This gentle therapy which saw the light of day in the XNUMXth century theorizes the cranial movement and that of the cerebrospinal fluid. Despite many controversies concerning this theory, it seems that it can relieve certain disorders in infants and adults …

This very gentle therapy aims to evaluate and improve the functioning of the craniosacral system. This is made up of the skull and the entire spine up to the sacrum (one of the bones of the pelvis), as well as the organs and anatomical structures they contain. There are, among other things, 3 superimposed membranes (the meninges), which surround and protect the brain and the spinal cord (itself located inside the spine). Cerebrospinal fluid, which is found between the layers of the meninges, is also part of it.

According to the craniosacral theory, the bones of the skull are mobile (of the order of the minute) while the cerebrospinal fluid is animated by an intrinsic expansion / retraction movement called “primary respiratory movement” (PRM). Thanks to their relative mobility, the bones of the skull and the meninges serve as buffers in this semi-closed “hydraulic” system. Any event that destabilizes this system could cause trouble and pain.

The main principles

Cranial osteopathy has its own principles, in addition to those of osteopathy. They are :

• The motility of the central nervous system: according to the therapists, there would be an expansion / retraction of the central nervous system by a rate of 8/12 per minute.
• The fluctuation of the cerebrospinal fluid: this rhythmic fluctuation will be 2-3 per minute.
• The membranes of reciprocal tension: it is the continuity of the membranes (these are the meninges formed by three membranous layers, namely the pia mater, the arachnoid and the dura mater) with all the fasciae of the organism.
• The link between the dura mater and the sacrum
• Mobility of the bones of the skull: by the shape of the bevelled sutures.

Despite the debates surrounding this therapy the benefits would be felt for certain conditions, here are some of them:

Relieve symptoms of colic in newborns

A preliminary study evaluated the effects of cranial osteopathic treatment to reduce crying, irritability and sleep disturbances associated with infantile colic8. In this study, 28 newborns aged 1 to 12 weeks were randomly divided into 2 groups. The babies of the first group received the treatment once a week for 1 weeks, the others, untreated, made up the control group. The results demonstrate a significant reduction in the crying associated with colic and an increase in the hours of sleep between the first and the last week of treatment, for babies in the treatment group only.

The plagiocéphalie

Plagiocephaly: this cranial asymmetry present at birth is very well managed by cranial osteopathy. The osteopath will examine the bones of the arch, the back of the head, and assess the membranes for mutual tension. He will also pay attention for the sphenobasilar synchondrosis (central joint of the skull). This therapy, if started on time, is generally effective and shows significant results after 3 sessions.

Acute Otitis Media (AOM)

This inflammation of the middle ear, secondary most of the time to an infection of the upper airways, is very well managed by cranial osteopathy. Indeed, the cranial could make it possible to reduce the need for antibiotics (Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc. Med 2003; 157 (9): 861-6

Reduce the time it takes to fall asleep and modify sympathetic nerve activity

The results of a laboratory study indicate that a specific cranial manipulation, the compression of the 4th ventricle (or CV4), would reduce the time to fall asleep and could modify the activity of the sympathetic nervous system9 (the technique would regulate the system orthosympathetic). Twenty healthy participants were randomly assigned to CV4 treatment, sham CV4, or received no treatment. Following CV4 treatment, onset of sleep was faster than for the other 2 groups. In addition, a modest but significant change in sympathetic muscle nerve activity was observed only following CV4 treatment.

Improve the quality of life and reduce anxiety in patients with fibromyalgia

A randomized clinical study evaluated the effects of craniosacral therapy on improving quality of life and reducing anxiety and pain levels in patients with fibromyalgia10. Eighty-four patients were randomly divided into 2 groups: real intervention and “false” ultrasound. After 25 weeks, at a rate of 2 sessions per week, significant improvements for all parameters were observed in the actual treatment group compared to the control group. On the other hand, 6 months after the treatment, no difference had persisted.

Decrease physical and verbal agitation in patients with dementia

A non-random pilot study was carried out in 200811 Nine patients aged 67 to 101 received daily treatment for an average of 5 minutes for 6 weeks. Significant decreases in measures of physical agitation and verbal agitation were observed during this time period. Three weeks after the intervention, the reduction in verbal agitation was maintained. On the other hand, in several cases, the physical agitation returned almost to the beginning.

