Clinical Practice Applications of Cranial Manipulation

Since the mid-1990s there has been a growth in clinical research and clinical trials utilizing Osteopathy in the Cranial Field (OCF)/Osteopathic Cranial Manipulative Medicine (OCMM). About 25 have been published in peer-reviewed journals.  Some of these studies include:

Otitis Media

  • Mills MV, Henley CE, Barnes LLB, et al. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Archives of Pediatrics & Adolescent Medicine. 2003;157:861-866.
  • Steele KM, Carreiro JE, Viola JH, et al. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Amer Osteopath Assoc. 2014;114(6): 436-447.

In these two clinical trials children with otitis media who received OMT with emphasis on OCMM showed significant improvement in middle ear tympanic membrane motion and reduction in middle ear effusion. This kind of benefit may also prevent the development of middle ear damage leading to hearing problems as the person grows older.

Neonatal ICU Length of Stay and Gastrointestinal Tract Disfunction

  • Pizzolorusso G, Turi P, Barlafante G, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropractic and Manual Therapies. 2011;19:15.
  • Cerritelli F, Pizzolorusso G, Ciardelli F, La Mola E, Cozzolino V, Renzeti C, D’Incecco C, Fusilli P, Sabatino G, Barlafante G. Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatrics. 2013;13:65.

In these two studies done in an Italian neonatal ICU, premature babies were treated with OCMM and the number of gastrointestinal dysfunctions were significantly decreased and the length of stay in the ICU was significantly reduced. These are obvious benefits to this population of patients and even suggests that there is financial cost reduction in ICU services and hospital stay with the application of OCMM.

Plagiocephaly

  • Lessard S, Gagnon I, Trottier N. Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complementary Therapies in Clinical Practice. 2011;17:193-198.

Plagiocephaly mean “crooked head” or deformed cranial bones usually due to a difficult labor and delivery of the child. Following the trend of application in the pediatric world, this study showed significant benefit of OCMM in reducing the amount of plagiocephaly in young children diagnosed with this condition. Also this study showed that OCMM is a viable alternative of the usual treatment for this condition which is helmet therapy.

Nervous System and Balance Functions Benefited by OCMM

  • Lopez D, King HH, Knebl JA, Kosmopolous V, Collins D, Patterson RM. Effect of comprehensive osteopathic manipulation treatment on balance in elderly patients: a pilot study. J Am Osteopath Assoc. 2011;111(6):382-388.
  • Fraix M, Gordon A, Graham V, Hurwitz E, Seffinger MA. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness. J Am Osteopath Assoc. 2013;113:394-403.
  • Cutler MJ, Holland BS, Stupinski BA, Gamber RS, Smith ML. Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: a pilot study. J Alt Compl Med. 2005;11:185-195.

In all these studies OCMM was the primary treatment employed. In a population of healthy geriatric patients the OCMM significantly improved balance and equilibrium. In a population of patients with dizziness, the dizziness was significantly reduced. In a population of health of healthy college students, the application of OCMM resulted in being able to fall asleep faster and sleep longer. These finding are suggestive of the benefit of OCMM in neurological functions of the human body. These types of results have led practitioners of OCMM to begin utilizing this treatment in cases of post-concussion syndrome and traumatic brain injury because of the apparent effects on brain functions related to these conditions.

Cranial Bone Motion

NASA and Russian Cosmonaut Inspired Research:  Some of the best research on cranial bone motion has come from physiology research attempting to find out what would happen to astronauts and cosmonauts subjected to long periods of zero gravity. The concern was whether or not mental and physical functions could be maintained. The answer was yes, indeed, humans can functions for long periods in zero gravity environments and along the way research showing cranial bone motion was obtained.

