Role of Craniosacral Therapy For Chronic Pain

ROLE OF CRANIOSACRAL THERAPY FOR CHRONIC PAIN: A March
SYSTEMIC REVIEW 2021
ABSTRACT
Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 1 of 32

BACKGROUNG:
Craniosacral Therapy (CST) is a non-invasive, mindfulness-based treatment approach

using gentle manual palpation techniques to release fascial restrictions between the cranium
and the sacrum. It is a form of alternative and complementary therapy.
AIM AND OBJECTIVE:
Aim of study was to review the effectiveness of craniosacral therapy for chronic pain
patients with any clinical conditions. The objective of the study was to review the scientific
basis of craniosacral therapy as a therapeutic approach in chronic pain patients.
METHODOLOGY:
Systemic review was conducted from the articles searched from PubMed, Science
direct, Google scholar and the Cochrane library electronic database and relevant websites and
professional organizations.
RESULT:
In the present study, data collection was done from 21 articles and few relevant
websites, which were selected on the basis of inclusion criteria. Many of the articles
concluded that effectiveness of CST in improving problems has not been proven scientifically
and few articles concluded that CST produce a major difference in decreasing pain.
CONCLUSION:
The present study concluded that craniosacral therapy is effective in patients with
chronic pain following any clinical conditions, but require further research study.
KEYWORDS:
Craniosacral, Cranial bones, Chronic pain, Craniosacral rhythm, Cerebrospinal fluid

INTRODUCTION

CHRONIC PAIN:
Pain is an unpleasant sensory and emotional experience associated with actual or

potential tissue damage.[1] Chronic pain is usually defined as pain lasting more than 3 months
and almost certainly has some, albeit variable, element of central sensitization. However, any
mechanistic combination — nociceptive, neuropathic, and central — may be present in a
given individual.[2] Chronic regional pain is present in 20% to 25% of the population and
chronic widespread pain is present in approximately 10% of the population.[2]
Treatment can be complex and difficult. While there are guidelines to direct
management of chronic pain associated with specific disorders such as cancer, osteoarthritis,
fibromyalgia or neuropathic pain, often there is no obvious cause for pain that persists despite
treatment.[1] Chronic pain disorders are the leading global cause of disability and are still
increasing in prevalence. Low back and neck pain, headache and migraine considerably affect
all age groups from the beginning of adolescence to middle-aged and older adults.[3]
Cognitive and emotional factors have a critically important influence on pain

perception and these relationships lie in the connectivity of brain regions controlling pain
perception, attention or expectation, and emotional states.[2] Frequently, the patient with
chronic pain syndrome will spend most of the day in bed, relinquishing responsibility for his
or her welfare to whomever will accept that responsibility.[4]
Pathophysiology of Chronic Pain:
It is complex and depends on its origin, being different for nociceptive, neuropathic,
visceral and mixed (e.g., cancer) pain. Acute nociceptive pain arises from activation of
nociceptors in the periphery by noxious stimuli (e.g., mechanical pressure, heat, cold or
chemicals) that damage or threaten to damage tissue. Afferent nociceptive signals can be
altered by a descending or modulatory system originating from several regions of the central
nervous system, including the somatosensory cortex, hypothalamus, periaqueductal gray
(PAG), pons, lateral tegmental area and nucleus raphe magnus. Activation of these
descending pathways promotes an analgesic effect (descending inhibition) effected and
modulated by various neurotransmitters, including noradrenaline and serotonin.[1]

FIGURE 1: Multiple mechanisms of chronic pain and potential effects of management

strategies
Peripheral and central sensitization result in an exaggerated response to painful

stimuli (hyperalgesia) and pain in response to normally nonpainful stimuli (allodynia),
leading to persistent chronic pain that is independent of the initial painful insult. Dysfunction
of descending serotonergic and noradrenergic modulatory pathways results in an imbalance
between inhibitory and excitatory pain signaling pathways within the central nervous system.
Over time, pain hypersensitivity also produces structural changes in the brain that perpetuate
chronic pain.[1]

