Cranial osteopathy: Another great piece from Hartman

[Luke Rickards]

Steve Hartman (the Dorko of osteopathy) continues his assult on OCF.
It is long past time for osteopathic physicians to relinquish proclivities to magical thinking and instead base their practice and teaching on biomedical standards of the 21st century. Please.

Luke

[nari]

I've been reading up on craniotherapy ...a bit...

Why does it remind me of the great art of phrenology?


Nari

[Marc]

I agree with Steve Hartman's position. But how can we explain the craniotherapy results?
Neurosciences? Yes, but what else ?
Marc (french ostéopath)

[bernard]

Marc,

The "else" isn't necessary, IMHO. :lightbulb

[Marc]

Marc,

The "else" isn't necessary, IMHO. :lightbulb
Rhôô :teeth:
What else .... about Neurosciences!

[Luke Rickards]

Marc,

Here is a start - http://www.barrettdorko.com/articles/analgesia_of_movement.htm

[Marc]

Thanks Luke!


"Perhaps clinicians like Sutherland gained a sense of ideomotor activity by simply using their hands in an especially non-provocative manner."
Non-provocative manner: it is exactly what I use to do.

"It has long been my experience that such an approach to palpation is absent from the teaching of manual skills in physical therapy, primarily due to an ignorance of ideomotor activity and its purpose."
Not in France: we use the ideomotion without knowing it.

Finally, I would like to emphasize that ideomotion is characterized by four easily recognized attributes:

• effortlessness

• warmth

• muscular softening, and

• surprise.

That's what I feel with our typically french technique: " l'ostéopathie tissulaire".
)It is very close to the SC, but without speaking about the ideomotion (fascial release, fascial memory ... what an idea? )

"Ideomotor activity may provide an explanation for clinical phenomena seen and documented for many years, phenomena that may very well have been misinterpreted. The therapy community has typically assumed that the ablation of inherent muscular activity would lead to rest and recovery. Conversely, manual care that encourages its full expression with permission and understanding is reasonable and potentially harmless. Clearly, it adheres to the traditions of osteopathic care in its original form."
I have to dig the subject ...

Thank's Barrett (and thank's Bernard)

PS: You will excuse my so bad English: haven't spoken for such a long time ....

[Luke Rickards]

we use the ideomotion without knowing it.

Marc, I agree, but not only in France. Well before I came across Barrett's essays I have heard dozens of descriptions of gentle active movement in patients from osteopaths who use 'indirect osteopathic techniques'. Such occurrences are usually labelled simply as 'inherent motion' or some kind of 'unwinding' and then mixed in with the PRM theory. What a shame.

[Marc]

Luke,

Marc, I agree, but not only in France.
I spoke only about the "osteopathie tissulaire" from Pierre Tricot :angel:

[Diane]

Learning about and considering ideomotion in the context of manual therapy is certainly a spell-breaker for all sorts of disparate countries and therapy systems.. sort of pulls the rug out from all the one-sided belief systems when we go interactive, doesn't it?

[Marc]

Not completely, Diane. The "osteopathie tissulaire" is discussed in France by the manipulators.
Osteopathy's theories are not my problem. I try to understand the results of osteopathy.
I am a "Padawan": here to learn of you, SomaSimplers :angel:

[Diane]

What's a Padawan, Marc? I'm guessing... anatomist?

[bernard]

Diane,
A padawan is a student that wants to be a Jedi (Stars War).

[Diane]

OK :D, got it. Thanks for bringing me up to speed on that Bernard.

[bernard]

BTW, Marc is a French DO and PT and he thinks that I'm a Jedi's teacher. ;)

[Marc]

Thank's Bernard ;)
You're a very good Jedi's teacher!
"How did the girls do this to you, young Padawan?” Zakii plucked a feather from his left ear and explained. “They were waiting for me in my dormitory. ..."
Colonial One - Stars War

Sorry Diane :angel:

[Diane]

I agree with Marc, Bernard, you are! :D

[Unregistered]

I agree with Steve Hartman's position. But how can we explain the craniotherapy results?
Neurosciences? Yes, but what else ?
Marc (french ostéopath)
What results? Can anyone identify a properly controlled clinical study that shows cranial therapy to be effective in the treatment of a specific condition?

