Why Cranial Therapy Is Silly

Stephen Barrett, M.D.

Craniosacral therapy (CST) is one of many terms used to describe a various methods based on fanciful claims that:

Most practitioners are osteopaths, massage therapists, chiropractors, dentists, or physical therapists. The other terms used to describe what they do include cranial osteopathy, cranial therapy, bio cranial therapy, and two chiropractic variants called craniopathy and sacro occipital technique (SOT).

Dubious Claims

Osteopaths attribute the origin of CST to osteopath William G. Sutherland (1873-1954), who published his first article on this subject in the early 1930s. From the mid-1970s onward, the leading proponent was John E. Upledger, D.O., who founded the Upledger Institute of Palm Beach Gardens, Florida. Various Institute publications have claimed:

From 2001 through the present time, the Institute Web site has stated:

Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system. By complementing the body's natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, including: migraine headaches; chronic neck and back pain; motor-coordination impairments; colic; autism; central nervous system disorders; orthopedic problems; traumatic brain and spinal cord injuries; scoliosis; infantile disorders; learning disabilities; chronic fatigue; emotional difficulties; stress and tension-related problems; fibromyalgia and other connective-tissue disorders; temporomandibular joint syndrome (TMJ); neurovascular or immune disorders; post-traumatic stress disorder; post-surgical dysfunction [4].

The Upledger Institute has also advocated and taught "visceral manipulation," a bizarre treatment system whose practitioners are claimed to detect "rhythmic motions" of the intestines and other internal organs and to manipulate them to "improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body." [5] Upledger died in October 2012, but the institute will perpetuate his teachings.

Some chiropractors claim that Nephi Cottam, D.C. introduced "cranial adjusting" (craniopathy) to the chiropractic world in 1929, several months before Sutherland publicly presented his methods. During the 1980s, a brochure distributed by his son Calvin Cottam, D.C., claimed that cranial adjustments had relieved "insanity, insomnia, paralysis . . . spoken aphasia, headache . . . trigeminal neuralgia, pain between the shoulders, pain in the stomach (apparently from ulcers), indurated empyema. . ." [6]

Weird Beliefs

Some of Upledger's assertions are among the strangest I have ever encountered. Chapter 2 of his book, CranoSacral Therapy: Touchstone of Natural Healing, describes how he discovered and communicates with what he calls the patient's "Inner Physician":

By connecting deeply with a patient while doing CranioSacral Therapy, it was possible in most cases to solicit contact with the patient's Inner Physician. It also became clear that the Inner Physician could take any for m the patient could imagine —an image, a voice or a feeling. Usually once the image of the Inner Physician appeared, it was ready to dialog with me and answer questions about the underlying causes of the patient's health problems and what can be done to resolve them. It also became clear that when the conversation with the Inner Physician was authentic, the craniosacral system went into a holding pattern [7].

The chapter goes on to describe Upledger's care of a four-month-old French baby who was "as floppy as a rag doll." Although the baby had never been exposed to English, Upledger decided to see whether the baby's "Inner Physician" would communicate with him via the craniosacral system:

I requested aloud in English that the craniosacral rhythm stop if the answer to a question was "yes" and not stop if the answer was "no." The rhythm stopped for about ten seconds. I took this as an indication that I was being understood. I then asked if it was possible during this session for the rhythm to stop only in response to my question and not for other reasons, such as body position, etc., The rhythm stopped again. I was feeling more confident. I proceeded [7].

Using "yes-no answers," Upledger says, he pinpointed the problem as "a toxin that was inhaled by the mother . . . over a period of about two-and-a-half hours while cleaning the grease off an antique automobile engine" during the fourth month of pregnancy. After "asking many particulars" about what he should do, Upledger was told to "pump the parietal bones that form a large part of the roof of the skull, and to pass a lot of my energy through the brain from the back of the skull to the front." As he did this, Upledger frequently checked with the baby's "Inner Physician." After about an hour, Upledger says, the baby began to move normally [7].

Two Deaths Reported

Relying on CST instead of effective treatment can be dangerous. Moreover, its practice indicates poor judgement that may harm patients in other ways. At least two deaths associated with craniosacral therapy have been reported:

Related Systems

British osteopath Robert Boyd (1933-2014) developed a variant he called Bio Cranial Therapy, which—according to the International Bio Cranial Web site—is "extremely helpful" for "chronic fatigue syndrome (CFS); varicosity and varicose ulcers; tinnitus; bladder prolapse; prostate disorders; Meniere's syndrome; cardiovascular disturbances including hypertension, angina; skin disorders (psoriasis, eczema, acne etc); female disorders (dysmenorrhoea, PMS (PMT), menorrhagia etc); arthritis and rheumatic disorders; fibromyalgia and heel spurs; gastric disorders (hiatus hernia, ulceration, colitis); asthma and a range of bronchial disorders including bronchiectasis and emphysema." [10]

Sacro-occiptal technique (SOT) combines theories about spinal fluid pressure with chiropractic theories about spinal "nerve pressure" as a cause of ill health. Chiropractors who advocate SOT claim to detect "blockages" by feeling the skull and spine and measuring leg lengths [11].

