Craniosacral therapy is a complementary treatment for a variety of neurological disorders in children, but most often used for autism spectrum disorders, ADHD, and traumatic brain injury. This therapy was developed during the late 20th century by osteopathic physician Dr John Upledger. Expanding upon earlier scientific research on the rhythmic beating of spinal fluid during operations of the spine, osteopathic physicians theorised that by applying gentle pressure to cranial sutures (places where cranial bones fuse), the protective layers which control spinal fluid movement could be relaxed. This new treatment came to be known as cranial osteopathy. Dr Upledger, an osteopathic physician, further developed and expanded this treatment into modern Craniosacral therapy. The treatment consists of a 10-step gentle and non-invasive protocol administered by trained craniosacral therapists. For the past 30 years, craniosacral therapy has been widely available throughout the United States and internationally. Though most commonly known as a treatment for adults with neurocognitive issues, early research was mainly with children with autism spectrum disorders.
Pediatric craniosacral therapists seek to restore “normal flow” of cerebrospinal fluid throughout the central nervous system - from the brain to the end of the spinal cord. The treatment consists of gentle massage and manipulation of the skull bones and articulations of the spinal column, many of which are not yet fused (i.e. still cartilaginous) in children. The gentle movement of these bones is said to improve the flow of cerebrospinal fluid by manipulating the meninges (protective connective tissues) which protect the brain and spinal tissue and remove any blockages and restrictions. It is thought that this movement provides restoration of the natural movements of cerebrospinal fluid (CSF) “flow”. The return to natural CSF flow is believed to restore balance to the central nervous system and put the body in a parasympathetic (relaxed) state.
Craniosacral therapy is based on the theory that movement restrictions at cranial sutures of the skull negatively affect the rhythmic impulses conveyed through the cerebral spinal fluid. The craniosacral system includes the brain, spinal cord, protective tissues (meninges), cerebrospinal fluid and the bones that surround and protect them. Cerebral spinal fluid is a plasma-like fluid that surrounds the brain and spinal cord. It also is present in the four interior ventricles internal to the brain. Cerebrospinal fluid provides the chemical and nutrient balance needed to support the brain and spinal cord. It also provides a protective cushion against injury and provides buoyancy to extremely soft brain and spinal tissue.
While the exact mechanism of craniosacral therapy is unknown, it is potentially related to the workings of the newly discovered glymphatic system. The glymphatic system, discovered in 2012, is the lymphatic system of the brain which clears out cellular waste and other materials from the cerebrospinal fluid. The improper functioning of the glymphatic system may lead to inflammation. Recent studies suggest that up to 69% of children with autism spectrum disorder may have neuroinflammation. And traumatic brain injury (TBI), by definition, involves the neuroinflammatory response to injury. Although the mechanism is unknown, craniosacral therapy is believed to help relieve this inflammation and by draining inflammatory cytokines.
Craniosacral practitioners include osteopathic and naturopathic physicians, physical therapists, and occupational therapists, as well as other allied health professionals. CST is performed on children as young as three, but it is thought that infants may also see a benefit, particularly after a traumatic birth. Insurers sometimes cover craniosacral therapy, but parents should check with their providers. As a gentle, non-invasive treatment, contraindications do not exist for craniosacral therapy in children.
In a 2017 survey, therapists reported that the primary outcomes of CST in autistic children are increased relaxation and reduced anxiety, with secondary outcomes of improved digestive function, improved emotional stability, reduced pain, and improved sleep. The therapists in the study reported that 1 to 5 treatment sessions were needed to see any benefit. Dr. Upledger’s landmark 1978 study (updated in 1990) reported that children with severe autism showed marked improvement in social behaviours and a reduction in self-harm. Open studies of post-TBI patients have reported a decrease in pain, improved sleep, improved memory and cognition. A 2018 pilot study determined that craniosacral therapy, as an adjunctive treatment (in addition to standard treatments), is safe for TBI.
Despite these positive case studies, open trials and anecdotal reports, clear scientific evidence is lacking for both the mechanism and the efficacy of craniosacral therapy. Randomized-controlled trials are lacking and funding to support this research is needed to determine the short and long-term benefits of craniosacral therapy. Hopefully, continuing investigation into the glymphatic system and the aetiology of brain disorders will further help understand this complementary treatment for pediatric neurological conditions.