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Osteopathic Cranial Manipulative Medicine

The “cranial concept” recognizes that there


  1. is spontaneous (active) rhythmic motion of the central nervous system (CNS) that is most prominently felt by skilled practitioners at the cranium and the sacrum. This motion is referred to as the “Cranial Sacral Rhythmic Impulse” (CSRI). In turn, the CSRI is thought to play an important role in generating optimal fluid flow within the CNS.


  1. are biomechanical properties of cranium that allow for or inhibit the optimal CSRI. The cranial and facial sutures are understood to be joints at which small, but important, motions occur in response to the CSRI as well as other forces that change intracranial pressure as well as on the surface of the face and skull.


Misconceptions about the “cranial concept”

  1. The “cranial concept” has been dismissed by many as “non-scientific” for two main reasons:


  1. The cranial/facial sutures “fuse” within the first few years of life.


  1. If there are motions of the bones at the sutures, the motions are too small to have any influence on the function of the body.


Neither of those critiques are valid.


  1. “Words matter!” It is correct that the widely open sutures at birth close, but they do not fuse, as the sutures persist throughout life and the bones remain separable (with one exception in which the two frontal (forehead) bones coalesce into one bone). Furthermore, the intra-sutural contents include not only veins, arteries, lymph but also connective fibers including elastic fibers—consistent with the understanding of the sutures as joints.


  1. Smaller motions have great significance in health: most notably the three small bones of the middle ear vibrate on one another, smaller motions than those potentially occurring at the sutures. When a middle ear joint fuses, hearing stops. Surgeons actually reconstruct middle ear joints to restore hearing.


  1. Historically most practitioners of cranial are taught to use extremely gentle touch to diagnose and treat cranial dysfunction and that more forceful techniques should never to be used. This approach has also been taught to non-physicians as “cranial sacral therapy.” While those “light touch” methods have application in certain clinical conditions, they reflect an incomplete (and thus scientifically invalid) approach as sufficient force must be used to investigate and treat the elastic properties of the cranium and indeed the entire musculoskeletal system.


As is the case with all OMT, before performing cranial mobilization techniques, practitioners conduct a comprehensive evaluation of each patient, taking into account their medical history, lifestyle factors, and psychosocial factors as well as an examination of functional biomechanics. Practitioners are trained to recognize any risks associated with cranial osteopathic techniques. They may modify or avoid certain techniques based on the patient's condition or medical history to increase safety.

 William James Brooks DO

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