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Cervical radiculopathy is a common condition that is usually due to compression or injury to a nerve root by a herniated disc or other degenerative changes of the upper spine. The C5 to T1 levels are the most commonly affected. In such cases local and radiating pains, often with neurological deficits, are the most prominent symptoms. Treatment of this condition is often difficult.

The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR).Image result for cervical radiculopathy

MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO were searched from inception to June 15, 2022, to identify studies that were randomized clinical trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach.

Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. The results show very-low certainty evidence supporting the use of

  • acupuncture,
  • prednisolone,
  • cervical manipulation,
  • low-level laser therapy

for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term.

There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty.

The authors concluded that there is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.

The fact that we cannot offer a truly effective therapy for CR has long been known – except, of course, to chiropractors, acupuncturists, osteopaths, and other SCAM providers who offer their services as though they are a sure solution. Sometimes, their treatments seem to work; but this could be just because the symptoms of CR can improve spontaneously, unrelated to any intervention.

The question thus arises what should these often badly suffering patients do if spontaneous remission does not occur? As an answer, let me quote from another recent systematic review of the subject: The 6 included studies that had low risk of bias, providing high-quality evidence for the surgical efficacy of Cervical Spondylotic Radiculopathy. The evidence indicates that surgical treatment is better than conservative treatment … and superior to conservative treatment in less than one year.

‘Bio’ – from biology

‘kin’ – from kinetics

‘ergy’ – not from energy as in physics but vital force as in chi and TCM

Together, these three terms give BIOKINERGY

Biokinergy is hardly well-known in most countries. Yet, in France, it’s all the rage. It is a manual therapy that allegedly restores the mobility of the patient’s body and increases the elasticity of its tissues while supporting the circulatory and nervous systems as well as our biological and psycho-emotional balance. It is said to incorporate concepts from osteopathy, fascia techniques, and Traditional Chinese Medicine.

Am I the only one who finds this more than a bit vague and full of platitudes?

So, what is biokinergy really?

Apparently, it is based on 4 main principles:

  1. Biomechanics
    Biokinergy takes into account the release of blockages and the rebalancing of the mobility of the different structures and tissue layers (bones, viscera, muscles, subcutaneous tissues, skin), through innovative neuro-informational processes

2. Fasciatherapy
Richly innervated, the fascias envelop, partition, and connect all our structures without discontinuity from head to toe and, as Dr. Guimberteau’s work has shown, from the skin to the depths of the bone. Their tensions are at the origin of pain, visceral dysfunctions, and disturbances of vascular and nervous exchanges which alter the functional balance of the organism. The fascia techniques developed at CERB aim, through specific treatment of the different strata of fascia, to cure all these disturbances

3. Energetics
The energetic action aims to regulate the metabolic and biochemical activity and the exchange of information that is constantly taking place between the different tissues of the body by circulatory, nervous, and electromagnetic means and by means of the meridians of Traditional Chinese Medicine.

As a place of affects, representations, emotions, and a tool for relationships, the body expresses our emotional damage through its tissue tensions and dysfunctions. By using the body as a mediation, Biokinergie develops a psycho-corporal approach with a therapeutic, prophylactic, and preventive aim. By going back to the origin of the stress, inscribed in the tissues, it allows patients to free themselves from their conscious and unconscious blockages in order to find a physical, emotional, and mental balance.

Biokinergy was developed by Michel LIDOREAU, a physiotherapist and osteopath, who studied shiatsu and Chinese massage. At the beginning of the 1980s, he claims to have discovered specific tissue tensions in our body, associated with both joint blockages and energetic imbalances. This led to the invention of biokinergy.

Personally, I am still puzzled and unclear about what all this is supposed to mean. Perhaps we get a bit further if we ask what the therapy is used for.

The aim of biokinergy, I learn from this seemingly competent source, is not to treat only the symptoms but to takle their causes. The body is a whole, and its imbalances can be expressed symptomatologically very far from their origin. It is important to understand that pathology is not a coincidence, but results from the accumulation of a multitude of imbalances that must be treated together if we want to be effective quickly and in the long term.