Symptoms of Chronic Pain:
The chief symptoms were described as burning, tightness, weakness, numbness,

tingling, queer or tired sensations that were often continuous day and night. They also
describe severe fatigue causing disability, worsening of symptoms during and after exercise,
and a “touch me not” reaction to examination.[2]
Arthur J. Barsky and Jonathan F. Borus indicated that the symptoms common to the
functional somatic syndromes include fatigue, weakness, sleep difficulties, headaches,
muscle aches and joint pain, problems with memory, attention, and concentration, nausea and
other gastrointestinal symptoms, anxiety, depression, irritability, palpitations and racing
heart, shortness of breath, dizziness or light-headedness, sore throat and dry mouth are highly
prevalent in the population in general.[2]
Beside the huge impact of chronic pain on the quality of life, another relevant issue is
the relation between pain and mortality: a 2009 work cohort record linkage study suggests
that severe chronic pain is associated with increased risk of mortality, independent of
sociodemographic factors.[5]
The Role of Physiotherapy in Chronic Pain
Physiotherapy is a vital aspect of pain management in many clinical conditions. Many

pain management strategies, such as medication or intervention techniques, will provide only
temporary relief of symptoms. Our goal is to provide a long-term solution to your pain by
addressing the underlying cause. For this reason it is recommended that physiotherapy should
be given in conjunction with other appropriate pain management techniques.[6] Exercise is an
effective treatment for various chronic pain disorders, including fibromyalgia, chronic neck
pain, osteoarthritis, rheumatoid arthritis and chronic low back pain.[7] Physical therapy for
patients with chronic pain should include exercise therapy tailored to the patient’s
preferences, needs, pain cognitions, musculoskeletal and central nervous system
dysfunctions.[7]
Knowing that chronic pain and disability are not only influenced by somatic
pathology, but also by psychological and social factors, multidisciplinary interventions for
chronic pain have become more accepted in various comprehensive approaches and have
rapidly increased in number over the last few decades.[8] There is evidence that pain

management programmes (PMP), using a multidisciplinary approach, can be effective.

Various treatment strategies such as acceptance and commitment therapy (ACT), cognitive
behavioral therapy (CBT) and mindfulness can be used. [9]
Exercise is a common component of both adult and adolescent multidisciplinary

rehabilitation and cognitive behavioral therapy.[10] Many kinds of therapeutic exercises have
already been used in the rehabilitation program such as conditioning, strengthening and
stretching exercises to improve mobility, muscle strength, muscle tone and improve range of
motion. Aerobic exercises may also be incorporated to improve endurance level of
cardiovascular system. One of the other desirable effect of sufficient intensity of exercise is
the release of beta-endorphin levels which can help alleviate pain and improve mood.[6]
Physical therapy modalities include pain relieving modalities like hot and cold packs,
ultrasound, short wave diathermy, low frequency currents (TENS, diadynamic currents,
interferential currents), high voltage galvanic stimulation, laser and neurostimulation
techniques like deep brain stimulation and transcranial magnetic stimulation along with
manual therapy. Commonly used physical agents in physiotherapy are heat, electricity, light,
sound, and cold. Most of these agents are used to improve the lymphatic and blood
circulation to the area due to a local vasodilation effect and possible muscle relaxation.[6]
LASER; Traction; Manual therapy like massage, myofascial release, joint mobilization;
Relaxation therapy and Mirror therapy are another physical therapy agent that can be used in
the treatment of pain.
Contraindications of electrical therapy include stimulation over cardiac pacemakers,

electrical implants, carotid sinus, epiglottis, abdomen and gravid uterus, anesthetic region,
recent scars to avoid wound dehiscence, metal implants and haemorrhage.
The rationale for physiotherapy in chronic pain stems from evidence of the beneficial
effects of exercise on tissue healing, function and mood coupled with the belief that activity
avoidance and resultant deconditioning contribute to ongoing pain by encouraging a negative
cycle of decreasing function and increasing pain.[11]
Patients should be provided with written instructions, dates for follow-up