  • Ueno T, Ballard RE, Shuer LM, Cantrell, Yost WT, Hargens AR. Noninvasive measurement of pulsatile intracranial pressure using ultrasound. 1998 Acta Neurochir [Suppl]. 71:66-69.
  • Ueno T, Ballard RE, Macias BR, Yost WT, Hargens AR. Cranial diameter pulsations measured by non-invasive ultrasound decrease with tilt. Aviat Space Environ Med. 2003;74:882-885.
  • Ueno T, Ballard RE, Shuer LM, Yost WT, Cantrell JH, Hargens AR. Ultrasonic measurement of intracranial pressure waveforms. 1997. Aeronautics & Space Transportation Technology Enterprise. NASA Ames
  • Ueno T, Ballard RE, Cantrell JH, Yost WT, Hargens AR. Noninvasive estimation of pulsatile intracranial pressure using ultrasound. 1996. Research & Technology: Human Exploration and Development of Space Enterprise: Technology Applications to Human Health. NASA Ames Research Center.

In this series of research publications a high tech ultrasound measurement device was developed by this research team that could measure micron range of accuracy, which is in the range of 1/1000th of a millimeter. In one experiment, human volunteers were tilted head down from horizontal to head straight down. At each point of successive degrees of head-down orientation, the distance from the inner surface of the front of the skull to the back of the skull increased to a maximum of over one millimeter, about 1/16th of an inch.

The authors state, “When intracranial pressure (ICP) increases, arterial pulsation produces ahigher amplitude ICP pulsation. Increased amplitude of ICP pulsations will be manifested by larger fluctuations in distance across the skull….Although the skull is often assumed to be a rigid container with a constant volume, we and others have demonstrated that skull moves on the order of a few micrometers in association with arterial pressure (systolic/diastolic) and changes in ICP pulsations.

From the Russian Cosmonaut program similar findings were reported.

  • Moskalenko YE, Kravchenko TI, Gaidar BV, et al. Periodic mobility of cranial bones in humans. Hum Physiol. 1999;25(1): 51-58.

This Cosmonaut team was led by Yuri Moskalenko, PhD who has been to the USA to teach in cranial educational programs. This 1999 publication reported that in healthy humans, cranial dimensions undergo continuous changes in anterior-posterior and side-to-side distances of 0.38 ± 0.21mm (in 18 human subjects) and a maximum deviation of up to 1 mm. These dimensions are consistent with NASA findings. They go on to describe that intracranial fluid volume increases by 12-15 milliliters, about half a teaspoon and seems to be enough to move the bones. Also the periodic rate of fluctuations was 6-14 cycles per minute, which is the rate reported by practitioners of OCMM.

Other USA Research

Much of the opposition to the idea that cranial bones move came from examination of old, dried out skeletal remains which indeed usually seem quite hard and immovable. Many skull specimens appeared to show no patent or observable evidence of sutures, and for this reason many in the medical scientific community believed that all cranial joints or sutures fused after a certain point in human growth. An anatomic study by Sabini and Elkowitz in 2006 shed much light on this topic.

  • Sabini RC, Elkowitz DE. Significance of differences in patency among cranial sutures. J Am Osteopath Assoc. 2006;106:600-604.

In this research they found a large difference in the amount of obliteration of the sutures among a large number of skull specimens. Some showed virtually all cranial sutures to be obliterated, but this was by far the exception. Most sutures remain visible, especially those when the muscles of mastication are attached to the skull. They state, “The theory that external forces maintain suture patency and complexity can be supported by morphologic characteristics of facial sutures, which are more serrated and interdigitated and remain patent for longer periods of time. This difference can be presumed to correlate with facial muscles necessary for speaking, mastication, and facial expression.”

Another study supporting cranial bone motion was published in 2009.

  • Crow WT, King HH, Patterson RM, Giuliano V. Assessment of calvarial structure motion by MRI. Osteopath Med Prim Care. 2009;3:8.

This study utilized 20 healthy human subjects and made eight MRI images thru the exact same coronal plane of the head of each subject. It is like cutting cantaloupe thru the same spot each time. Using very high tech MRI image analysis software, it was apparent that the dimensions of the images changed. The exact same plane showed statistically significant area within the skull from largest to smallest area. For this to occur, the bones would have to move.

To summarize these basic science research projects, there is indeed evidence of cranial bone motion, and there is even speculation that the motion is initiated by intracranial fluid volume changes, especially the blood flow through the brain. It is important to point out that while there is this evidence of cranial bone motion, the medical scientific community at large have not yet completely accepted this view.