BlueCross BlueShield of Tennessee Medical Policy Manual

Craniosacral Therapy

DESCRIPTION

Craniosacral therapy is 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. Craniosacral therapy, as developed by John Upledger, is taught through the Upledger Institute in Palm Beach Gardens, Florida to lay people as well as to chiropractors, dentists, physical therapists and other licensed health care workers. In the mid-1970s, Upledger, an osteopathic physician, reported the detection of a craniosacral rhythm that he believed to be the pulse of flow of the cerebrospinal fluid. Upledger maintains that removing restrictions of the flow of cerebrospinal fluid via craniosacral osteopathic manipulative techniques improves symptoms or problems.

Craniosacral therapy (i.e., CST, craniosacral motion, craniosacral rhythm) is based on the theory that movement restrictions at the cranial sutures of the skull negatively affect rhythmic impulses conveyed through the cerebral spinal fluid from the cranium to the sacrum. All structures, which are in contact with the cerebral spinal fluid, including the brain, spinal cord and their protective membranes, are seen as part of the cranio-sacral system. All other structures of the body are believed to be affected indirectly through innervations arising from, or returning to, the central nervous system, or directly through mobility of the musculoskeletal system. (Green C, et al., 1999).

The foundation of craniosacral therapy, cranial therapy (i.e., cranial osteopathy, craniosacral treatment) is the manipulation of the cranial bones. Cranial therapy, as developed in the early 1900's by Dr. William Sutherland, is also based on a connection of the cranium to the sacrum via the dura. Both craniosacral therapy and cranial therapy are used for a wide variety of ailments (e.g., acute systemic infectious conditions, chronic pain problems, localized infection, dysfunction of viscera, depression, strabismus, auditory problems, autism). At present, physicians and scientist are attempting to verify whether a craniosacral rhythm does in fact exist and whether the bones of the cranium are actually mobile.

POLICY

Craniosacral therapy for the diagnosis and/or treatment of all diseases and conditions is considered investigational.

ADDITIONAL INFORMATION

Well-designed studies in peer review journals regarding the application of craniosacral therapy are lacking.

The use of craniosacral therapy does not meet the following technology evaluation criteria:

• The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.

• The technology must improve the net health outcome.

• The technology must be as beneficial as any established alternatives.

• The improvement must be attainable outside the investigational settings.

SOURCES

Centre for Health Services and Policy Research. (1999, May). A systematic review and critical appraisal of the scientific evidence on craniosacral therapy. Retrieved September 17, 2002 from http://www.chspr.ubc.ca/node/373.

Flynn, T. W., Cleland, J. A., & Schaible, P. (2006). Craniosacral therapy and professional responsiblity. Journal of Orthopaedic & Sports Physical Therapy, 36 (11), 834-836.

Green, C., Martin, C. W., Bassett, A., & Kazanjian A. (1999). A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complementary Therapies in Medicine, 7 (4), 201-207.

Greenman, P.E., & McPartland, J. M. (1995). Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. Journal of the American Osteopathic Association, 95 (3), 182-188. Abstract retrieved October 3, 2002 from PubMed database.

Hanten, W. P., Dawson, D. D., Iwata, M., Seiden M., Whitten, F. G., & Zink, T. (1998). Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates. Journal of Orthopaedic and Sports Physical Therapy, 27 (3), 213-218. Abstract retrieved October 3, 2002 from PubMed database.

Moran, R. W., & Gibbons, P. (2001). Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. Journal of Manipulative and Physiological Therapy, 24 (3), 183-190. Abstract retrieved October 3, 2002 from PubMed database.

Phillips, C. J., & Meyer, J. J. (1995). Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery. Journal of Manipulative and Physiological Therapeutics, 18 (8), 525-529. Abstract retrieved October 3, 2002 from PubMed database.

Rogers, J. S., & Witt, P. L. (1997). The controversy of cranial bone motion. Journal of Orthopaedic and Sports Physical Therapy, 26 (2), 95-103. Abstract retrieved October 3, 2002 from PubMed database.

Rogers, J. S., Witt, P. L., Gross, M. T., Hacke, J. D., & Genova, P. A. (1998). Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons. Physical Therapy, 78 (11), 1175-1185. Abstract retrieved October 3, 2002 from PubMed database.

Wirth-Pattulo, V., & Hayes, K. W. (1994). Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements. Physical Therapy, 74 (10), 908-916. Abstract retrieved October 3, 2002 from PubMed database.

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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