Craniosacral therapy (CST), or cranial-sacral therapy, is an alternative therapy used by occupational therapists, physiotherapists, massage therapists, naturopaths, and chiropractors. Craniosacral therapy was developed by Dr. John Upledger around 1983, and is loosely based on osteopathy in the cranial field (OCF), which was developed in 1899 by William Garner Sutherland. In the United States, OCF, or cranial osteopathy, as it is more commonly known, can only be practiced by fully licensed physicians (DOs, MDs and, in some states licensed naturopathic physicians, or NDs) and dentists. Cranial osteopathy is considered an extension of osteopathic medicine, and its training is therefore strictly regulated by the osteopathic medical profession and its governing bodies.
The settled scientific consensus is that craniosacral therapy is pseudoscience, and its practice is quackery. Medical research has concluded that there is no evidence for the therapy's effectiveness.
History and conceptual basis 
Cranial Osteopathy was originated by osteopath William Sutherland (1873–1954) in 1898–1900. While looking at a disarticulated skull, Sutherland was struck by the idea that the cranial sutures of the temporal bones where they meet the parietal bones were "beveled, like the gills of a fish, indicating articular mobility for a respiratory mechanism.
From 1975 to 1983, osteopathic physician John E. Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at Michigan State University as clinical researchers and professors. They assembled a research team to investigate the purported pulse and further study Sutherland's theory of cranial bone movement. Upledger and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement, and the concept of a cranial rhythm. Later reviews of these studies have concluded that their research did not meet enduring standards to offer conclusive proof for the effectiveness of craniosacral therapy and the existence of cranial bone movement.
Practitioners of craniosacral therapy assert that there are small, rhythmic motions of the cranial bones attributed to cerebrospinal fluid pressure or arterial pressure. The premise of CST is that palpation of the cranium can be used to detect this rhythmic movement of the cranial bones and selective pressures may be used to manipulate the cranial bones to achieve a therapeutic result. However, the degree of mobility and compliance of the cranial bones is considered controversial and is a critically important concept in craniosacral therapy.
The therapist lightly palpates the patient's body, and focuses intently on the communicated movements. A practitioner's feeling of being in tune with a patient is described as entrainment. Patients often report feelings of deep relaxation during and after the treatment session, and may feel light-headed. This is popularly associated[by whom?] with increases in endorphins, but research shows the effects may actually be brought about by the endocannabinoid system.
There are few reports of adverse events from CST treatment. In one study of craniosacral manipulation in patients with traumatic brain syndrome, the incidence of adverse effects from treatment was 5%.
Primary respiratory mechanism 
The Primary Respiratory Mechanism (PRM) has been summarized in five ideas.
Inherent motility of the central nervous system 
The postulated intracranial fluid fluctuation is described by practitioners as an interaction between four main components: arterial blood, capillary blood (brain volume), venous blood and cerebrospinal fluid (CSF).
Fluctuation of the cerebrospinal fluid 
There is research which demonstrates examiners are unable to measure craniosacral motion reliably, as indicated by a lack of inter-rater agreement among examiners. The authors of this research conclude this "measurement error may be sufficiently large to render many clinical decisions potentially erroneous". Alternative medicine practitioners have interpreted this result as a product of entrainment between patient and practitioner, a principle which lacks scientific support. The subject of whether or not craniosacral motion can be reliably palpated remains a subject of debate with studies producing mixed results.
Mobility of the intracranial and intraspinal dural membranes 
In 1970, Upledger observed during a surgical procedure on the neck what he described as a slow pulsating movement within the spinal meninges. He attempted to hold the membrane still and found that he could not due to the strength of the action behind the movement.
Mobility of the cranial bones 
The extent to which cranial bones are able to move is considered controversial and studies of the existence and degree of cranial motion have yielded mixed findings. Cranial sutures are the areas in which the eight cranial bones are joined. During infancy, the cranial bones are not rigidly fused to each other, but are instead bound together by a membrane known as a fontanelle where two sutures join. Between the first and second year of life, the cranial bones begin to move together and fuse as a normal part of development. Studies examining the age of the closure of the cranial sutures have reported mixed findings. Closure has been reported to occur during adolescence while other studies indicate greater individual variability in the timing of this closure with fusion of the lambdoid suture, sagittal suture, and coronal sutures taking place in the fourth decade of life, but complete fusion of all sutures not occurring until advanced age (the eighth decade of life has been reported); some studies have found that the sutures never rigidly fuse. According to Gray's Anatomy, "[w]hen such sutures are tied by sutural ligament and periosteum, almost complete immobility results".
