John Matthew Upledger, CEO of Upledger Institute International and son of craniosacral therapy pioneer John E. Upledger, DO, responds to the Alternative Meds Update on craniosacral therapy by Sherril Sego, FNP-C, DNP: 


We thank Sherril Sego for helping to spread the word about Upledger CranioSacral Therapy (CST) and want to share some information to clarify a few points in her article. There are varying schools of thought that developed out of William G. Sutherland’s initial work.

Much of the early research on Sutherland’s findings was performed by osteopathic physician Dr. John E. Upledger. Dr. Upledger was hired by Michigan State University to prove or disprove the work of Dr. Sutherland. Based on this research, Dr. Upledger developed a treatment modality, which he named “CranioSacral therapy” in order to differentiate his research-based techniques from cranial osteopathy.


Upledger CST focuses on the whole body and the interactions within it. CST incorporates evaluation and gentle mobilization of the cranium, dura mater, dural tube, and sacrum, as well as the continuity of this anatomical system with the fascia of the entire body.

An important feature of CST is the attention given to the body’s fascial system since the dura mater is the core of this membranous system. Restrictive patterns within the fascia translate their forces throughout the body. 


The production, reabsorption, and subsequent draining of the cerebrospinal fluid (CSF) into the venous portion of the cardiovascular system produce a subtle movement of the cranial bones called the CranioSacral Rhythm (CSR). The CSR is also reflected throughout the body via the delicate stimulation of the motor cortex during the production phase.

CST uses the palpation of the CSR via the bones of the cranium and throughout the body to detect and release restrictions in the membranous system that could potentially cause sensory, motor, or neurologic dysfunctions. As such, CST is intended to facilitate the body’s ability to self-correct. 


The fibromyalgia study cited [in the article] demonstrated the effectiveness of managing the symptoms of fibromyalgia over time. When contrasted with [drug] treatment and associated side effects, CST offered a gentle and viable alternative. 


CST is recommended for all ages — newborns to geriatrics — when performed by a highly skilled practitioner trained in the various specialties. There are few contraindications to CST, but they should be noted: CST should not be done in individuals with acute stroke, acute cerebral hemorrhage, aneurysm, or any acute cerebral vascular condition with an active bleed.

CST should not be done in anyone with an epidural leak, recent skull fracture, or acute traumatic brain injury, or in certain cases of brain herniations, tumors, or conditions in which changes in intracranial fluid pressure could conceivably cause a problem. — John Matthew Upledger, CEO, Upledger Institute International, Palm Beach Gardens, Fla. (194-3)


Dr. Sego responds: 


As health-care providers, we can all agree that exploring the actual clinical significance of CST for the average primary-care provider is the ultimate goal of this discussion. 


In describing the actual technique of CST, it appears that the subtleties of the practice are a set of finely tuned skills that would require intensive training and experience. Having read the literature, I do understand the subtle difference between mobilization, or freeing up, and manipulation, and agree that this is a fine point of clarification but not likely to be one of focus for the general practitioner.

The tenet that the skilled practitioner must not only be able to physically detect this phenomenon of the body, but then discern the physiologic significance for the rest of the body, is clear. As with many alternative medical practices however, there is nearly as much literature refuting this as there is supporting it, and inter-rater reliability of this skill has not always been upheld. 


Ultimately, the decision is usually made by the patient. Unfortunately, this is often not dictated by the potential for benefit of the practice, but by the financial aspect of whether or not health insurance covers the therapy. In my own experience, this is a real and frustrating point.

Some insurance companies specify that CST is considered “physical therapy” and cover the practice only if it is performed by a licensed physical therapist. 


In summary, the age-old premise put forth by Hippocrates of “do no harm” would most likely be upheld by CST. It is a practice that, at worst, would fail to meet the goals of the patient and the practitioner. But in the real world of restricted resources and evidence-based practice, CST may not be the best investment for return. (194-4) 

Sherril Sego, FNP-C, DNP, is a primary-care nurse practitioner at the Department of Veterans Affairs Medical Center in Kansas City, Mo.


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