MSUCOM - Public Relations - Communique Online Spring 2002

Understanding the Body’s Rhythm:
Cranial Osteopathy

by K. Friday

Cranial osteopathy is, perhaps, one of the most misunderstood practices in osteopathic medicine, even as studies on its outcomes and underlying mechanisms continue to expand the knowledge and effectiveness of the field.

The term "cranial osteopathy" is the preferred term, though it is often used interchangeably with what is popularly known as "cranial-sacral therapy."

In the 1920s, Dr. William Garner Sutherland, a pioneer of osteopathic medicine, theorized that the bones of the head were mobile—even in adults—and could be manipulated. This fundamental insight—along with the diagnostic and palpatory techniques he developed—made cranial osteopathy possible in the decades to come.

Lisa Vredevoogd teaches cranial techniques during a small group didactic session.

Today, cranial osteopathy practitioners examine and treat a complex system encompassing the brain and spinal cord, cranial bones, the sacrum, spinal membranes and muscles, and the cerebrospinal fluid. As Lisa Vredevoogd, DO, an assistant professor of osteopathic manipulative medicine explains, cranial osteopathy is essentially based on the fundamental principle that the central nervous system is perpetually in motion.

"There is research that demonstrates that this part of the nervous system has its own rhythm, and over the years there have been more and more observations of this motility," Dr. Vredevoogd explains. "It has been observed during surgery, and it has also been imaged. Sutherland has described this inherent motion as the ‘primary respiratory mechanism’ that includes the fluctuation of the cerebrospinal fluid."

Two important studies in this regard were ones involving MSUCOM researchers. In 1976 a group of MSUCOM biomechanics professors published a study demonstrating the movement of the cranial bones in monkeys. A more recent study was one co-authored by Barbara Briner, DO, an MSU assistant professor of osteopathic manipulative medicine, and two MSU professors of physiology, S. Richard Heisey, PhD, and Thomas Adams, PhD. Published in 1992, this study documented the cranial rhythm and the movement of the parietal bones in cats. Both studies have effectively debunked a long-standing assumption that the cranium in mammals was immobile. The implications for cranial osteopathy were clear.

Barbara Briner was among those whose research documented cranial bone movement.

In clinical practice, osteopathic physicians who use cranial must understand this complex rhythm and be able to discern normal motion and asymmetrical, restricted motion. It is literally a hands-on science that demands advanced palpatory skills. Dr. Briner, a long-term instructor of cranial techniques, says that she frequently asks her students to practice with their eyes closed and learn to "see with their hands," as she likes to call it.

David Grimshaw gently examines the skull structure of a small patient.

But as David Grimshaw, DO, an assistant professor of osteopathic medicine explains, there is nothing inherently special or esoteric about cranial osteopathy. "Cranial is not really a separate aspect of osteopathy," he says, "it is simply an extension of osteopathic principles and practices into the cranium. You are listening to the tissues, examining and encouraging their inherent motion, and assisting the body’s ability to heal itself."

Adults with trauma to the brain and other parts of the nervous system are ideal candidates for cranial osteopathy, Dr. Grimshaw says, but so are infants and children. "Sometimes an infant’s cranium fails to return to a healthy configuration after birth," he explains. "When this happens, infants frequently have trouble breast-feeding and can have asymmetry of their skull and decreased motion in their neck. Other common problems include chronic ear infections, reflux, and recurrent sinusitis."

Dr. Grimshaw knows cranial osteopathy’s effectiveness because he has seen it first hand. One of Dr. Grimshaw’s most successful cases involved a six-year old girl who had been referred to his clinic by an outside physician. Suffering from chronic headaches and sinus infections, the girl had had 14 surgeries over the course of her life without much improvement. Dr. Grimshaw found tremendous restrictions in her cranial-sacral system, removed as many as he could, and the girl’s sinuses began to drain and her headaches lessened. Even the girl’s teachers noticed the dramatic improvement.

Despite successes like these, it is clear that cranial osteopathy is still a minority practice in what is still a minority profession. As Dr. Briner explains, although the field is extremely promising, it is relatively slow to grow because "there aren’t an overwhelming number of NIH grants to study this kind of thing. Most of the relevant studies have been conducted by a small group of very determined researchers."