consultations and encouraged to ask questions so that their concerns are addressed.[1] While
there are guidelines to direct management of chronic pain associated with specific disorders

such as cancer, osteoarthritis, fibromyalgia or neuropathic pain, often there is no obvious

cause for pain that persists despite treatment.[1] It requires careful establishment of realistic
expectations and formulation of an individualized, tiered, multimodal plan that can
successfully bring pain relief and improve function.[1]
CRANIOSACRAL THERAPY:
It is a form of alternative and complementary therapy that is used by chiropractors,

osteopaths, massage therapists and some physiotherapists. Craniosacral Therapy (CST) is
derived from osteopathic manipulative treatment and uses mindful, very gentle fascial
palpation techniques to reduce sympathetic arousal by modifying body rhythms and to
support the body’s function and capability of self-regulation by relaxing physical and mental
structures.[12] The basis of craniosacral therapy is the subjective detection of pulsation and
rhythm created by the flow of cerebrospinal fluid around the body.[13]
It is a non-invasive, mindfulness-based treatment approach using gentle manual

palpation techniques to release fascial restrictions between the cranium and the sacrum. It is
also defined as a structured diagnostic process that evaluates the mobility of the osseous
cranium, the related mobility of the skull and sacrum and the palpation of the CRI
(craniosacral rhythm impulse) throughout the body.[14]
Besides releasing myofascial structures, CST intends to normalize sympathetic nerve

activity, often increased in chronic pain patients, by modifying craniosacral body rhythms.[3]
Upledger described the CST as a gentle, hands on approach that releases tension deep in the
body to relieve pain and dysfunction and also improve full body health and performance.
The craniosacral system anatomically encompasses the structures of the central nervous
system including the skull, the cranial sutures, the cerebrospinal fluid, and the membranes of
the brain and the spinal cord.[15]
CST is used for different clinical conditions, in adults as well as in children. CST is
used for a wide variety of diseases, including migraines and headaches, chronic neck and
back pain, stress and tension-related disorders, motor-coordination impairments, infant and
childhood disorders, brain and spinal cord injuries, chronic fatigue, fibromyalgia,
temporomandibular joint disorder, scoliosis, central nervous system disorders, learning

disabilities, attention deficit hyperactivity disorder, post-traumatic stress disorder, orthopedic

problems and many other conditions.[16]
These techniques are based mainly on the study of anatomic and physiologic
mechanisms in the skull and their relation to the body as a whole, which includes a system of
diagnostic and therapeutic techniques aimed at treatment and prevention of diseases.[17]
Mechanism of CST:
A Brain and Nervous system operate the body functions. Craniosacral therapy helps
in maintaining the circulation of cerebrospinal fluid (CSF). A pulse through the fluids
proceeds through the entire craniosacral system, from the sutures in the skull to the spinal
cord. Every day our body gets affected by a certain amount or level of stress, and sometimes
the changes occur, it tightens the tissues and also alter the craniosacral system. The alteration
of the craniosacral system causes tension around the spinal cord and the brain which
ultimately leads to restrictions.
In the craniosacral theory, fascial restrictions within the craniosacral system lead to
abnormal, arrhythmic motion of the cerebrospinal fluid. This craniosacral rhythm is
assessable by palpation and quantifiable by encephalogram, myelogram, and magnetic
resonance imaging. There is also growing evidence for fascial involvement in pain
chronification. Studies have shown increased activity of fascial nociceptors within restricted
connective tissue, which can contribute to remodelling processes of inflammation and
fibrosis, increased tissue stiffness, muscle tension, and chronic pain.[15] An important
component of craniosacral mobility is referred to as the primary respiratory mechanism
(PRM), which manifests as palpable motion of the cranial bones, sacrum, dural membranes,
central nervous system and cerebrospinal fluid (CSF).[18]
Primary Respiratory Mechanism:
It was described by Sutherland in 1990. The mechanism is called primary because it is

directly concerned with the fluctuation or energy flow of cerebrospinal fluid necessary for
maintaining life. Sutherland considered this of primary importance.[13]
Here, the term respiratory should be understood as the process of homoeostasis or

fluid interchange at cellular level, which is called internal respiration.

