MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Osteopathic tradition in the cranial field (OCF) postulates that the primary respiratory mechanism (PRM) relies on the anatomical links between the occiput and sacrum. Few studies investigated this relationship with inconsistent results. No studies investigated the occiput-sacrum connection from a neurophysiological perspective.

This study aims to determine whether the sacral technique (ST), compared to the compression of the fourth ventricle (CV4) technique, can affect brain alpha-band power (AABP) as an indicator of a neurophysiological connection between the occiput and sacrum.

Healthy students, 22-30 years old for men and 20-30 years old for women, were enrolled in the study and randomized into eight intervention groups. Each group received a combination of active techniques (CV4 or ST) and the corresponding sham techniques (sham compression of the fourth ventricle [sCV4] or sham sacral technique [sST] ), organized in two experimental sessions divided by a 4 h washout period. AABP was continuously recorded by electroencephalogram (EEG) of the occipital area in the first 10 min of resting state, during each intervention (active technique time) and after 10 min (post-active technique time), for a total of approximately 50 min per session. Analysis was carried out utilizing a repeated-measure ANOVA within the linear general model framework, consisting of a within-subject factor of time and a within-subject factor of treatment (CV4/ST).

Forty healthy volunteers (mean age ± SD, 23.73±1.43 years; range, 21-26 years; 16 male and 24 female) were enrolled in the study and completed the study protocol. ANOVA revealed a time × treatment interaction effect statistically significant (F=791.4; p<0.001). A particularly high increase in mean AABP magnitude was recorded during the 10 min post-CV4, compared to both the CV4 and post-sCV4 application (p<0.001). During all the times analyzed for ST and sST application, no statistically significant differences were registered with respect to the resting state.

The authors concluded that the ST does not produce immediate changes on occipital AABP brain activity. CV4, as previous evidence supported, generates immediate effects, suggesting that a different biological basis for OCF therapy’s connection between the head and sacrum should be explored.

Why on earth should a different biological mechanism be explored? Why not conclude that OCF and its assumptions are pure nonsense?

The answer to these questions is not difficult to find: the authors are from the ‘Istituto Superiore di Osteopatia, Milan, Italy’! One can understand that, at this institution, people are unlikely to agree with my conclusion that OCF is based on absurd concepts and does not merit further research.

5 Responses to Cranial osteopathy is based on absurd concepts and does not merit further research

  • 05 September 2022 – The very well connected project of the Dungl family named „„Osteopathy“ at the University of Krems announces:

    https://science.apa.at/power-search/5803177255213663412

    „Osteopathy on the evidence test bench

    Around 30,000 Austrians are treated by an osteopath every week. Nevertheless, there is no regulated, recognized job description for this. Above all, it has been scientifically proven to have an effect on chronic pain conditions. This is the result of a comprehensive analysis of the scientific literature by Andrea Siebenhofer-Kroitzsch, Head of the Institute for General Practice and Evidence-based Health Services Research at MedUni Graz.

    According to a survey by Statistics Austria from 2019, ten percent of all over 15-year-olds in Austria visit an osteopath at least once a year. With 1,500 to 2,000 osteopaths, that’s around 30,000 treatments per week, for which there is still no legal framework in Austria,” said the President of the Austrian Society for Osteopathy (OEGO), Margit Halbfurter, at a panel discussion of the Praevenire Health Initiative in Austria Alpbach in Tyrol. The situation seems a bit bizarre: Patients are apparently looking for relief of their symptoms in a discipline that officially does not exist in Austria and that is most likely to exist in the slipstream of physiotherapy. Margit Halbfurter: “In 13 European countries, osteopathy is anchored as a health profession (by law; note). The pioneer was Great Britain in 1993. There is full-time academic training for this in seven countries. In contrast, osteopathy is not anchored in our health system. The job title is not protected, the training is not regulated.” Although the reputable established osteopathy training institutions provide for studies with at least 1,500 to 2,000 hours including a master’s degree, this is not mandatory. Basically, anyone can call themselves an osteopath. The lack of recognition as a legally regulated health profession also means that reimbursement of therapy costs by the health insurance companies (insurance benefit) is currently unthinkable. The chairman of the Austrian health insurance company , Andreas Huss, said that the activities of clinical psychologists are only just being included in the range of services.Effect is scientifically proven
    On the other hand, the effect of manipulative therapy in the context of osteopathy is apparently getting better and better scientifically proven. This was the result of an analysis of the existing reviews on “Effectiveness and safety of osteopathic treatments”, which Siebenhofer-Kroitzsch recently completed. Although the literature study was carried out on behalf of OEGO, the expert stressed that the work was “technically independent” – as always. The director of the institute in Graz and her co-author Thomas Semlitsch evaluated a total of 27 systematic reviews according to their significance. 16 of them were only published from 2016, 13 came from Europe. 15 of the evaluated publications dealt with the effectiveness of osteopathy in diseases of the muscles and skeleton. The result, which could also be an up-to-date guide to which complaints and clinical pictures patients are most likely to seek help from an osteopath and expect an improvement in their condition, according to the authors: “Osteopathic treatments are less common in adults with chronic non-oncological pain, chronic (non-specific; note) low back pain (also during pregnancy), acute neck pain and in premature babies (reduction of the length of hospital stay; note).” For these areas of application, there are indications in the scientific literature of a positive effect with moderate reliability. This means that further studies “are unlikely to change” this view. On the other hand, there are no effects with a low reliability of the available scientific evidence for adults with acute non-specific low back pain, fibromyalgia and headache patients and, for example, people with chronic obstructive pulmonary disease. There is no scientific evidence of an effect for applications in dentistry and jaw medicine, in cancer and other diseases (e.g. cardiovascular diseases). “Medium or moderate evidence for certain indications (areas of application; note), that’s actually quite a lot,” said Gerald Gartlehner, head of the department for evidence-based medicine at the University for Continuing Education (Krems). After all, only a third are in modern medicine of all procedures sufficiently proven by good scientific studies in their effects.