Cranial osteopathy would also have a role to play in the treatment of benign headaches, during certain dizziness, chewing disorders, chronic neck pain, etc.

The specialist

Most often he is an osteopath DO trained initially in craniosacral therapy during his studies or eventually during specialized training. He can also be a non-osteopathic therapist and not a doctor.

Like any therapist, he must be attentive, caring and passionate. It must have a fine touch, capable of detecting areas of tension. He adapts to his patient, according to his age, his antecedents.

The practitioner must have developed, in addition to the great finesse of touch, qualities such as neutrality, presence in order to be centered to receive information from the patient, and mindfulness. Even if he also includes manipulations, the therapist, by his capacity of reception, would allow the “vital forces” of the patient to take charge of the healing.

Course of a session

After taking a history, making an observation of your posture, the therapist will proceed to the examination of the sacrum, the skull. Thanks to a very delicate touch, the therapist will assess the quality of the membranes and sutures of the skull, will feel the “primary respiratory movement”. Craniosacral therapy therapists would be able to assess its amplitude, symmetry and quality. Then the practitioner will analyze the quality of the movement of the sacrum in line with the movement of the base of the skull, in order to perceive a tension at the level of the dura mater (outer meninges which attaches from the skull to the sacrum). By dint of training, the practitioner acquires an increased sensory perception which would allow him to detect all the disorders. Craniosacral treatment aims to balance the hydraulic forces of the craniosacral system through a relaxing touch.

Through points of contact along the spine, the craniosacral system would also influence the nervous system as well as the pineal and pituitary glands, housed in the brain, which regulate several hormones, including serotonin.

If, theoretically, any restriction of the primary respiratory movement leads to a weakening of the self-healing mechanisms, the reestablishment of this movement would allow these mechanisms to return to work. It is in this sense that craniosacral therapy is sometimes used as a preventive approach. It would also be appropriate for a number of physical, mental and emotional issues (for somato-emotional therapists). In summary, the approach is said to work by helping self-healing mechanisms to dispel the negative effects on the body of stresses of all kinds, including violent shocks.

Become a craniosacral practitioner

In France, craniosacral therapy is mainly performed by osteopaths who either “specialize” in this area or use it in parallel with their other techniques. To practice osteopathy you must have the DO (osteopathic diploma), obtained after 5 years of compulsory studies. There are also physiotherapists and doctors trained in osteopathy.

Other therapists are trained in biodynamic institutes. The teaching takes place in this case in the form of seminars.

There is the Upledger Institute in North America, which is the best-known teaching and certification institution. The training is given in various countries, in the form of seminars which generally last 4 or 5 days. There are more than thirty of them, some covering the base, others focusing on specific issues. Access to most courses is restricted to healthcare professionals, but a few introductory seminars are open to anyone.

Contraindications of craniosacral therapy

Although cranial osteopathy is a gentle technique, before using it, it is best to take some precautions. Before any infectious process, fever, during inflammation, before any benign or malignant tumor process, before a neurological disease (such as cauda equina syndrome for example), during nausea, vomiting, it is essential to see a doctor.

Some side effects such as nausea, diarrhea, headaches, stiffness, may be present after the session. In any case, finding out about the training of the therapist is essential.

Cranial therapy is a branch of osteopathy. The latter was theorized in the United States in 1874 by Andrew Taylor Still (doctor and pastor). Still developed osteopathy and founded the American School of Osteopathy. One of the students, Dr. William Garner Sutherland (1873-1954), a keen observer, began to study the various bones of the skull. In 1899, the idea occurred to him that the bones of the skull would produce minute movements, all punctuated by an expansion / retraction movement of the cerebrospinal fluid: this is the primary respiratory movement ”(MRP). Cranial osteopathy was born.

“He is struck like a flash by the intuition that the cranial bones are” bevelled like the gills of a fish, indicating thereby mobility for a respiratory mechanism “1.

1 “The brain as seen by Swedenborg and Sutherland’s cranial concept, David B. Fuller”

For more than forty years, Sutherland continued his research, with his wife Adah, even going so far as to experiment with his research on himself. At the end of his work he published the book “The Cranial Bowl” in 1939.

Sutherland’s work will be continued by other osteopaths, such as Harold Magoun (1898-1981), a pupil of Sutherland, who in 1951 published “osteopathy in the cranial field” developing a mechanistic view of the cranial, then Rollin Becker ( 1910 – 1996) also a pupil of Sutherland who will develop a more vitalist vision. The cranial will also be developed by Viola Frymann (1921-2016) who will extend it to infants and children. In 1964 she came to Paris to teach cranial osteopathy in Europe. We will also quote Anne Walles, and Robert Fulford.

