move around independant of one another. I would think that should be easy enough to disprove. As far as I can see, the frontal and parietal bones attached to each other jigsaw puzzle style. The coronal suture looks like a long series of interlocking bits. And even if one section could actually be moved over a fraction of an inch, doesn’t that mean the far side of the bone would have to move out an equal distance?

And considering how easily the skin of the scalp wanders over the skull when probed with a finger, I don’t see how it’s possible to tell when any detected movement is the skin, muscle, or any of the other soft tissue layers that you have to get through before you can feel what’s going on with the bone.

79

Not to mention-if they were that easily moved, wouldn’t we be giving ourself frequent skull fractures every time we shampoo?

80

Neither am I. I want the facts, supported by evidence and results that can be reproduced. The fact is that there is no evidence showing craniosacral therapy is more effective than a placebo. Whether the plates move is irelevant. Whether there is a craniosacral pulse is irelevant. These things would only figure into an explanation of why craniosacral therapy works. Again, there is no evidence that it does work. It does not matter that some people in the past may have said ‘Craniosacral therapy could not possibly work because the plates do not move, and there is no pulse.’ . I, and most of the posters in this thread, say ‘It could not work because studies have not shown it to be more effective than a placebo.’. Only studies which show it to be more effective than placebo would constitute evidence in support of craniosacral therapy.