[Marc]

What results? Can anyone identify a properly controlled clinical study that shows cranial therapy to be effective in the treatment of a specific condition?
That's exactly why I am looking for explanations .... for the results I have when I work on a skull, that cranial therapy can't explain. SC?

[Baecker]

That's exactly why I am looking for explanations .... for the results I have when I work on a skull, that cranial therapy can't explain. SC?

hi,

could you please explain what kind of results you achieve with cranial therapy?

[Marc]

For example a baby 9 month old:
- wake up 6/7 times each night
- sleep only half an hour each day

After 1 treatment, and the day after:
- wake up only twice each night
- sleep 3 hours each afternoon (the first time the parents woke it :eek: :eek: )

[Diane]

If I may add something to the discussion, I would like to point out that aside from questions about whether or not the cranial bones move, if it is or isn't a perceptual fantasy/conceptual hallucination, there is something to be said for treating heads, or perhaps more specifically, skin on heads.

There are columns/nuclei in the brainstem, both incoming and outgoing, to and from stuctures in the head and face and neck, that are separate, distinct, and possibly evolved later from/than those servicing the rest of the body. My educated guess is that the brain pays special attention, therefore, to these parts of the periphery. Possibly the bits of brain focused on these nuclei are responsive to manual neuromodulation is more amplified ways, neurologically. Just a theory at this point, but based on known neuroanatomy. (See thumbnail of hindbrain of 10 mm embryo.) I know of no actual study that has been done yet to rule out or disprove such a theory.

[Baecker]

hi marc,

sounds very good, did you do only cranial treatment?

i hear these stories a lot from osteopaths or from cranio sacral treatments. in case of babies we cannot really say placebo is in effect. could you briefly explain what you did. did you try to correct a spheno basilar torsion?
do you feel palpating spheno basilar are accurate? sorry to ask you so many questions.

i hear also cranio therapy is good with sinuses chronic and acute. there was also a study which had some good results with cranio in case of otitis media.

i got once treated from an osteopath he found a painful spot in the upper cervical on myself, he treated the skull with a big force tried to open up some sutures, then after the painful spot at the upper cervical was gone. he explained it to me but i cannot remember all now but it surely was effective. was it only skin he treated? i don't know i felt the effect rather at the bones.

[Marc]

hi marc,

sounds very good, did you do only cranial treatment?

i hear these stories a lot from osteopaths or from cranio sacral treatments. in case of babies we cannot really say placebo is in effect. could you briefly explain what you did. did you try to correct a spheno basilar torsion?
do you feel palpating spheno basilar are accurate? sorry to ask you so many questions.
I haven't speak english for such a long time... It's a true challenge :eek:
No I didn't try to correct the spheno basilar. I use a global technic really close to Simple Contact (as I understand Barrett's and Bernard's explanations)

i hear also cranio therapy is good with sinuses chronic and acute. there was also a study which had some good results with cranio in case of otitis media.
This guy got an otitis everytime he fall in the water (a paddler of my team)
http://uspckphoto04.site.voila.fr/vire2004/dscf0021.jpg
After just one treatment 5 years ago, he never got otitis ...

i got once treated from an osteopath he found a painful spot in the upper cervical on myself, he treated the skull with a big force tried to open up some sutures, then after the painful spot at the upper cervical was gone. he explained it to me but i cannot remember all now but it surely was effective. was it only skin he treated? i don't know i felt the effect rather at the bones.
was it only skin he treated?
Diane please ??? :angel:

[Marc]

