Cranial Osteopathy

Source: 2006 Original Osteopathy, Santa Monica, California

Do the cranial bones move?

The controversy rages, as does one man struggle with his brother. The premise of cranial bone motion is central to Cranial Osteopathy. Our teachings, practices, and cured patients have relied on it for over sixty years.

Technically, it's no debate. The finest anatomy texts always illustrate the 28 cranial bones separately, with discussion on how they fit together, what their functions are, and so on. A reasonable person could deduce, that since the cranial bones are separate and distinct, there must be motion between them, preventing their fusion. In fact, four researchers, Frymann (1971), Michael and Retzlaff (1975), and Moskalenko (1980,'96,'98) have all shown that the cranial bones do, indeed, move. Frymann measured skull diameters on living human subjects. After extensive recordings, her studies showed that the cranial bones exhibit a rhythmic mobility that is different from the breathing rate. Michael and Retzlaff measured the cranial bone motion of squirrels. Their findings showed cranial bone motion with a rate of 5-7 cycles/minute that did not corresponded to heart rate or changes in venous pressure. Moskalenko used computer analysis of various physiological measurements to show cranial bone "fluctuations" of 6-14 cycles/minute. A fifth and sixth researcher, Heifetz and Weiss (1981), decided to temporarily increase the pressure inside the heads of two comatose patients. They injected solution into the brain. Guess what they found? The cranial bones move, spreading apart in response to the rising internal pressure. Six researchers, one conclusion.

So then, anyone who knows this research can not debate. Cranial bones move.

Cranial Osteopathy also contends that the brain and spinal cord have inherent motility. Cranial Osteopaths, collectively, since the 1940's have sensed this with their trained fingers. Seven studies, involving twelve researchers, have demonstrated brain and spinal cord motion. They range from observations on nerve cells moving rhythmically in tissue culture, to multiple MRI studies on humans, recording the brain actually moving, rhythmically and consistently, as it sits inside the living skull! Included, are the studies done by Greitz (1992), Enzmann & Pelc (1992), Poncelet et al. (1992), Feinberg & Mark (1987), Maier (1994), Miklis et al. (1994), Wolley & Shaw, and Clark & Hyden. All have demonstrated, in one way or another, the inherent motility of the brain and spinal cord.

The basic tenets, then, of brain, spinal cord, and cranial bone motion hold true.

So what about the efficacy of Osteopathy as applied to real patients? Does it work, with real life ailments?

The issue of something working or not is more complicated than it seems. I could barrage a man with information on how well something works, but if his heart is closed, then, for him, it will not work.

In the nine years I have spent honing my Osteopathic skills, I have seen, and continue to see results that astound me. Chronic ear infections cured. Herniated disks requiring surgery, healed. Chronic injuries, often aggravated for years, healed. And one of my favorites: injuries produced by other practitioners, reversed and cured. These have been some of my personal experiences in patient care. What follows is a bit of the existing research in print.


Osteopathy Means Fewer Ear Infections
A study published in Arch Pediatrics in 2003 showed that children with recurrent middle ear infections, who received Osteopathic manipulation, had fewer ear infections, needed less surgery (to place tubes), and had more normal hearing studies (tympanograms) than children who did not. "No adverse reactions were reported" in the study.

The article concluded that: "The results of this study suggest a potential benefit of osteopathic manipulative treatment as adjuvant [in addition to routine pediatric care] therapy in children with recurrent AOM [acute otitis media]; it may prevent or decrease surgical intervention or antibiotic overuse."


Osteopathy Means Fewer Drugs and Fewer Expenses to Back Pain Sufferers
A study in the New England Journal of Medicine in 1999 compared Osteopathic spinal manipulation with standard care for patients with low back pain. The "osteopathic-treatment group required significantly less medication (analgesics, antiinflammatory agents, and muscle relaxants) and used less physical therapy." The "differences in cost were significant."

This article concludes that: "Given the known and potentially serious adverse effects and costs or nonsteroidal antiinflammatory drug therapy, the achievement of equal outcomes in regard to pain relief, function, and satisfaction, with less use of medication and physical therapy, suggests an important benefit of osteopathic manipulative treatment; this type of treatment deserves careful examination through a formal cost-benefit analysis."


Osteopathic Treatment Results in Positive Gains in Children With Spastic Cerebral Palsy
A study published in the journal of Clinical Pediatrics in 2004 compared parental perceptions of 23 children, diagnosed with cerebral palsy, who were treated by osteopathic manipulation as compared to 19 children who were not (the control group). Over a twenty-four week course of therapy, "twenty-one of the 23 parents of the children in the osteopathic group reported improvement in their child during the course of the therapies."