    Contact:
    https://science.apa.at/legal/ueber-uns/

    • this is MOST underwhelming!
      Dr. Zauner-Dungl was a junior doctor on my team when I was chair of PMR in Vienna. I am not aware that she is capable of doing good science. The report seems to be unpublished and looks like pure fantasy.

      • I’d probably phrase this better as a question: isn’t the business model of some clever European doctors and their SCAM institutes in the field of TCM, osteopathy and other SCAMs issuing letters of reference to each other so that they can achieve cooperation with universities for their SCAM project, which then award the titles BSc and MSc for SCAM? Isn’t that a lucrative business for everyone involved?

  • As I have already shown several times and also explained on my homepage, one must differentiate between the techniques of manual treatment of the musculoskeletal system and the theoretical concepts. These concepts have changed over the centuries. For example, if we see the Merseburg spells or the concept of disappearance of symptoms by the old Gnostic spelling of Quintus Serenus in the 3rd century AD, this changed with the advent of Christianity and later in the Age of Enlightenment.

    Were the medical books of the Quintus Serenus still written in hexameters in order to better memorize the doctrinal content (just as all the original Ayurvedic Indian medical literature was written in verse in Sanskrit, and from which Hippocrates copied pages and copied texts without citing the source.), so today’s texts in medicine are rather rational and the students have trouble learning them and make up auxiliary verses in rhyming form as mnemonics. It would be asking too much if medical writers were to go back to writing their books in rhyme. What does that tell us now?

    The concepts of manual techniques from the Enlightenment era replace the beliefs of previous eras. Anton Mesmer’s vitalism replaces the faith of a pastor Gassner and iatromechanics replaces the Merseburg magic spells. Phrenology replaces the concept of humoral pathology that thought resides in the heart and that the brain serves only to produce moisture.

    Before and after the American Civil War, vitalism / mesmerism and phrenology experienced a peak in the USA that was delayed in comparison to Europe. Freemasonry also inspired iatromechanics and described God as the greatest of all mechanics. So it is not surprising that these ideas form the basis of clever marketing concepts in the USA, such as osteopathy, chiropractic, neuropathy, etc. Christian Science and all the many other concepts are in part nothing more than a conglomerate of naturalistic pseudo-religious concepts from the time of the European Enlightenment. They all claim that there is a self-healing.

    Hahnemann’s homeopathy is also an attempt to position the medieval sympathetic healing concepts using the magic of alchemy against the Arabic heavy metal medicine of Paracelsus. Luckily, he was able to save many lives from the medicine of the time precisely because he didn’t use poison. Of course, his medicine was ineffective, but unlike Paracelsus’ medicine, it was not toxic. The development of medicine takes place in line with the paradigm shift in a society, and it is the same with manual treatment. The concepts of Nuad Thai Massage or TuiNa / AnMo are different than the concepts of Mr. Mosengeil or Swedish therapeutic gymnastics. Charcot’s concepts of hysteria or 19th-century gynecology are different from those of Mr. Thure Brandt or Mr. Stapfer. It took a long time for medicine to discover that fire is not an element like water, earth and air, leading to the collapse of an entire diagnostic concept. So did you want to judge medicine by its concepts or by the effect of its remedies? Both are necessary to understand the therapeutic interaction.

    This concept of self-healing, vitalism and iatromechanical freemasonry began to crumble in US osteopathy when a book entitled “On Self-limiting Diseases” was published and when medicine began to develop effective drugs. From this point in time, manual medicine became more and more of a marginal phenomenon in the training of osteopathic physicians in the USA, which was sometimes ridiculed.

    US osteopathy became part of modern medicine with and especially after World War I. However, the marginalized field of manual osteopathic treatment has not managed to critically reflect on itself, not more than chiropractic has. Instead, it continues to cling to the pseudo-scientific junk of Enlightenment-era history.

    It is now clear that no improvement can be expected from European Osteopathic Manipulators. It is irrelevant whether they are medical doctors who have studied scientific medicine who after that learn osteopathic manual techniques, “pure” osteopaths like in Great Britain or physiotherapists who have converted to osteopathy. At the latest after the training they are all brainwashed.

    The US government still listed osteopathy as a sect before World War II, along with chiropractic, homeopathy and Christian Science. This only changed during the course of the Second World War, when osteopathic medical schools trained thousands of good doctors for the army. European osteopathy in England has never taken this step towards becoming scientific. Then in the 1970s this wave swept over to the continent, after the first wave was destroyed by the Nazis and they burned their German books because they were condemned as part of US Jewish Freemasonry.

    However, the manual techniques handed over through these ideologically charged marketing concepts can be helpful in a concept of manual treatment that works rationally and systemically in the context of evidence-based medicine. If you know the risk of certain manual techniques, you will no longer use them. This learning process is the same as medicine has learned to withdraw certain drugs from the market or to stop using drugs that have proven ineffective or to replace old ones with new ones that are better. No one stuns with chloroform these days because there is a better standard. Following the path of rational evaluation, one will not use manual cranial techniques in the context of a concept that has still uncritically proved pseudoscientific and esoteric.

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