If I may add something to the discussion,
It would be very nice :thumbs_up

There are columns/nuclei in the brainstem, both incoming and outgoing, to and from stuctures in the head and face and neck, that are separate, distinct, and possibly evolved later from/than those servicing the rest of the body. My educated guess is that the brain pays special attention, therefore, to these parts of the periphery. Possibly the bits of brain focused on these nuclei are responsive to manual neuromodulation is more amplified ways, neurologically. Just a theory at this point, but based on known neuroanatomy. (See thumbnail of hindbrain of 10 mm embryo.) I know of no actual study that has been done yet to rule out or disprove such a theory.
Bernard told me something like that, a few days before.
Another point of view: the cranial skin's innervation comes from the fifth cranial nerve ...
http://www.yna.org/NLF01Page1.jpg

And if the trigeminal ganglion was more than a simple ganglion ... A way of treatment ?

[Baecker]

hi marc thx for responding!

so if you apply cranio for the otitis you use just a general approach?

[Marc]

hi marc thx for responding!

so if you apply cranio for the otitis you use just a general approach?
Today, I say yes: "tissular approach" from Pierre Tricot. (I read Bernard, Diane, Barrett ....I do not agree with the cranio-sacral's theories)
http://perso.wanadoo.fr/pierre.tricot/ (in french only, sorry, but you may use translators ;) )

For the guy I used classic crano-sacral's technics :mg: (sorry Diane :D )

[bernard]

Marc,
skull and aface are important component in body representation.
http://www.somasimple.com/forums/showthread.php?t=648

As Diane said it, there is many clues saying that face/neck are sustaining a big part of emotion processes (Damasio).
Tetraplegic people have less emotions but they remain. They stay because peripheral stimuli from face/neck are still there.

It seems understandable that treatment touching skin areas have good chances to engage some reaction.

[Marc]

Marc,
It seems understandable that treatment touching skin areas have good chances to engage some reaction.
Yes indeed!
I just imagine than the Fifth is a shorter way to the cranial nerves nuclei interactions (if exist ???).

[Diane]

Nice picture! Here are a few more that I like to show patients. I want them to know what I'm going to be affecting when I handle their heads. The skin on the back of the head is serviced by occipital nerves from the upper C spine. See thumbnail. See other thumbnail for side view of more cutaneous nerves. There is a lot of striated muscle in the face/head. Funnily enough the striated muscle comes paraxial mesoderm, same as everywhere else, while the bone and teeth and just about everything else mesodermal comes from neural crest. The head is thought to have evolved later than the spinal cord, so it had to be wired in after the rest of the critter was already built, and built out of other stuff. :rolleyes:

Whatever. Anyway, my point is, I vote for the head bones not being able to move, but for enormous amounts of input being able to be made through skin on the face/head. Motor outflow changes will feel dramatic to both patient and practitioner: there is really quite a lot of striated muscle all over the head. Feels great when it finally eccentrically lengthens. Suddenly the head shell can breathe. Of course it will feel like bone is moving: Bone is being decompressed a bit probably, but feels like a lot probably. The practitioner doesn't do it by memorizing a bunch of supposed torsions of things deep in the head and then imagining he or she is actually able to undo them with intricate handholds or placements or pressures.. someone probably sat there holding a head one day, pondered anatomy, and either dreamed that stuff up, or else felt the head suddenly do something of a motor outflow sort, and assumed he or she had "caused" it manually and wrote down what they thought they did all the way into the centre of the head, assuming a biomechanical cause/effect relationship.

I'm not saying don't have a series of moves in mind. The patient's nonconscious mind will feel more secure if your hands feel confident and sure and if they feel as if you have a plan in mind, but wait for their head to respond. So it's OK to think about the "map". I'm only saying that in this, as in all of life, the map is not the territory. AND I'm saying it doesn't have to be the "traditional" map. It can be one you map out for yourself based on your own reasoning. :D

[Marc]

Thank's for this post Diane.
Netter's atlas is a great reference :thumbs_up

"Motor outflow changes will feel dramatic to both patient and practitioner: there is really quite a lot of striated muscle all over the head. Feels great when it finally eccentrically lengthens. Suddenly the head shell can breathe. Of course it will feel like bone is moving: Bone is being decompressed a bit probably,
but feels like a lot probably. The practitioner doesn't do it by memorizing a bunch of supposed torsions of things deep in the head and then imagining he or she is actually able to undo them with intricate handholds or placements or pressures.."

