by David on August 15, 2011
I often find that my patients either seem to be holding their breath as though expecting some calamity to befall them or have forgotten how to breathe, so shallow and chest centred is their breathing. As I treat them, it's evident that this is the result of enormous tension held in their respiratory diaphragm, the huge dome-like muscle that separates the chest from the abdomen. The tension held here can sometimes be so acute that it causes chest pain sufficiently severe to seem like an impending heart attack!
Tensions held in the respiratory diaphragm are evident in a wide range of conditions reported by patients who come to me for a craniosacral treatment: conditions such as tension and other headaches; neck and shoulder pain; anxiety and panic attacks; allergies; intestinal issues of many kinds including Candida; and pelvic, lower back and lower limb problems. There is a possible physiological explanation for a link between respiratory diaphragm tensions and the wide range of conditions in which such tensions are evident arising from the physical connections between the diaphragm and: the pericardium (the membrane in which the heart sits); the pleurae (external covering of the lungs); some of the ribs; the lower end of the sternum (the breast-plate); and the crura at L3, the third lumbar vertebra ( the lower part of the spine).
The two principal neck muscles, the sternocleidomastoid and trapezius are attached to the sternum and ribs respectively (with the other ends being attached to the back of the skull) so tensions held in the diaphragm can be transmitted into the neck, shoulders and head contributing to headaches and neck and shoulder pain. Similarly, diaphragmatic tensions can be transmitted downwards to the L3 connection contributing to pelvic, low back and leg problems.
The diaphragm also helps the return of venous blood from the lower limbs to the heart; and provides part of the pressure required during urination, defecation and child-birth. It also contains three major openings that enable key structures to pass from the chest cavity to the abdomen: the principal artery (the aorta) and vein (inferior vena cava) serving the lower parts of the body and limbs; the food-pipe (oesophagus) and the two vagus cranial nerves that run the digestive system and have other key functions. It helps if these openings can be kept tension free!
A large part of what we do during craniosacral treatments is to release tensions held in the respiratory diaphragm as a significant contribution to improving the health of the people I treat.
David.
by David on February 27, 2011
One of the frequent criticisms of complementary therapy, such as craniosacral therapy, is that it hasn’t been validated scientifically by randomised, double-blind trials. My Profession’s main research problem, noted in my earlier blogs, is the difficulty in finding the funding required to enable such studies to be run with a sufficiently robust design and independent, authoritative validation. It’s a pity that constant critics of complementary medicine do not bring the same robust critical analysis to the way in which clinical trials are designed.
For example, a new study, published in the journal, Science Translational Medicine, suggests that many pharmaceuticals only work because people expect them to, not because they have any ‘real’ chemical effect on the body. The study – listed at the end of this blog - investigated whether divergent expectations alter the effectiveness of a powerful painkiller remifentanil by applying heat to the legs of volunteers and using brain imaging to assess the effect of a constant dose of the painkiller under three experimental conditions: no knowledge that a painkiller was being used; a positive expectation that the painkiller would give relief; and, finally, a negative expectation that no relief would be obtained.
Positive expectation doubled the painkilling effect of the drug; whereas negative expectation lead to no measurable relief being obtained! These results were substantiated by significant changes in the neural activity in the regions of the brain involved with coding pain intensity; with positive results affecting the endogenous pain modulatory system and negative results the hippocampus.
These results also strongly suggest that a patient’s expectation critically affects the therapeutic effect obtained from prescription drugs; and that the design of clinical trials should specifically factor in this possibility. The power of the mind is not just ‘new age psycho babble’ any more.
I recognise the substantial benefits we all receive from prescription drugs so this blog is not an attack on the drugs industry. However, this experiment – taken together with the comment in my last blog about the lack of legislative control on the ingredients of placebos used in clinical trials – shows that the way in which all clinical trials are designed is flawed. Hence my earlier comment that critics of complementary medicine should bring the same critical analysis to the design of critical trials used for allopathic medicine.
I believe in the value of research – as does my professional association which is currently sponsoring one our members through a Masters by Research degree to underpin the start of our research programme – but am asking for ‘level playing field’ thinking to be applied to all medicines whether allopathic or complementary.
Citation: U. Bingel, V. Wanigasekera, K. Wiech, R. Ni Mhuircheartaigh, M. C. Lee, M. Ploner, I. Tracey, The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil. Sci. Transl. Med. 3, 70ra14 (2011).
