Evidence based support for Craniosacral/Osteopathic Therapy

CST or craniosacral therapy is a form of osteopathic manipulation developed by osteopathic physician, John Upledger. CST has shown to be beneficial for a variety of ailments must notably, muscular aches and pains, headaches and anxiety. CST is a form of gentle healing touch designed to bring equilibrium to the craniosacral rhythm pulsing throughout our bodies. The craniosacral rhythm refers to the filling and emptying of the cerebrospinal fluid that encompases our brain and spinal cord. This pulse is detected by a CST therapist and can also be observed through magnetic resonance imaging. Restoring a disrupted craniosacral rhythm can cause an overstimulated nervous system to relax while concurrently releasing fascial restrictions that were contributing to pain.  

It has been hypothesized that the cranial bones will fuse around the second year of life. However, Dr. Upledger led research between 1975 and 1983 to demonstrate these bones in our skull we believed to be fused and static actually have more motion than previously thought. He and his team worked on cadavers to disprove calcification of sutures in the skull. What they found was surprising. The cadavers’ cranial joints actually contained collagen, elastic fibers, arteries, capillaries, veins, nerves and neuroreceptors¹. While this disproved calcification of the joint sutures it did not yet prove that the cranial bones can move independently from one another due to the pulsing cerebrospinal fluid CST therapists call the craniosacral rhythm. 

In an effort to prove his theories on this, Dr. Upledger and his team worked on live monkeys where they were able to track parietal bone movements using antennas cemented to their cranial bones (the monkeys were anesthetized for the surgery and pain-free throughout the experiment). They discovered the parietal bones could move, independent of each other, at about 12 cycles per minute. This motion was stopped as soon as Dr. Upledger placed his fingertip on the monkey’s coccyx.¹ This further supported his craniosacral theory on how the hydraulic force of the cerebrospinal fluid pulsing through the brain and spinal cord’s membranes affecting the myofascial network could be influenced by external pressure.

Although much of CST’s efficacy is anecdotal and clinically observed, there are studies that affirm the effectiveness of this healing modality. A blind randomized sham-controlled trial was performed to assess the efficacy of CST. Fifty four patients were divided into two groups; a CST group or a sham-light touch group. They were assessed before treatment and after 8 weeks and again 3 months later. Researchers primarily assessed pain intensity during these checkpoints and pressure pain sensitivity, functional disability, quality of life, well being, anxiety, depression and stress perception, secondarily. The results showed significant improvements in both pain intensity and quality of life for the CST group after 3 months of treatment.²

A meta-analysis on the effectiveness of CST on patients with chronic pain was performed which included 10 different randomized controlled trials with 681 participants. Effectiveness was based on improvements in pain intensity primarily, and in mood and overall quality of life, secondarily. The study concluded that patients’ administered CST versus sham-touch therapy experienced greater pain relief and improved quality of life that lasted 6 months.³

A CST appointment is similar to a massage but the patient remains fully dressed and typically lasts between 15-30 minutes. The practitioner will assess different ‘listening stations’ or areas where the craniosacral rhythm may be felt by placing their hands and feeling for the pulse. The practitioner works their way around the body and ultimately places most of their attention on or around the head with a variety of holding positions. The practitioner spends time with each hold until they feel a release from the patient before moving on the next. Most patients get the most relief from CST with regular weekly or biweekly sessions. 


  1. CranioSacral Therapy and Scientific Research, Part I by Dr. John Upledger D.O, OMM
  2. PMID 26340656
  3. PMID: 31892357

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