It is a mechanism because all the constituent parts are interrelated and work together
as a unit and will affect each other correspondingly.[13]
The Craniosacral Pulse:
It is a useful diagnostic tool. Irregularities of rhythm or quality will indicate blockage

or restriction of fluid pathways, in the free flow of cerebrospinal fluid.[13] The fluid should
flow without any restrictions to all the cells of the body for proper health and functioning of
all body tissues. If any restriction takes place, it can lead to dysfunction and physiological
disorder.
This can be assessed by a gentle palpatory touch noting fascial restriction or cranial
pulse irregularities which will be felt as an alteration in the normal fluid flow. Assessment is
by palpation with hands placed anywhere on the body but principally at the cranium or
sacrum.[13]
Side Effects and Risks of CST:
The most common side effect is mild discomfort during treatment which is often
temporary and will fade within 24 hrs. There are certain individuals who shouldn’t use CST
and is contraindicated for them. These include people who have severe bleeding disorders, a
diagnosed aneurysm and a history of recent traumatic head injuries, which may include
cranial bleeding or skull fractures.
The Actual Method of CST:
The therapy is very gentle. It is not a process of intervention in order to ‘fix’ anything.
The therapist intervenes only gently to facilitate the body’s innate ability to correct any mal-
alignment and misfunction within its systems.[13] It is not about realigning head bones.
This therapy consists of applying very mild manual traction on cranial bones in
flexion or extension stages of the craniosacral cycle. The aims were to contribute to re-
establishing the normal movement of cranial bones and to intervene in the autonomic nervous
system by releasing bone and membranous restrictions.[19]
The CST method is for the therapist to place their hands on the bones and use them as
“handles” to ever-so-gently stretch the underlying membranes.[20] CS therapists use “release”
and “pumping” manipulation to produce motion in that particular body area. Such physical

manipulations purport to direct blood flow and eventually more movement in that particular
area.[21]
FIGURE 2: Craniosacral Motion
Craniosacral therapy procedures were: still point (occipital), compression-

decompression of temporomandibular joint, decompression of temporal fascia, compression-
decompression of sphenobasilar joint, parietal lift, frontal lift, scapular waist release and
pelvic diaphragm release.[19]
Palpation of the cranium theoretically allows the examiner to perceive the rhythmic
impulse resulting from the widening and narrowing of the skull at rates described variously as
10 to 14 cycles per minute, 6 to 12 cycles per minute, or 8 to 12 cycles per minute. Multiple
attempts have been made to demonstrate interrater reliability of this craniosacral rhythm.[22]
Proponents of CST have reported that between 5 to 10 g of force applied across a cranial
suture can assist with normalizing suture movement and intracranial rhythm.[23]

FIGURE 3: Palpating Craniosacral rhythm at feet
First, Upledger (2003) claimed that CST can never be validly tested in a scientific
way, with standard controls over internal and external validity, under what he calls
“laboratory conditions.” His assertions about the CS therapist “blending” with the patient,
using the patient’s “inner wisdom” and “inner physician” to shape the therapeutic regime for
that particular client suggests that the therapy technique will vary per patient and thus a
controlled study of the CST methodology is unattainable. In fact, Upledger wrote, “It seems
to me that the only studies that can be done to validate the efficacy of (CST) are clinical
outcome studies that do not dictate the protocol”. In his opinion, “it’s the outcome that
counts, whether you understand the process or not”.[21]
Craniosacral therapy is a gentle, potent and safe treatment. This is true healing as
craniosacral therapy allows the release of all physical and emotional disturbances together. It
is deeply relaxing and allows patients to focus attention on their own inner resources at the
same time as the release of physical restrictions.[13]

AIM
AND
OBJECTIVE

AIM:
Aim of the study was to review on the effectiveness of craniosacral therapy for
chronic pain following any clinical condition.
OBJECTIVE:
The Objective of this research was to review critically the scientific basis of
craniosacral therapy as a therapeutic intervention for patients with variety of clinical
conditions that causes chronic pain.