The body has an amazing memory capacity. It keeps track of all our traumas (falls, repetitive gestures, false movements, emotional shocks, fatigue, stress) in the form of tensions, blockages, and energetic [biological, metabolic] imbalances. Initially, the body compensates and adapts, but gradually these disorders add up. They then end up hampering the functioning of the joints, disturbing the activity of the organs and compressing the blood vessels and nerves. The conduction of blood and nerve impulses is no longer done correctly, which favors the installation of biological disorders, the inflammation of tissues, and the appearance of pain (tendonitis, arthritis, gastritis, colitis, etc.). This can gradually lead to tissue degeneration.

The aim of a Biokinergy treatment is therefore to restore the body’s optimal functioning by restoring the function of all systems (locomotor, visceral, vascular, nervous, hormonal, etc.); this is done by releasing areas of tension and blockages, to restore flexibility to the tissues and free up, among others, the vascular and nervous axes.

Blast! I am getting more and more lost here. This just does not make much sense. Perhaps it is best to ask what actually happens during a therapy session. Again, the seemingly competent source offers some information:

A Biokinergy session lasts about 1 hour. After a precise interrogation, it consists in “reading” the body to find the tissue windings in order to reharmonize them. Bearing in mind that the human organism forms a whole, the biokinergist applies, from coil to coil, the corrections adapted to the disorders encountered. The techniques are gentle.

Well, this isn’t all that clear either.

Let’s take another approach: is there any evidence that biokinergy works? My Medline search gives a very clear answer: “Your search for biokinergy retrieved no results.”

So, now we know!

Biokinergy serves only one proven purpose: it improves the bank balance of the therapist.

On this blog, we are often told that only a few chiros still believe in Palmer’s gospel of subluxation. This 2023 article seems to tell a different story.

The authors claim that the term demonstrates the widespread use and acceptance of the term subluxation and
acknowledges the broader chiropractic interpretation by recognition and adoption of the term outside the profession. In particular, it emphasizes the medical recognition supported by some of the medical evidence incorporating the
construct of a chiropractic vertebral subluxation complex and its utilization in practice.

The vertebral subluxation concept is similar to the terms spinal dysfunction, somatic dysfunction, segmental dysfunction or the vague vertebral lesion. These terms are primarily used by osteopaths, physiotherapists, and medical doctors to focus their manipulative techniques, but they relate primarily to the physical-mechanical aspects. In this respect, these terms are limited in what they signify. The implication of just plain osseous biomechanical dysfunction does not incorporate the wider ramifications of integrated neural, vascular, and internal associations which may involve greater ramifications, and should be more appropriately referred to as a vertebral subluxation complex (VSC).

The authors also claim that, in recognition of acceptance of the subluxation terminology, a 2015 study in North America found that a majority of the 7,455 chiropractic students surveyed agreed or strongly agreed (61.4%) that
the emphasis of chiropractic intervention in practice is to eliminate vertebral subluxations/vertebral subluxation complexes. A further 15.2% neutral, and only 23.3% disagreeing. It is suggested that ‘modulation’ of vertebral subluxations may have attracted an even higher rate of agreement.

The authors conclude that the evidence indicates that medicine, osteopathy, and physiotherapy have all
used the term ‘subluxation’ in the chiropractic sense. However, the more appropriate, and inclusive descriptive term of vertebral subluxation complex is widely adopted in chiropractic and the WHO ICD-10. It would be most incongruous for chiropractic to move away from using subluxation when it is so well established.

A move to deny clarity to the essence of chiropractic may well affect the public image of the profession. As Hart states ‘Identifying the chiropractic profession with a focus on vertebral subluxation would give the profession uniqueness not duplicated by other health care professions and, therefore, might legitimatise the existence of chiropractic as a health care profession. An identity having a focus on vertebral subluxation would also be consistent with the original intent of the founding of the chiropractic profession.’

The term ‘vertebral subluxation’ has been in general use and understanding in the chiropractic profession as is ‘chiropractic subluxation’ and ‘vertebral subluxation complex’ (VSC). It is a part of the profession’s heritage. Critics of concepts regarding subluxation offer no original evidence to support their case, and that appears to be just political opinion rather than providing evidence to substantiate their stand.