I agree with this point of view.
BUT: we (DO) can treat (?) a baby's regurgitation with cranio sacral technics. That's the reason why I spoke about cranial nerves interaction.
It's perhaps totally false :confused:

The patient's nonconscious mind will feel more secure if your hands feel confident and sure and if they feel as if you have a plan in mind, but wait for their head to respond.
Absolutely right !

[Baecker]

thx marc,
i understand that you worked before in the classical way and you were trying to move bones of the skull and feel the rythm, am i right?
now i like to know do you have same results/outcome if you just using the SC "tissue approach" or is it different?

what the osteopath did on me was rather very quick and forceful.

he did another technique which made me laugh inside, he was pulling my ear trying to fix the temporal bone in that way. he made laugh because i was thinking if i tell people that i am paying this guy to pull my ear out.

[Diane]

BUT: we (DO) can treat (?) a baby's regurgitation with cranio sacral technics. That's the reason why I spoke about cranial nerves interaction.
Marc, if you check out that thumbnail in post #22, the one of a transverse section through the hindbrain of a 10mm human embryo, you'll see there are 4 afferent columns and three efferent columns, all in very close proximity. I have no problem with the idea that when I touch skin (pretty much anywhere, but over the "area" is the best bet) or stretch it this way or that slightly (setting off those SA Type II mechanoreceptors that comprise 19% of all skin reception, and fire continuously to lateral stretch), that I'm changing the flavor of input though the skin into the hindbrain, through the general somatic afferents or on the head, the special somatic afferents. Then I have no problem with being able to note different motor outflow occurring in response, through any of the three efferent columns, one of which goes to general somatic striated, one to branchial somatic (throat/head) and one to smooth muscle. Autonomics control smooth muscle including vascular lumen size/blood flow. Vagus is right there, reading everything all the time. No problem. Baby's system will use whatever it can to "learn" to feel better. All you have to do is hang in there long enough for the desired change to occur. There doesn't have to be any fantasy of head bones moving. Giving up belief systems doesn't mean something bad will happen. :D

[bernard]

marc,
Just look at the cranial nerves nuclei and you'll found a lot of muscular/endocrin... responses.
http://thalamus.wustl.edu/course/brstem.html
http://thalamus.wustl.edu/course/face.html

[Marc]

Thank you Diane.
"Giving up belief systems doesn't mean something bad will happen." :thumbs_up
I'm slowly evolving ;)
Your explanation is really interesting. But when you say "All you have to do is hang in there long enough for the desired change to occur." I cannot refrain from thinking that it is perhaps not sufficient. (but I work on my mind :angel: )

[Marc]

Hi Baecker

now i like to know do you have same results/outcome if you just using the SC "tissue approach" or is it different?
I don't use SC (I do not still know this technique), I just think that the technics I use is really close to SC.
And YES, I have results with the "tissue approach".


he did another technique which made me laugh inside, he was pulling my ear trying to fix the temporal bone in that way. he made laugh because i was thinking if i tell people that i am paying this guy to pull my ear out.
Haa, the "ear pull" technic. Don't laugh Beacker. It's a great osteopathic technics! Isn't it Diane?:D

[Baecker]

i found a new link to cs

i think its pretty nicely done with bad outcome for the support of the theory of cs

http://etd.library.pitt.edu/ETD/available/etd-11182004-100054/unrestricted/downey12-04.pdf

[bernard]

Chiropr Osteopat. (javascript:AL_get(this, 'jour', 'Chiropr Osteopat.');) 2006 Jun 8;14:10. Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=pubmed_Abstract&db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=16762070) Links (javascript:PopUpMenu2_Set(Menu16762070);) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--www.biomedcentral.com-graphics-pubmed-1746-1340.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=Abstract-def&PrId=3196&uid=16762070&db=pubmed&url=http://www.chiroandosteo.com/content/14//10) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--www.ncbi.nlm.nih.gov-corehtml-query-pubmed-pmc.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=Abstract-def&PrId=3494&uid=16762070&db=pubmed&url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16762070)
Cranial osteopathy: its fate seems clear.