Involuntary motion of the sacrum between the ilia 
|This section is empty. You can help by adding to it. (May 2013)|
Systematic reviews 
A systematic review conducted in 1999 found "insufficient scientific evidence to recommend craniosacral therapy to patients, practitioners or third party payers for any clinical condition." Further studies were carried out between 1999 and 2011.
In 2011 a systematic review concluded that the evidence base surrounding craniosacral therapy and its efficacy is sparse and composed of studies with heterogeneous design. The authors of this review stated that currently available evidence was insufficient to draw conclusions and that further study is needed to better evaluate if craniosacral therapy has therapeutic benefit.
In October 2012 Edzard Ernst conducted a systematic review of randomised clinical trials of craniosacral therapy. He concluded that "the notion that CST is associated with more than non-specific effects is not based on evidence from rigorous randomised clinical trials". Commenting specifically on this conclusion Ernst commented on his blog that he had chosen the wording as "a polite and scientific way of saying that CST is bogus." Ernst also commented that the quality of five of the six trials he had reviewed was "deplorably poor," a sentiment prefigured by an earlier (August 2012) review which noted the "moderate methodological quality of the included studies."
- Crislip, Mark (2011). "Alas poor Craniosacral. A SCAM of infinite jest, of most excellent fancy". Science Based Medicine. Retrieved 7 September 2012.[self-published source?]
- Norcross, John C.; Koocher, Gerald P.; Garofalo, Ariele (2006). "Discredited psychological treatments and tests: A Delphi poll". Professional Psychology: Research and Practice 37 (5): 515–22. doi:10.1037/0735-7028.37.5.515.
- Wheeler, Thomas J. (February 21, 2006). "A Scientific Look at Alternative Medicine". Retrieved 2012-01-12.[self-published source?]
- Bledsoe, BE (2004). "The elephant in the room: Does OMT have proved benefit?". The Journal of the American Osteopathic Association 104 (10): 405–6; author reply 406. PMID 15537794.
- Hartman, Steve E (2006). "Cranial osteopathy: Its fate seems clear". Chiropractic & Osteopathy 14: 10. doi:10.1186/1746-1340-14-10. PMC 1564028. PMID 16762070.
- Atwood, KC (2004). "Naturopathy, pseudoscience, and medicine: Myths and fallacies vs truth". MedGenMed 6 (1): 33. PMC 1140750. PMID 15208545.
- Aronoff, George R., ed. (1999). Evaluation and Treatment of Chronic Pain (3rd ed.). Lippincott Williams and Wilkins. p. 571. ISBN 978-0-683-30149-6.
- Barrett, Stephen. "Why Cranial Therapy Is Silly". Quackwatch. Retrieved December 2012.
- Ernst, Edzard (2012). "Craniosacral therapy: A systematic review of the clinical evidence". Focus on Alternative and Complementary Therapies 17 (4): 197–201. doi:10.1111/j.2042-7166.2012.01174.x.
- Jäkel, Anne; von Hauenschild, Philip (2012). "A systematic review to evaluate the clinical benefits of craniosacral therapy". Complementary Therapies in Medicine 20 (6): 456–65. doi:10.1016/j.ctim.2012.07.009. PMID 23131379.
- Upledger, John E (1995). "Craniosacral Therapy". Physical Therapy 75 (4): 328–30. PMID 7899490.
- Upledger, JE (1978). "The relationship of craniosacral examination findings in grade school children with developmental problems". The Journal of the American Osteopathic Association 77 (10): 760–76. PMID 659282.
- Upledger, JE; Karni, Z (1979). "Mechano-electric patterns during craniosacral osteopathic diagnosis and treatment". The Journal of the American Osteopathic Association 78 (11): 782–91. PMID 582820.
- Green, C.; Martin, C.W.; Bassett, K.; Kazanjian, A. (1999). "A systematic review of craniosacral therapy: Biological plausibility, assessment reliability and clinical effectiveness". Complementary Therapies in Medicine 7 (4): 201–7. doi:10.1016/S0965-2299(99)80002-8. PMID 10709302.
- Seimetz, Christina N.; Kemper, Andrew R.; Duma, Stefan M. (2012). "An investigation of cranial motion through a review of biomechanically based skull deformation literature". International Journal of Osteopathic Medicine 15 (4): 152–65. doi:10.1016/j.ijosm.2012.05.001.