The evidence presented in this paper supports the contention that there would be no vertebrogenic symptoms associated with physiologically normal vertebral segments. The term designated by chiropractors to identify abnormal or pathophysiological segmental dysfunction is the vertebral subluxation. It has been a part of chiropractic heritage for over 120 years.


Vis a vis such a diatribe of compact BS, I am tempted to point out that “critics of concepts regarding subluxation offer no original evidence to support their case” mainly because it is not they who have to produce the evidence. It is the chiropractic profession that needs to do that.

But they are evidently unable to do it.


Because chiropractic subluxation is a myth and an invention by their chief charlatan.

It is true that this fabrication is intimately linked to the identity of chiropractic.

It is furthermore true that chiros feel unable to throw it overboard because they would lose their identity.

What follows is simple:

Chiropractic is a fraud.





This study from the department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine tested whether new-onset impairments (NOI) of neurological functions identified by Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) will improve more so after osteopathic manipulative medicine (OMM) than after concussion-education.

College athletes presenting to the outpatient academic healthcare center (AHCC) with concussion due to head injury within the preceding 2 weeks were recruited for this IRB-approved, randomized, single-blinded trial. Consented men and women were randomized into two groups:

  • the verum group received two OMM treatments;
  • the control group received two concussion-education sessions.

Preseason, Baseline, ImPACT was compared to Post-Injury scores to determine NOI. Baseline, Post-Injury, and Post-Interventions ImPACTs were compared by analysis of variance (ANOVA, α≤0.05). Post-Injury correlations and mean changes in King-Devick (KD) scores were analyzed.

Post-Injury NOI were found in 77.8% (14/18) men and 85.7% (6/7) women, including ImPACT subscore indices for verbal and visual memory, processing speed (PS), and reaction time (RT). Of those with NOI, mean visual memory recovered by 50.0% following one and by 104.9% (p=0.032) following two OMM treatments in men and by 82.8% (p=0.046) following one treatment in women. Following two interventions, the mean RT in men receiving OMM improved by 0.10 more than education (p=0.0496). The effect sizes of OMM were large (Cohen’s d=1.33) on visual memory and small (Cohen’s d=0.31) on RT.

The authors concluded that NOI in visual memory and RT following concussion significantly improved in the OMM group compared to the education group. Integrating OMM utilizing physical exam and this treatment was a safe individualized approach in athletes with acute uncomplicated concussions. Further research is warranted to improve the utilization of OMM for individuals with concussion.

What the abstract does not tell you is that the two groups were extremely small and that they became even smaller, as some patients were lost to follow-up.

In addition, the results were all over the place.

Furthermore, it is noteworthy that neither the therapists nor the patients were blinded and the observation period was short. Finally, the authors state in their conclusions that OMM is safe. Considering the sample size and the attrition rate (perhaps all those patients lost to follow-up died?), this is of course ridiculously wishful thinking.

So, what can we conclude from this study? I don’t know about you, but I conclude that the department of Osteopathic Manipulative Medicine, New York Institute of Technology College of Osteopathic Medicine could do with a good science teacher.

The purpose of this review was to

  • identify and map the available evidence regarding the effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions;
  • identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.

Two reviewers independently screened and selected the studies, extracted key findings and assessed the methodological quality of included papers. A descriptive synthesis of reported findings was undertaken using a level-of-evidence approach.

Eighty-seven articles were included. Their methodological quality varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with

  • adolescent idiopathic scoliosis (AIS),
  • asthma,
  • attention deficit hyperactivity disorder (ADHD),
  • autism spectrum disorder (ASD),
  • back/neck pain,
  • breastfeeding difficulties,
  • cerebral palsy (CP),
  • dysfunctional voiding,
  • excessive crying,
  • headaches,
  • infantile colic,
  • kinetic imbalances due to suboccipital strain (KISS),
  • nocturnal enuresis,
  • otitis media,
  • torticollis,
  • plagiocephaly.

The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower-quality studies. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing

  • asthma (pulmonary function),
  • headache,
  • nocturnal enuresis.

There was inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.

The authors concluded that, whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

Perhaps the most important findings of this review relate to safety. They confirm (yet again) that there is only limited reporting of adverse events in this body of research. Six reviews, eight RCTs and five other studies made no mention of adverse events or harms associated with spinal manipulation. This, in my view, amounts to scientific misconduct. Four systematic reviews focused specifically on adverse events and harms. They revealed that adverse events ranged from mild to severe and even death.