REVIEW
OF
LITERATURE

1. Heidemarie Haller; Gustav Dobo; Holger Cramer (2021) conducted study on the use
and benefits of Craniosacral Therapy in primary health care: A prospective cohort
study. The study concluded that CST is used for preventive and therapeutic purposes
to improve personal resources and to treat a wide range of physical and mental
symptoms in all age groups from infants to older adults. The utilization of CST may
provide a promising additional treatment option for primary care patients who are
interested in complementary therapies. As for the health-care providers and
insurances, supporting the use of CST might not only improve patient health but also
reduce costs. Further trials using randomized controlled designs are needed to confirm
the exploratory study results in different patient populations.[12]
2. Heidemarie Haller; Romy Lauche, et al (2020) conducted study on Craniosacral
therapy for chronic pain: a systematic review and meta-analysis of randomized
controlled trials. The study concluded that this meta-analysis suggests significant and
robust effects of CST on pain and function, which are not exclusively explainable by
placebo responses or effects due to non-specific treatment mechanisms. More RCTs
strictly following CONSORT are needed to further corroborate the efficacy,
comparative effectiveness, and safety of CST in patients with chronic pain
conditions.[3]
3. Salduker et al (2019) conducted study on Practical approach to a patient with chronic
pain of uncertain etiology in primary care. The study concluded that Chronic pain,
especially where there is no obvious biological cause, may be associated with
considerable suffering and despair. However, with an individualized biopsychosocial
management plan, it is usually possible to relieve at least some of the pain and
improve function and quality of life. Managing pain takes time and needs to be done
in partnership with the patient. Careful communication is essential to manage
expectations, encourage a healthy lifestyle and to explain why some medications need
to be stopped or changed. Nevertheless, with a little extra effort, the systematic
approach described in this article can be extremely rewarding for both health care
providers and their patients.[1]
4. Parul Sharma and Vinika Chaudhary (2018) conducted study on The Therapeutic
Approach for Pain. the study concluded that Physiotherapy must be started as early as
possible to minimise pain, stiffness, contractures and deformities. Ergonomic

guidance must be followed regularly. Follow up is equally important specially for

chronic spinal and arthritis pain. Exercises should be done under the guidance of
qualified Physiotherapist and progressive exercises to be given as patient improves.
Standardised outcome measures, both functional and self-report, that are currently in
widespread use in pain management centres should be advocated for broad clinical
use to effectively measure outcomes and provide a benchmark for management.
Support for ongoing professional development and career structure should be put in
place, and ongoing research for the physiotherapy management of people with chronic
pain should be better supported by funding bodies to ensure best evidence-based
practice.[6]
5. William Raffaeli; Elisa Arnaudo (2017) conducted study on Pain as a disease: an
overview. The study concluded that there is an essential difference between pain as a
symptom and chronic pain. The scientific community has also recognized the
specificity of this condition on the basis of the identification of several associated
pathologic modifications, but the recognition of pain as a disease in its own right
remains debated, principally owing to the lack of an ultimate scientific description of
this pathologic condition. This work aims at filling the gap in the World Health
Organization’s ICD by presenting a “classification system that is applicable in
primary care and in clinical settings for specialized pain management”. Thus, a
vicious circle is created: without a definition of pain as a disease, despite the scientific
knowledge already available on the pathologic mechanisms underlying this condition
and the socioeconomic burden of chronic pain, pain does not gain the attention it
deserves and is not adequately studied in order to consolidate definitively its
recognition as a disease in its own right. Therefore, we believe that proposals aimed at
improving the definition of pain as a disease which might result in a primary pain
diagnosis and an adequate classification of its clinical forms should be embraced and
encouraged.[5]
6. Judith Semmons (2016) conducted study on the role of physiotherapy in the
management of chronic pain. The study concluded that in 1846, having heard the
news of the benefits of ether as an anaesthetic, Oliver Wendell Holmes stated: “the
deepest furrow in the knotted brow of agony has been smoothed for ever.” We have
made considerable progress since then, but managing chronic pain, enabling patients