Hartman SE (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Hartman+SE%22%5BAuthor%5D).

Department of Anatomy, College of Osteopathic Medicine, University of New England, Biddeford, ME, 04005, USA. shartman@une.edu.

ABSTRACT: BACKGROUND: According to the original model of cranial osteopathy, intrinsic rhythmic movements of the human brain cause rhythmic fluctuations of cerebrospinal fluid and specific relational changes among dural membranes, cranial bones, and the sacrum. Practitioners believe they can palpably modify parameters of this mechanism to a patient's health advantage. DISCUSSION: This treatment regime lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, "cranial" methods remain popular with many practitioners and patients. SUMMARY: Until outcome studies show that these techniques produce a direct and positive clinical effect, they should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health elsewhere.

PMID: 16762070 [PubMed - in process]

[Nabor Costa]

I am reading this entire conversation with a lot of attention, like Marc also working with techniques cranial osteopathy, and certainly patients say they feel better after this therapy. Of course, as osteopath, I do not believe that the bones of the skull move (at least not as it is said in osteopathy), but something happens in patients to improve, placebo? I do not know.

Explanations of Diane I find very interesting (Diane has convinced me more than my own osteopath teachers :rolleyes:), and I would go deeper into the knowledge of neurophysiology to understand it better, but I evolve slowly as Marc and some others osteopaths.


I have spent several years working with osteopathy, and I think it is a therapy that gets good results, but has several handicaps, first it's osteopathy is based on tenets of the 19 th century that almost nobody doubts, so with difficulty can evolve. Second, all research than is done in osteopathy is for own consumption, not given to meet other professionals from different fields of science that can make a critique of the investigation, so difficulty we'll have credibility in the face of other professionals. Thirdly, osteopathy should see less toward its own navel and take advantage of all the progress made by other sciences to grow, and demonstrate that it is effective (i think it is really effective), please do not consider all osteopaths as healers without training, we are professionals who normally spend many hours to study, the problem is that in our training we are not geared to seek truthful information or research, things must change, but they will slowly, the first thing is doubting dogmas.


The reference Hartman I have been reading and I think devastating, perhaps things are not white or black if not many shades of gray .... But i miss a lot of serious investigation and collaboration with areas such as neurophysiology or histology ... Maybe the problem of osteopathy is the fear of loss of separate identity

[Luke Rickards]

Hi Nabor,

Thanks for your input here. It's great to have more osteopaths around.

Osteopathy tends be a little amorphous and I'm not sure what shape it takes in Spain, but I'd like to address some of your comments.

I think it is a therapy that gets good resultsI don't think it is possible to make such a generalisation. Osteopaths usually use a wide range of manual therapy techniques/therapies, some of which have good evidence of effectiveness, and others which have absolutely no evidence of effectiveness whatsoever, such as cranial osteopathy. It may be argued that these techniques, which are now in general use by most manual therapy professions, are more effective when applied according to osteopathic 'philosophy', but so far that is mostly anecdotal- and there is some recent evidence to suggest that this may not be true.

osteopathy is based on tenets of the 19 th century that almost nobody doubtsIf nobody doubted the original wording of these tenets then it is not likely that we would have seen the rewriting of these by the AOA (http://www.osteopathic.org/index.cfm?PageID=ost_tenet).

