There is no evidence that craniosacral therapy improves head shape in patients with pIagiocephaly

With all the drive toward acceptance of non-traditional and alternative medical treatments, it is no surprise that the field of craniosacral therapy and chiropractic “medicine” has found some footing in the treatment of infants with plagiocephaly and torticollis. As a science-minded individual, it is difficult if not impossible to posit a viable explanation as to why these modalities would work. The idea that one can somehow manually manipulate or mold the cranial bones of an infant (or anyone else) is absurd. As a craniofacial surgeon, I have performed over 400 cranial remodeling procedures (where the bones of the infant cranium are removed and remodeled) on infants and young children with craniosynostosis. I can assure you that the bones are quite firm and cannot be “pushed” into shape by hand. In fact, surgical bone remodeling even in young infants usually requires specialized tools to deform the bone and even then, the bone shape tends to rebound back to its original shape. Surgeons often must cut the bone to provide any lasting shape alteration. The image below shows the frontal bones of an 8-month old infant who required surgery for craniosynostosis, or fusion of the cranial sutures. I perform similar procedures about once per week, and can attest to the strength of the cranial bones even at this young age. It is true that a constant external force in one area over time can alter growth- that is how cranial deformation occurs in the first place (see text section, Mechanism). Nevertheless, placing ones hands on an infant’s head and pushing in for a few hours per week will have no effect. Even if we entertain the absurd proposition that one could alter shape temporarily by pushing on the cranium, the internal pressure of the brain, acting to push the other 23 hours/day, 7 days/week, would quickly counteract the shape change. This is why most cranial shape changes from the birthing process spontaneously resolve.

One aspect of cranial flattening that is favorable to practitioners selling this type of treatment is the natural “improvement” seen in infants after 4 months of age (see the section on No Treatment in the text). As discussed previously, one can invariably rely on the fact that flattening typically stops getting worse after age 4-5 months (once the infant achieves sufficient motor control to overcome torticollis) and that the appearance will look better as the head continues to grow. It is scientifically flawed to ascribe this degree of improvement to any particular modality without a control group (i.e compared to a group that has no treatment). I have searched for a controlled trial demonstrating the effectiveness of craniosacral therapy to doing nothing- there are none. I found one study that uses ratios and showed improvement in 12 patients- no control, and ratios as a metric of treatment outcome is worthless since even a fixed degree of flattening will appear to improve due to head growth alone. (see critique of cranial ratios in the text- a major flaw of most research in this field).

As an attending surgeon at Boston Children’s Hospital I encountered a group of craniosacral therapists who were managing some of my patients with plagiocephaly. The business was cash only and the patients were seen several times per week for a hour each session. Several of the families were convinced that the treatments were making a difference, even though my direct measurements of the head showed no absolute improvement. I sent word through the families that I would welcome a controlled study and, as part of that, would send patient to them if they were willing to allow me to monitor progress vs. no treatment and helmet therapy. Silence. They were clever enough to know that such a study would inevitably show the useless nature of the craniosacral treatment and mark the end of their cash business treating these unsuspecting patients. I will make the same offer to any craniosacral therapist or group daring enough to put their treatment up for scientific scrutiny. I am quite confident that there will be no takers…..

The exposed anterior cranium of an 8-month old infants undergoing cranial remodeling for craniosynostosis. The bones are not soft or malleable. They are, in fact, strong enough that they must be cut with a power tool and are very resistant to stress contouring. The proposition that one can “manipulate” these bones with hourly sessions using manual pressure is an absurdity and shows the disconnect between the musings of the those who propagate false or speculative ideas (usually for financial gain) and those who have experienced the objective truth.