to experience a better quality of life remains challenging.10 Whereas some patients

are unable to engage with treatment, for others pain management can be life changing
e to quote one patient: “their treatment and response to it, has been a complete
revelation”.[9]
7. Haller et al (2016) conducted study on Craniosacral Therapy for the Treatment of
Chronic Neck Pain: A Randomized Sham-controlled Trial. The study concluded that
CST was shown to be specifically effective and safe in reducing neck pain intensity
and may improve the functional disability and the quality of life up to 3 months after
the intervention. Particularly in chronic and recurrent neck pain, CST may be a
worthwhile treatment option in addition to standard medical care. Further studies with
rigorous methodological designs and long-term follow ups are needed to confirm CST
efficacy in neck pain treatment.[15]
8. Castro-Sanchez et al (2016) conducted study on Benefits of Craniosacral Therapy in
Patients with Chronic Low Back Pain: A Randomized Controlled Trial. The study
concluded that ten sessions of craniosacral therapy resulted in a statistically greater
improvement in pain intensity, haemoglobin oxygen saturation, systolic blood
pressure, serum potassium, and magnesium level than did 10 sessions of classic
massage in patients with low back pain. Future trials should investigate the long-term
effectiveness of these interventions in patients with LBP.[17]
9. Leslie J. Crofford (2015) conducted study on Chronic pain: Where the body meets
brain. The study concluded that Central pain amplification is perceived pain that
cannot be fully explained on the basis of somatic or neuropathic processes and is due
to physiologic have shown a complex relationship between the physiologic stress
response and chronic pain symptoms. Unfortunately, treatments for chronic pain are
woefully inadequate and often worsen clinical outcomes. Developing new treatment
strategies for patients with chronic pain is of utmost urgency. This essay provides a
framework for thinking about chronic pain and developing new treatment
approaches.[2]
10. J. Nijs; R. Smeets et al (2015) conducted study on Exercise Therapy for Chronic Pain:
Retraining mind & brain. The study concluded that Physical therapy for patients with
chronic pain should include exercise therapy tailored to the patient’s preferences,
needs, pain cognitions, musculoskeletal and central nervous system dysfunctions. A

broad biopsychosocial view is required for applying effective exercise therapy for
patients with chronic pain, and can be provided in primary, secondary or tertiary care.
This accounts for physical therapists working in the field of musculoskeletal pain,
neurology, pediatrics, internal medicine and geriatrics.[7]
11. Dilini Rajapakse et al (2014) conducted study on Presentation and management of
chronic pain. The study concluded that Chronic pain in children and young people
remains an entity which is often poorly recognised, evaluated and managed leading to
unnecessary distress and poor health outcomes. In addition to the significant cost to a
child’s quality of life, the economic burden of chronic pain in young people in the UK
was estimated in 2005 to be approximately £8000 per child per year. Progress in the
development and investigation of novel treatments for childhood chronic pain remains
slow in comparison with other chronic health problems.[11]
12. Edzard Ernst (2012) conducted study on Craniosacral therapy: a systematic review of
the clinical evidence. The study concluded that very few RCTs of CST exist. Most of
these trials are seriously flawed. Therefore, there is insufficient evidence to suggest
that CST has therapeutic effects beyond placebo.[16]
13. A. Jäkel; P. von Hauenschild (2012) conducted study on A systematic review to
evaluate the clinical benefits of craniosacral therapy. The study concluded that the
review revealed the paucity of CST research in patients with different clinical
pathologies. CST assessment is feasible in RCTs and has the potential of providing
valuable outcomes to further support clinical decision making. However, due to the
current moderate methodological quality of the included studies, further research is
needed.[18]
14. Guillermo A. Mataran-Pe narrocha et al (2011) conducted study on Influence of
Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with
Fibromyalgia. The study concluded that the present study shows that craniosacral
therapy improves the quality of life of patients with fibromyalgia, reducing their
perception of pain and fatigue and improving their night rest and mood, with an
increase in physical function. Our craniosacral therapy protocol also reduces anxiety
levels, partially improving the depressive state. This manual therapy modality must be
considered as a complementary therapy within a multidisciplinary approach to these