The Scientific Viewpoint

I do not believe that CST has any therapeutic value. Its underlying theory is false because the bones of the skull fuse by the end of adolescence and no research has ever demonstrated that manual manipulation can move the individual cranial bones [12]. Nor do I believe that "the rhythms of the craniosacral system can be felt as clearly as the rhythms of the cardiovascular and respiratory systems," as is claimed by another Upledger Institute brochure [13]. The brain does pulsate, but this is exclusively related to the cardiovascular system [14], and no relationship between brain pulsation and general health has been demonstrated.

Many years ago, three physical therapists who examined the same 12 patients diagnosed significantly different "craniosacral rates," which is the expected outcome of measuring a nonexistent phenomenon [15]. Another study compared the "craniosacral rate" measured at the head and feet of 28 adults by two examiners and found that the results were highly inconsistent [16].

In 1999, after doing a comprehensive review of published studies, the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that the theory is invalid and that practitioners cannot reliably measure what they claim to be modifying. The 68-page report concludes that "there is insufficient evidence to recommend craniosacral therapy to patients, practitioners, or third party payers." [17]

In 2011, the Archives of Disease in Childhood published the results of a well-designed randomized, controlled study of 142 children ages 5-12 with cerebral palsy. About half received cranial therapy (up to six sessions) and the others were placed on a "waiting list." After six months, the researers found no difference between the treatment and no-treatment groups in gross motor function or the child's quality of life [18].

In 2002, two basic science professors at the University of New England College of Osteopathic Medicine concluded:

Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. Since no properly randomized, blinded, and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations [12].

In 2005, one of the professors reported that despite their persistent effort, craniosacral therapy and its "imaginary biology" were still taught in all of the DO schools in the United States and questions about it remained on DO licensing exams [19].

In 2016, a French research team that a comprehensive review of the scientific literature concluded: "Our results demonstrate, consistently with those of previous reviews, that methodologically strong evidence on the reliability of diagnostic procedures and the efficacy of techniques and therapeutic strategies in cranial osteopathy is almost non-existent." [20] I certainly agree! In fact, I believe that most practitioners of craniosacral therapy have such poor judgment that they should be delicensed.

Related Articles

Reader Comment

As a physical therapist and exercise physiologist, I'd like to thank you for your article on "craniosacral therapy". Too many patients and therapists have been duped by this so-called therapy. If these therapist were ever to suggest to any self-respecting neurosurgeon, that they could move the sutures of the skull with ounces of force, they would get laughed right out of the room. I have personally witnessed how saws and drills are needed (with more than a few ounces of force) to alter the structure of the adult skull. To tell patients that you have the ability to analyze the cerebral spinal fluid flow with your fingertips and then "normalize" it by mobilizing the cranial sutures is not just quackery but malpractice. They should lose their license.


  1. Discover CranioSacral Therapy. Undated flyer distributed in 1997 by the Upledger Institute.
  2. Upledger CranioSacral Therapy I. Brochure for course, November 1997.
  3. For serious education in complementary care . . . come to the source. Brochure for course, Upledger Institute, Aug 2001.
  4. Discover CranioSacral Therapy. Upledger Institute Web site, accessed Feb 10, 2018.
  5. Visceral manipulation. Upledger Institute Web site, accessed Aug Aug 2001 through July 2007.
  6. Cottam C. The first known statement about any cranial adjusting technique by any professional group. Including in a promotional mailing in 1987.
  7. Upledger JE. CranoSacral Therapy: Touchstone of Natural Healing. Berkeley, Caliifornia: North Atlantic Books, 1999, p 51-58.
  8. Barrett S. Bizarre therapy leads to patient's death. Chirobase, July 7, 2003.
  9. Findings of fact, conclusions of law, and disciplinary order. Missouri Dental Board v Joseph H. Kerwin, D.D.S.. Cause No. 01-1073 DB, June 22, 2009.
  10. Bio Cranial Therapy in action. International Bio Cranial Web site, accessed Aug 21, 2001.
  11. Homola S. Bonesetting, Chiropractic, and Cultism, 1963.
  12. Hartman SE, Norton JM. Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine 6(1):23-34, 2002.
  13. Workshop catalog, Upledger Institute, 1995.
  14. Ferre JC and others. Cranial osteopathy, delusion or reality? Actualites Odonto-Stomatologiques 44:481-494, 1990.
  15. Wirth-Pattullo V, Hayes KW. Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Physical Therapy 74:908-16, 1994.
  16. Rogers JS and others. Simultaneous palpation of the craniosacral rate at the head and feet: Intrarater and interrater reliability and rate comparisons. Physical Therapy 78:1175-1185, 1998.
  17. Kazanjian A and others. A systematic review and appraisal of the scientific evidence on craniosacral therapy. BCOHTA, May 1999.
  18. Wyatt K. Cranial osteopathy for children with cerebral palsy: A randomised controlled trial. Archives of Disease in Childhood, doi:10.1136/adc.2010.199877, Feb 24, 2011.
  19. Hartman SE. Cranial osteopathy: its fate seems clear. Chiropractic & Osteopathy, June 8, 2006.
  20. Guillard A and others. Reliability of diagnosis and clinical efficacy of cranial osteopathy: A systematic review. Plos One, Dec 9, 2016.

This article was revised on February 11, 2018.

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