In terms of therapeutic benefit, the review confirms the findings from the previous research, e.g.:

  • Green et al (Green S, McDonald S, Murano M, Miyoung C, Brennan S. Systematic review of spinal manipulation in children: review prepared by Cochrane Australia for Safer Care Victoria. Melbourne, Victoria: Victorian Government 2019. p. 1–67.) explored the effectiveness and safety of spinal manipulation and showed that spinal manipulation should – due to a lack of evidence and potential risk of harm – be recommended as a treatment of headache, asthma, otitis media, cerebral palsy, hyperactivity disorders or torticollis.
  • Cote et al showed that evidence is lacking to support the use of spinal manipulation to treat non-musculoskeletal disorders.

In terms of risk/benefit balance, the conclusion could thus not be clearer: no matter whether chiropractors, osteopaths, physiotherapists, or any other healthcare professionals propose to manipulate the spine of your child, DON’T LET THEM DO IT!

Osteopathy is currently regulated in 12 European countries: Cyprus, Denmark, Finland, France, Iceland, Italy, Liechtenstein, Luxembourg, Malta, Portugal, Switzerland, and the UK. Other countries such as Belgium and Norway have not fully regulated it. In Austria, osteopathy is not recognized or regulated. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a Europe-based survey, whereby an updated profile of osteopaths not only provides new data for Austria but also allows comparisons with other European countries.

A voluntary, online-based, closed-ended survey was distributed across Austria in the period between April and August 2020. The original English OPERA questionnaire, composed of 52 questions in seven sections, was translated into German and adapted to the Austrian situation. Recruitment was performed through social media and an e-based campaign.

The survey was completed by 338 individuals (response rate ~26%), of which 239 (71%) were female. The median age of the responders was 40–49 years. Almost all had preliminary healthcare training, mainly in physiotherapy (72%). The majority of respondents were self-employed (88%) and working as sole practitioners (54%). The median number of consultations per week was 21–25 and the majority of respondents scheduled 46–60 minutes for each consultation (69%).

The most commonly used diagnostic techniques were: palpation of position/structure, palpation of tenderness, and visual inspection. The most commonly used treatment techniques were cranial, visceral, and articulatory/mobilization techniques. The majority of patients estimated by respondents consulted an osteopath for musculoskeletal complaints mainly localized in the lumbar and cervical region. Although the majority of respondents experienced a strong osteopathic identity, only a small proportion (17%) advertise themselves exclusively as osteopaths.

The authors concluded that this study represents the first published document to determine the characteristics of the osteopathic practitioners in Austria using large, national data. It provides new information on where, how, and by whom osteopathic care is delivered. The information provided may contribute to the evidence used by stakeholders and policy makers for the future regulation of the profession in Austria.

This paper reveals several findings that are, I think, noteworthy:

  • Visceral osteopathy was used often or very often by 84% of the osteopaths.
  • Muscle energy techniques were used often or very often by 53% of the osteopaths.
  • Techniques applied to the breasts were used by 59% of the osteopaths.
  • Vaginal techniques were used by 49% of the osteopaths.
  • Rectal techniques were used by 39% of the osteopaths.
  • “Taping/kinesiology tape” was used by 40% of osteopaths.
  • Applied kinesiology was used by 17% of osteopaths and was by far the most-used diagnostic approach.

Perhaps the most worrying finding of the entire paper is summarized in this sentence: “Informed consent for oral techniques was requested only by 10.4% of respondents, and for genital and rectal techniques by 21.0% and 18.3% respectively.”

I am lost for words!

I fail to understand what meaningful medical purpose the fingers of an osteopath are supposed to have in a patient’s vagina or rectum. Surely, putting them there is a gross violation of medical ethics.

Considering these points, I find it impossible not to conclude that far too many Austrian osteopaths practice treatments that are implausible, unproven, potentially harmful, unethical, and illegal. If patients had the courage to take action, many of these charlatans would probably spend some time in jail.

This double-blind, randomized study assessed the effectiveness of physiotherapy instrument mobilization (PIM) in patients with low back pain (LBP) and compared it with the effectiveness of manual mobilization.