In 1970, Prof. John Upledger became interested in the cranial bone, following an operation on the spinal cord. Being convinced that the restoration of the primary respiratory movement could play a primordial role in health care, he decided to teach this technique to all health professionals (it had until then been reserved for osteopaths). To do this, he established the Upledger Institute in Florida in 1985. Thus was born CranioSacral Therapy.

The approach of Dr. Sutherland and that of Prof. Upledger are very similar, however Prof. Upledger at the end of his life emphasized the biodynamic and somato-emotional aspect, developing the concept of “vital force”. .

At first, Prof. Upledger’s craniosacral approach was most prevalent in North America, where his practitioners united in the American CranioSacral Therapy Association (CATSA), while those in the biodynamic stream formed the Biodynamic Craniosacral Therapy Association of North America (BCTA / NA). The biodynamic current is now more present in Europe, in particular in Great Britain.

In France the cranial has been developed since 1964 and the arrival of H. Magoun, V. Frymann, Th. Scholey, which will lead schools to integrate the cranial into their teaching.

Controversy around cranial osteopathy

Controversies exist regarding craniosacral therapy. Science does not recognize the movement of the cranial bones, their fusion taking place after birth and during childhood, see the beginning of adulthood (spheno-basilar synchondrosis ossifying around 21 years old).

The popularity of this therapy, led researchers to look into the question, their work not concluding with certainty to the mobility of the cranial bones.

The primary respiratory movement of cerebrospinal fluid also does not have medical class approval. However, certain clinical experiences exist which have made it possible to compare the measurements. Faced with the excessive disparity from one osteopath to another, it was difficult to draw solid conclusions13.

The British Columbia Office of Health Technology Assessment (BCOHTA) also published in 1999 a systematic review and critical appraisal of the scientific evidence on craniosacral therapy, which shows “that there is not enough scientific evidence to recommend the therapy. craniosacral to patients, practitioners or third parties for any clinical condition ”.

There is also a debate within the osteopathic world. Jean Claude Herniou osteopath DO was the author of a column entitled “The primary respiratory mechanism does not exist” (Revue Aesculape n ° 10 of January-February 1998). However, the latter does not in any way reject the existence of mobility of the bones of the skull (INTERVIEW with Jean Claude HERNIOU, Osteopath DO DGBM by Guy ROULIER DO). Indeed, to the question “does the skull move? “Mr. Herniou answers bluntly:” Obviously; moreover, if the bones of the skull were fixed, there would be no sutures. In addition, this non-mobility would be an exception in the laws of life, which would make, in my opinion, this cranial system even more interesting! “

A study on the mobility of the cranial vault was also carried out which did not conclude on the absence of movement14.

However, as Herniou recalls in his interview, Professor Tamboise in 1984 demonstrated the presence of numerous osteoblasts (bone cells responsible for bone synthesis) within sutures, which accredits significant activity at this level. . It was also discovered a great vascularization and innervation in this area.

Despite these many debates, cranial osteopathy remains widely taught in osteopathic schools (with a few exceptions) contributing to the wide therapeutic range of this practice.

Since clinical research is scarce, osteopathy does not benefit from the same research resources as medicine.

Many debates exist on craniosacral therapy, the theory not necessarily being in line with practical reality. However, there is a clinical reality to which many therapists will be able to testify. Faced with the diversity of therapists and their explanations, it is often difficult for patients to navigate. I advise you to pay attention to the training of the practitioner. It is best if its training is accredited by the Ministry of Health. Word of mouth is still the safest way. You can also rely on internet reviews.

I am an osteopath DO, working in a liberal cabinet. I use the wide therapeutic range that osteopathy offers me, including craniosacral therapy when I deem it necessary. It is not a question of moving a bone of the skull or of articulating it as one would do for a shoulder for example. But there are tensions in the skull, which can easily be explained by the aponeuroses surrounding them, the muscles attached to them, and the bevelled sutures. This gentle therapy can therefore be perfectly suited to infants, to patients with severe pain … There is a principle in medicine that can be applied here, and that I constantly apply in the office: “primum non nocere”! 15 (first do no harm!).