patients, also including pharmaceutical, physiotherapeutic, psychological and social

treatments.[19]
15. Thomas Zane (2011) conducted study on A Review of Craniosacral Therapy. The
study concluded that we must critically examine new ideas, decide if there is rational
evidence for them, reject the bunk and apply the knowledge that sifts through. CST
conceptual underpinnings have been shown to be flawed and are not substantiated by
medical science. Its effectiveness in improving problems to which it has been applied
has not been proven scientifically. There seems little to be gained from application of
this therapy. Consumers would be advised to consider other proven effective
alternatives to the use of CST for treating autism.[21]

METHODOLOGY

Study Design:
The project was designed as a systemic review of craniosacral therapy for patients
with chronic pain.
Search Strategy:
PubMed, Science direct, Google scholar and the Cochrane library electronic database
were searched for articles from 1984-2021. Search terms included 'craniosacral', 'cranial
bones', 'chronic pain', 'craniosacral rhythm' and 'cerebrospinal fluid'. Also, a fugitive literature
search was conducted of relevant websites and professional organizations.
Inclusion Criteria:
Articles were included if they reported RCTs of CST for any human condition. Study
also includes craniosacral interventions and health outcomes. Pathophysiology of craniosacral
system and chronic pain is also included. All the articles were selected on the basis of
inclusion criteria.

RESULT

In the present study, data collection was done from 24 articles and few relevant
websites, which were selected on the basis of inclusion criteria. Out of 24 articles, 3 articles
were based on meta-analysis, 1 case study, 13 systemic review, 3 randomized sham control
trial, 1 retrospective survey, 1 quasi experimental study, 1 pilot study and 1 prospective
cohort study.
Out of 24 articles, many of the articles concluded that effectiveness of CST in

improving problems to which it has been applied has not been proven scientifically and few
articles concluded that CST produce a major difference in decreasing pain and improving
quality of life in different clinical conditions.

DISCUSSION

The review of study is on Craniosacral Therapy for Chronic Pain. In the present study
data collection was done from 24 articles and few relevant websites. Out of which most of the
articles proved that there are no major side effects of CST on chronic pain patients but its
effectiveness in improving problems have not been scientifically proven, so further research
is needed.
Few articles proved that CST is very effective in chronic pain patient, physically as
well as emotionally. They have also proven the improvement in quality of life in chronic pain
patients with different conditions.
Patricia A. Downey et al. did an experimental study on Craniosacral Therapy: The

Effects of Cranial Manipulation on Intracranial Pressure and Cranial Bone Movement. The
study concluded that low loads of force, similar to those used clinically when performing a
craniosacral frontal lift technique, resulted in no significant changes in coronal suture
movement or ICP in rabbits. These results suggest that a different biological basis for
craniosacral therapy should be explored.[22]
There is no evidence of using a 5-10g of force to normalize suture movement and

intracranial rhythm. It is not scientifically proven.
Jäkel, P. von Hauenschild did a systematic review to evaluate the clinical benefits of
craniosacral therapy. The study concluded that the paucity of CST research in patients with
different clinical pathologies. CST assessment is feasible in RCTs and has the potential of
providing valuable outcomes to further support clinical decision making. However, due to the
current moderate methodological quality of the included studies, further research is
needed.[18]
Brian Isbell and Sue Carroll did a study on the effectiveness of craniosacral treatment
which proved that patients treated in the craniosacral teaching clinics felt that their symptoms
improved.[24] Also, one pilot study on the effects of craniosacral therapy upon symptoms of
post-acute concussion and post-concussion syndrome, which proved that CST is a low-risk
conservative treatment option for post-concussion syndrome and is worthy of further clinical
study.[25]

