[Ed. Note:  The opinions expressed below are solely those of the author.  They do not represent the opinions of the editor, publisher, or this publication.  Anyone with a medical problem is strongly encouraged to seek professional medical care.]    

Dear Editor:

I read the article on cranial sacral therapy (CST) in the November 2005 issue of Chiari & Syringomyelia News with great interest.

A modern advocate of CST is Andrew Weil, M.D.. Dr. Weil is a renown and extraordinary popular author who has written multiple books on alternative medicine. He was recently on the cover of Time magazine. His advocacy of CST is responsible to a large degree for its current popularity. As popular as Dr. Weil is, it should be noted that he is considered by most professionals as a quack. He is prominently featured on the Quack Watch website (http://www.quackwatch.org/11Ind/weil.html).

In Dr. Weil's book, "Spontaneous Healing", a number 1 New York Times bestseller with more than one million copies sold, a brief discussion on CST is provided. According to Dr. Weil, CST has its origin in 1800's osteopathic medicine. In 1874, Andrew Taylor Still founded a new profession based on mechanically adjusting the body to allow the circulatory and nervous system to function smoothly. Later, in 1939, William Sutherland announced his discovery called the primary respiratory mechanism and a technique for modifying it that came to be known as cranial sacral therapy. Sutherland believed that the central nervous system and its associated structures were in constant rhythmic motion and that this motion was essential to health. Since the rhythmic expansion and contraction of this system resembled breathing and because he considered it to occur in the most vital organs, he termed it "primary respiration". According to Sutherland, primary respiration involved the motion of the cranial sutures, the expansion and contraction of the hemispheres of the brain, and the motion of the membranes covering the brain and spinal cord as well as other structures. A restriction to the normal rhythm of primary respiration can result in many different diseases and poor health. By adjusting the body with gentle manipulations (such as the bones of the skull), restrictions can be eliminated and good health restored.

Dr. Weil learned about CST from Dr. Bob Fulford of Cincinnati. Fulton believed that restrictions were a result of trauma which could occur in one of three ways. The first is trauma associated with birth. The second is physical trauma particularly early in life. The third is psychological trauma particularly early in life.

The CST practitioner moves his/her hands across the body to detect disruptions in the primary respiratory pulse. When a restriction is detected, gentle manipulations are applied to eliminate the restriction and restore the normal pulse or rhythm.

The concept of primary respiration fits remarkably well to what we presently know about Chiari. In Chiari, malformed or herniated cerebellar tonsils block the normal pulse of cerebral spinal fluid by restricting the opening of the base of the skull or foreman magnum. This restriction results in compression to the hindbrain (cerebellum, brain stem and lower cranial nerves) which in turn leads to a wide variety of neurological symptoms.

The concept of primary respiration is not the problem. It's the treatment approach (CST) that is so hard to swallow. The notion that the human hand can detect CSF pulsation restriction is ridiculous. Dr. Fulton claimed that instruments of great sensitivity were needed to detect restrictions and that the hand was the most sensitive of all instruments. Dr. Fulton claimed that he could detect a single human hair under 17 sheets of paper and this degree of sensitivity was needed to detect restriction. I suggest when seeking a practitioner of CST, that the prospective patient take a hair at home and place it under 17 sheets of paper and then ask the practitioner to detect it in the office before agreeing to treatment and especially charges.

Equally absurd is the notion that gentle manipulations of the body or bones can eliminate these alleged restrictions as you correctly pointed out in your article. The supreme test here would be to take a Chiari patient confirmed to have blocked CSF flow by Cine MRI, let a CST practitioner do their thing and then see if CSF flow is improved with Cine MRI post treatment.

In addition to the faulty basis of CST, there are no well controlled clinical studies supporting its effectiveness as was also correctly pointed out in the article.

Following my decompression in 1999, I continued to feel poorly and requested my primary care physician to refer me to a physical therapist (PT). The PT had no knowledge of Chiari and attempted to treat me like a patient with upper spinal cord injury. After a few weeks of therapy, it was clear that no progress was being made. At that point, the PT suggested I seek CST which was also available at the clinic. Before committing to CST, I read up on it and rejected it completely on theoretical grounds. I did not seek CST treatment at the rehab clinic. A couple of months later, I was treating myself to a full body massage at my fitness center when the masseuse informed me that she was a trained practitioner of CST. Because I was skeptical, she offered to administer it to me for free. I agreed and she proceeded to move her hands over my body. After approximately 10 minutes, she stopped and told me that she could find nothing wrong with my clear fluid movement. Net, my one and only CST encounter was inconclusive.

If cranial sacral therapy works, it is working on the basis of the power of suggestion on people whose aliments are psychologically rooted and who are susceptible to such suggestions. To anyone who says I am wrong, I say show me the data from well controlled clinical trials as anecdotal reports are unreliable and considered unacceptable as scientific proof.

R. P. D'Alonzo, Ph.D.

 

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