Osteopathic treated group, specific parental comments:
"Improved 'dramatically' with walking, runs without holding onto furniture-age 32 months."
"Stood for the first time, climbs everywhere-age 34 months."
"Running for the first time; chases boys; very coordinated; kicked ball for first time-age 8 years."
"No surgery on his hips 'The orthopedist was stunned'-age 12 years."
"Able to use skateboard for the first time-age 12 years."
In the control group, however, only 2 of 17 parents reported "general but nonspecific improvement" in any area. "One child reported improvement in speech and in mood and the other reported improvement just in mood." On the other hand, "five children in the control group reported worsening of mood."

The basic conclusion: No intervention. No specific benefit.

These examples offer a glimpse, experienced by patients and researchers, of the bounty of benefits that Osteopathy offers.

The research supports us. The evidence is undeniable. The decision is yours.


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References:
Standring, S., Gray's Anatomy, 39th British Ed., Elsevier, 2005.
Gray, H. & Carter H.V., Gray's Anatomy, 15th Ed., 1901, Reprinted by Barnes & Nobles Books, 1995.
Jones, James H. (with contributions from Seffinger, Michael, D.O.) "The Controversy of Osteopathy in the Cranial Field: The Research Status the Primary Respiratory Mechanism," 2005.
Frymann, V.M. "A Study of the Rhythmic Motions of the Living Cranium", JAOA, Vol. 70, 1971, 928-945.
Michael, D.K., & Retzlaff, E.W., "A Preliminary Study of Cranial Bone Movement in the Squirrel Monkey", JAOA, Vol. 74, 1975, 860-864.
Moskalenko, Y. et al., "The Biophysical Organization of the System of Cerebral Circulation", Chapter 2, In: Biophysical Aspects of Cerebral Circulation, Pergamon Press, 1980, 41-42.
Moskalenko, Y., "Bioengineering Support of the Cranial Osteopathic Treatment", Medical and Biological Engineering and Computing, Vol. 34, Supplement 1, Part 2, 1996, 185-186.
Moskalenko, Y., "The Phenomenology and Mechanics of Cranial Bone Fluctuations", paper Presented at the Proceedings of the First Russian Symposium. St. Petersberg, Russia, May 27-29, 1998.
Heifetz, M.D., & Weiss, M., "Detection of Skull Expansion with Increased Intracranial Pressure", Journal of Neurosurgery, Vol. 55, 1981, 811-812.
Sutherland, W.G., The Cranial Bowl, Freeman Press, 1939.
Grietz, D., et al., "Pulsatile Brain Movements and Associated Hydrodynamics Studied by Magnetic Resonance Phase Imaging, the Monro-Kellie Doctrine Revisited", Radiology, Vol. 34, 1992, 370-380.
Enzmann, D.R., & Pelc, N.J., "Brain Motion: Movement with Phase-Contrast MR Imaging", Radiology, Vol. 185, (3), 1992, 653-660.
Poncelet, B.P. et al., "Brain Parenchyma Motion: Measurement with Cine Echo-Planar MR Imaging", Neuroradiology, Vol. 185, (3), 1992, 645-651.
Feinberg, D.A., & Mark, A.S., "Human Brain Motion and Cerebrospinal Fluid Circulation Demonstrated with MR Velocity Imaging", Radiology, Vol. 163, (3), 1987, 793-799.
Maier, S.E., et al., "Brain and Cerebrospinal Fluid Motion: Real Time Quantification with M-Mode MR Imaging", Radiology, Vol. 193, (2), 1994, 447-483.
Miklis, D.J., et al., "Oscillatory Motion of the Normal Cervical Spinal Cord," Radiology, Vol. 192, (1), 1994, 117-121.
Magoun, H., Osteopathy in the Cranial Field, 3rd Ed. The Journal Printing Company, 1976.
Millis, M.V. et al., "The use of Osteopathic Manipulative Treatment as Adjuvant Therapy in Children With Recurrent Otitis Media," Arch Pediatr Adolesc Med. 2003; 157: 881-866.
Anderson, Gunnar B.J. et al., "A comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain," The New England Journal of Medicine, 1999; 341: 1426-1431.
Duncan, B. et al., "Parental Perceptions of the Therapeutic Effect from Osteopathic Manipulation or Acupuncture in Children with Spastic Cerebral Palsy," Clinical Pediatrics, May 2004; 349-353.