CONCLUSION

The present study concluded that craniosacral therapy is effective in patients with
chronic pain following any clinical conditions, but require further research study. It also
concludes that the amount of force to produce craniosacral movement and rhythm varies in
patients with chronic pain.

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2. Crofford, L. J. (2015). Chronic Pain: Where the body meets the brain. Transactions of
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therapy for chronic pain: a systematic review and meta-analysis of randomized
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13. Hollenbery, S., & Maureen, D. (August 1994). An Introduction to Craniosacral

Therapy. Elsevier Inc.
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Role of Craniosacral Therapy For Chronic Pain

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Role of Craniosacral Therapy For Chronic Pain

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ROLE OF CRANIOSACRAL THERAPY FOR CHRONIC PAIN: A March

SYSTEMIC REVIEW 2021

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 1 of 32

Craniosacral Therapy (CST) is a non-invasive, mindfulness-based treatment approach

AIM AND OBJECTIVE:

Craniosacral, Cranial bones, Chronic pain, Craniosacral rhythm, Cerebrospinal fluid

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 2 of 32

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 3 of 32

Pain is an unpleasant sensory and emotional experience associated with actual or

Cognitive and emotional factors have a critically important influence on pain

Pathophysiology of Chronic Pain:

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 4 of 32

FIGURE 1: Multiple mechanisms of chronic pain and potential effects of management

Peripheral and central sensitization result in an exaggerated response to painful

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 5 of 32

Symptoms of Chronic Pain:

The chief symptoms were described as burning, tightness, weakness, numbness,

The Role of Physiotherapy in Chronic Pain

Physiotherapy is a vital aspect of pain management in many clinical conditions. Many

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 6 of 32

management programmes (PMP), using a multidisciplinary approach, can be effective.

Exercise is a common component of both adult and adolescent multidisciplinary

Contraindications of electrical therapy include stimulation over cardiac pacemakers,

Patients should be provided with written instructions, dates for follow-up

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 7 of 32

such as cancer, osteoarthritis, fibromyalgia or neuropathic pain, often there is no obvious

It is a form of alternative and complementary therapy that is used by chiropractors,

It is a non-invasive, mindfulness-based treatment approach using gentle manual

Besides releasing myofascial structures, CST intends to normalize sympathetic nerve

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 8 of 32

disabilities, attention deficit hyperactivity disorder, post-traumatic stress disorder, orthopedic

Primary Respiratory Mechanism:

It was described by Sutherland in 1990. The mechanism is called primary because it is

Here, the term respiratory should be understood as the process of homoeostasis or

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 9 of 32

The Craniosacral Pulse:

It is a useful diagnostic tool. Irregularities of rhythm or quality will indicate blockage

Side Effects and Risks of CST:

The Actual Method of CST:

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 10 of 32

FIGURE 2: Craniosacral Motion

Craniosacral therapy procedures were: still point (occipital), compression-

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 11 of 32

FIGURE 3: Palpating Craniosacral rhythm at feet

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 12 of 32

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Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 15 of 32

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 16 of 32

guidance must be followed regularly. Follow up is equally important specially for

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 17 of 32

to experience a better quality of life remains challenging.10 Whereas some patients

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 18 of 32

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 19 of 32

patients, also including pharmaceutical, physiotherapeutic, psychological and social

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 20 of 32

Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 21 of 32

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Shree Swaminarayan Physiotherapy College, Kadodara, Surat. Page 23 of 32