- McPartland, JM; Mein, EA (1997). "Entrainment and the cranial rhythmic impulse". Alternative therapies in health and medicine 3 (1): 40–5. PMID 8997803.
- McPartland, John M.; Giuffrida, Andrea; King, Jeremy; Skinner, Evelyn; Scotter, John; Musty, Richard E. (2005). "Cannabimimetic Effects of Osteopathic Manipulative Treatment". The Journal of the American Osteopathic Association 105 (6): 283–91. PMID 16118355.
- Greenman, PE; McPartland, JM (1995). "Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome". The Journal of the American Osteopathic Association 95 (3): 182–8; 191–2. PMID 7751168.
- Greitz, D; Franck, A; Nordell, B (1993). "On the pulsatile nature of intracranial and spinal CSF-circulation demonstrated by MR imaging". Acta radiologica 34 (4): 321–8. PMID 8318291.
- Greitz, D.; Wirestam, R.; Franck, A.; Nordell, B.; Thomsen, C.; Ståhlberg, F. (1992). "Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging". Neuroradiology 34 (5): 370–80. doi:10.1007/BF00596493. PMID 1407513.
- Wirth-Pattullo, V; Hayes, KW (1994). "Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements". Physical therapy 74 (10): 908–16; discussion 917–20. PMID 8090842.
- Rogers, Joseph S; Witt, Philip L; Gross, Michael T; Hacke, Jon D; Genova, Perry A (1998). "Simultaneous Palpation of the Craniosacral Rate at the Head and Feet: Intrarater and Interrater Reliability and Rate Comparisons". Physical Therapy 78 (11): 1175–85. PMID 9806622.
- Halma, Kelly D.; Degenhardt, Brian F.; Snider, Karen T.; Johnson, Jane C.; Flaim, M. Schaun; Bradshaw, Danielle (2008). "Intraobserver Reliability of Cranial Strain Patterns as Evaluated by Osteopathic Physicians: A Pilot Study". The Journal of the American Osteopathic Association 108 (9): 493–502. PMID 18806078.
- Upledger, J E; Vredevoogd, J. (1983). Craniosacral Therapy. Eastland Press. ISBN 0-939616-01-7.[page needed]
- Herring, Susan W. (2008). "Mechanical Influences on Suture Development and Patency". In Rice, David P. Craniofacial Sutures: Development, Disease and Treatment. Frontiers of Oral Biology 12. Karger. pp. 41–56. doi:10.1159/000115031. ISBN 978-3-8055-8326-8. PMC 2826139. PMID 18391494.
- Morriss-Kay, Gillian M.; Wilkie, Andrew O. M. (2005). "Growth of the normal skull vault and its alteration in craniosynostosis: Insights from human genetics and experimental studies". Journal of Anatomy 207 (5): 637–53. doi:10.1111/j.1469-7580.2005.00475.x. PMC 1571561. PMID 16313397.
- Williams, P L; Warwick, R; Dyson, M; Bannister, L H. (1989). Gray's Anatomy (37th ed.). Edinburgh: Churchill Livingstone. p. 468. ISBN 0-443-02588-6.
- Ferguson, Andrew (2003). "A review of the physiology of cranial osteopathy". Journal of Osteopathic Medicine 6 (2): 74–84. doi:10.1016/S1443-8461(03)80017-5.
- Nelson, Kenneth E.; Sergueef, Nicette; Glonek, Thomas (2006). "The Effect of an Alternative Medical Procedure Upon Low-Frequency Oscillations in Cutaneous Blood Flow Velocity". Journal of Manipulative and Physiological Therapeutics 29 (8): 626–36. doi:10.1016/j.jmpt.2006.08.007. PMID 17045096.
- Nelson, Kenneth E.; Sergueef, Nicette; Glonek, Thomas (2006). "Recording the Rate of the Cranial Rhythmic Impulse". The Journal of the American Osteopathic Association 106 (6): 337–41. PMID 16790539.
- Jäkel, Anne; Von Hauenschild, Phillip (2011). "Therapeutic Effects of Cranial Osteopathic Manipulative Medicine: A Systematic Review". The Journal of the American Osteopathic Association 111 (12): 685–93. PMID 22182954.
- Ernst, Edzard (2012). "Up the garden path: craniosacral therapy". Retrieved 15 December 2012.