all research than is done in osteopathy is for own consumptionFirstly, I feel it is very important that osteopathy should provide evidential justification for its beliefs and practices- no other profession is going to do this for us. Secondly, I don't believe the statement is entirely true. The IJOM publishes articles that are relevant to all manual therapists, the content of which I bring here regularly and is often praised by the PTs and other therapists on this site. Further, there are many osteopathic researches that publish in other well-respected manual and physical therapy journals.

osteopathy should see less toward its own navel and take advantage of all the progress made by other sciences to growThis is something that is not unique to osteopathy. It is a complex issue and may only have its solution at undergraduate level education. The university where I studied had a number of progressive lecturers who actively engaged this issue.

When you have 10 posts you will be able to access this editorial (http://www.somasimple.com/forums/showpost.php?p=41413&postcount=7). I think you will enjoy it.

[Marc]

Osteopaths usually use a wide range of manual therapy techniques/therapies, some of which have good evidence of effectiveness, and others which have absolutely no evidence of effectiveness whatsoever, such as cranial osteopathy.

Luke, I can't agree with such a generalisation: "OCCIPITAL NERVES" Diane's techniques, ideomotor effects are able to explain some "cranial osteopathy" good results, even if in fact "cranial osteopathy" is a simple "manual therapy"

[Luke Rickards]

Hi Marc,

Actually, I think we are agreeing here. The point was, Can we say that it is the 'osteopathic' aspect of osteopathic spinal manipulation, or osteopathic fascial release, or osteopathic putting your hands gently on the head, that is the effective therapy, or is it some other mechanism? Most clinicians and their patients would answer that it is the osteopathic part. But we are yet to prove it.

[Javier Gonzalez]

Hi Marc and Luke. I agree with both of you, but I think the problem is the lack of studies to explain the neurophysiology of these interventions. I think it is important to include science in osteopathy. It is very interesting IJOM editorial:

Nicholas P Lucas, Is there a place for science in the definition of osteopathy?, Int J Osteopath Med (2007), doi:10.1016/j.ijosm.2007.10.001

[Nabor Costa]

Hi all.

Luke, pleased to meet you.

Well, I think my bad english doesn't permit me to say things so well as i would like. I must to admit than i have given my opinion based in situation of osteopathy in Spain. And we are suffering from the lack of training to see new information an views. It's for this than I'm here, for to learn more and to listen some others osteopaths and therapists.

As I said, i thing than the tradicionals concepts of cranial osteopathy don't help me for understand why pacients feel better, but I thing (like Javier and Marc), than something happens, but we can not explain that (ideomotion??? I don't know, that theory doesn't explain all in my opinion, but i'll read it again with more attention).

I'm happy to exchange views with you.

[Luke Rickards]

Hi Nabor,
I must to admit than i have given my opinion based in situation of osteopathy in Spain.That is perfectly understandable. To my knowledge, osteopathic thinking and practice varies considerably from country to country, and sometimes even within countries.

[Luke Rickards]

I think it is important to include science in osteopathy.It appears that this will be one of the main topics being discussed at the Advancing Osteopathy conference (http://www.osteopathy08.co.uk/en/conference_l/) in London next month.

[Nabor Costa]

It appears that this will be one of the main topics being discussed at the Advancing Osteopathy conference (http://www.osteopathy08.co.uk/en/conference_l/) in London next month.

I hope that you report us about that event ;).

[Luke Rickards]

Unfortunately, I won't be able to make it to the conference.

[Luke Rickards]

Nabor,

You should be able to access this editorial (http://www.somasimple.com/forums/showpost.php?p=41413&postcount=7) now.

[Nabor Costa]

Luke, I cannot to access into the link, I supose that it's because I'm not even took 30 days in the forum. Don't worry, I have the patience to wait a few more days, while i still have many things to read and study here. :D:D

A greeting.

[Luke Rickards]

Nabor,

Try following these (http://www.somasimple.com/forums/showpost.php?p=7057&postcount=1) instructions.