Thirty-two participants with LBP were randomly assigned to one of two groups:

  • The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education.
  • The manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education.

Both groups had 4 treatment sessions over 2-3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions:

  • Numeric Pain Rating Scale (NPRS),
  • Oswestry Disability Index (ODI) scale,
  • Pressure pain threshold (PPT),
  • lumbar spine range of motion (ROM),
  • lumbar multifidus muscle activation.

There were no differences between the PIM and manual groups in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm2), lumbar spine ROM (PIM: ⩽ 9.49∘, Manual: ⩽ 0.88∘), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm).

The authors concluded that both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.

If this conclusion is meant to tell us that both treatments were equally effective, I beg to differ. The improvements documented here are consistent with improvements caused by the natural history of the condition, regression towards the mean, and placebo effects. The data do not prove that they are due to the treatments. On the contrary, they seem to imply that patients get better no matter what therapy is used. Thus, I feel that the results are entirely in keeping with the hypothesis that spinal mobilization is a placebo treatment.

So, allow me to re-phrase the authors’ conclusion as follows:

Lumbar mobilizations do not seem to have specific therapeutic effects and might therefore be considered to be ineffective for LBP.

The aim of this evaluator-blinded randomized clinical trial was to determine if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to the same exercise program in patients with non-specific shoulder pain.

Forty-five subjects were randomly allocated into one of three groups:

  • manual therapy (glenohumeral mobilization technique and rib-cage technique);
  • thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique);
  • sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique).

All groups also received a therapeutic exercise program. Pain intensity, disability, and pain-free active shoulder range of motion were measured post-treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures.

All groups reported improved pain intensity, disability, and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures.

The authors concluded that the addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

What does that mean?

I think it means that the improvements observed in this study were due to 1) exercise and 2) a range of non-specific effects, and that they were not due to the manual techniques tested.

I cannot say that I find this enormously surprising. But I would also find it unsurprising if fans of these methods would claim that the results show that the physios applied the techniques not correctly.

In any case, I feel this is an interesting study, not least because of its use of sham therapy. But I somehow doubt that the patients were unable to distinguish sham from verum. If so, the study was not patient-blind which obviously is difficult to achieve with manual treatments.

This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.

Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.

The findings show:

  • Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
  • At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.

Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.

The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.

The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.

Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”

Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.


The aim of this study was to evaluate the effectiveness of craniosacral therapy on different features in migraine patients.

Fifty individuals with migraine were randomly divided into two groups (n = 25 per group):

  • craniosacral therapy group (CTG),
  • sham control group (SCG).

The interventions were carried out with the patient in the supine position. The CTG received a manual therapy treatment focused on the craniosacral region including five techniques, and the SCG received a hands-on placebo intervention. After the intervention, individuals remained supine with a neutral neck and head position for 10 min, to relax and diminish tension after treatment. The techniques were executed by the same experienced physiotherapist in both groups.

The analyzed variables were pain, migraine severity, and frequency of episodes, functional, emotional, and overall disability, medication intake, and self-reported perceived changes, at baseline, after a 4-week intervention, and at an 8-week follow-up.

After the intervention, the CTG significantly reduced pain (p = 0.01), frequency of episodes (p = 0.001), functional (p = 0.001) and overall disability (p = 0.02), and medication intake (p = 0.01), as well as led to a significantly higher self-reported perception of change (p = 0.01), when compared to SCG. The results were maintained at follow-up evaluation in all variables.

The authors concluded that a protocol based on craniosacral therapy is effective in improving pain, frequency of episodes, functional and overall disability, and medication intake in migraineurs. This protocol may be considered as a therapeutic approach in migraine patients.

Sorry, but I disagree!

And I have several reasons for it:

  • The study was far too small for such strong conclusions.
  • For considering any treatment as a therapeutic approach in migraine patients, we would need at least one independent replication.
  • There is no plausible rationale for craniosacral therapy to work for migraine.
  • The blinding of patients was not checked, and it is likely that some patients knew what group they belonged to.
  • There could have been a considerable influence of the non-blinded therapists on the outcomes.
  • There was a near-total absence of a placebo response in the control group.

Altogether, the findings seem far too good to be true.



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