David.
by David on February 13, 2011
An interesting conjunction of stories caught my eye recently. First was a complaint made to the Advertising Standards Authority (ASA) by a named member of the public: this was about the alternative medicine supplements sold by Boots about which the complainant commented there was no scientific evidence supporting the health benefits claimed for the products. The same complainant had made similar comments approximately one year earlier.
The next item was a report about the failed diabetic drug Mediator now banned in France and which is not only thought to cause heart valve damage but also 5oo deaths.
A few days earlier, there had been a report on the 40th anniversary of the thalidomide scandal: 10,000 babies born with serious disabilities of whom about half survived. Their mothers used thalidomide to cure morning sickness during their pregnancies.
Last was a story about research carried out into placebos used by drug companies during clinical trials by researchers for the Annals of internal medicine – “What’s on placebos: who knows? Analysis of randomised, controlled trials,” Annals of Internal Medicine (annals.org). Placebos are given to a randomly chosen group to provide a comparison with the results obtained from another randomly chosen group being given the drug being trialled.
There are no regulations of any kind that govern the makeup of placebos. To express it mildly this seems strange bearing in mind that placebos can affect the result of trials in significant ways! The annals of internal medicine researchers discussed a trial of a drug used to treat anorexia linked with cancer. They found that the placebo contained lactose. Lactose intolerance is often found among cancer patients: clearly, when patients taking the placebo complained of stomach problems it’s bound to make the drug used by the other group look much better!
The researchers also found that the contents of placebo pills were only disclosed in 8.2% of the 176 trials they reviewed. They concluded that the nature of the placebo can influence the outcome of randomised trials and that the formulation of the placebo should be disclosed in all cases.
This is by no means the first time that the design of randomised, controlled trials used by drug companies has been criticised for being flawed; nor, in the case of Mediator, the first time serious side effects reported from prescribed drug usage have been ignored (an 11 year period for this drug).
This is not to be taken as criticism of prescribed drugs usage of which provide enormous benefits for all of us. It is, however, a comment, on the zealousness of complementary medicine critics who seem unable to bring the same critical and clinical insights into the design of prescribed drug trials – especially when the disclosed side effects of such drugs are so much worse than those arising from complementary medicines many of which are harmless and which users seem to feel benefit them.
David.
by David on November 24, 2010
Patients frequently ask me how craniosacral therapy works: the straightforward answer is that no-one knows. There are a number of hypotheses but none of them proven. Like many complementary therapies, we are small in number in the UK (about 500 in my professional association which is the largest in the UK) and find it almost impossible to raise funds for research. Such funds as we are able to raise are used in research to demonstrate that craniosacral therapy works rather than into how it works; such as the research my professional association is sponsoring referred to elsewhere in these blogs.
We are generally categorised as an energy therapy by which I mean the interaction that takes place when a therapist puts their hands on a patient’s body. Craniosacral therapists are aware of what seem to be three distinct energy rhythms when we place our hands on our patients: known to us as the long tide – which beats once every 100 seconds; the mid tide – that beats at 2.5 cycles per minute; and the cranial rhythm that beats 8 to 14 times per minute. My experience is that whatever intelligence is at work during a craniosacral treatment ‘decides’ upon the appropriate rhythm required during a treatment; and we usually find that the energy frequency changes several times during a treatment. To the best of my knowledge, none of these cycles have been validated scientifically and cycle counts usually vary when several therapists work together. However counts generally approximate to the rhythms given above.
There is some controversy within our profession about what is referred to as biodynamic craniosacral therapy where the schools that teach it tend to focus on the long and mid tides to the exclusion of the cranial rhythm. I find that the latter is very useful for some conditions such as wrist strain and joint strains generally; and also for checking how well the tissues are responding to changes in the deeper rhythms. Rhythms vary during a treatment. To me, everything we do is craniosacral therapy and doesn’t need a more refined description.
It’s interesting to speculate whether the body’s energy flows are the main resource tapped into during a treatment; or whether relaxing the tissues energetically simply allows for improvements in fluid flows leading to the chemicals produced by the body - known as peptides and which provide a key element in running the body’s systems – reaching their receptors more effectively, thus leading to improved health. It could be a linked chain of events starting with energy flow improvements which enable improvements in fluid flows.
We can speculate but we don’t know. Perhaps Occam’s razor provides the best solution: the simplest option provides the ‘right’ answer, the simple solution being that it works for a large proportion of the people we treat as confirmed by the number of referrals we receive from satisfied patients; but also informally from parts of the Medical profession including practicing Doctors! This thought certainly confirms my Association’s decision to focus on sponsoring research that shows that what we do is safe and that it works!
David.