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JAOA Vol 112 No 1 January 2012 9King Editorial

T wo articles on cranial osteopathicmanipulative medicine (OMM) 1,2were published in the December 2011issue of JAOAThe Journal of the Amer-ican Osteopathic Association,and a reviewof a clinical study reporting the benefitsof cranial manipulation appears in thepresent issues installment of TheSomatic Connection. 3 All of these items bring much-needed attention to the dis-

cussion on the validity of the conceptand clinical benefits of cranial OMM inthe practice of health care.

There is arguably as much, if notmore, current research attention devotedto cranial OMM as there is to any othersingle OMM procedure, yet cranial pro-cedures remain the most controversial. 4Despite the controversy, I believe thereis mounting support for virtually allaspects of cranial OMM, including the-oretical assumptions (eg, the Primary

Respiratory Mechanism elements), clin-ical benefits, and physiologic mecha-nisms of action.

As one reads the systematic review by Jkel and von Hauenschild, 2 it becomes apparent that a number ofstudies that used cranial OMM were notincluded because of the strict selectionprocess used by the authors. Their inclu-sion criteria required that only articlesthat specifically described cranial manip-ulation be included. Hence, Jkel andvon Hauenschild have a possibly lim-

ited conclusion, as follows: The cur-rently available evidence on the clinicalefficacy of cranial OMM is heteroge-neous and insufficient to draw defini-tive conclusions.2 They further state theobvious, writing, further research intothis area is needed. 2 This conclusion isappreciated and respected for its scien-tific purity, and indeed, the article is notyet another anticranial OMM screed

far from it. However, their review couldhave been more comprehensive and stillmaintained scientific integrity.

While the tenets of modern researchwould lead us to isolate the specificOMM maneuver that may produce ameasurable beneficial outcome, in actualclinical practice multiple OMM maneu-vers are usually employed. In any dis-cussion of the effects of cranial OMM, Ican think of at least 3 articles in whichclinical benefit in the use of cranial OMM

was demonstrated but specific descrip-tions of cranial OMM were lacking 5,6orcranial OMM descriptions were vaguelyreferred to. 7 While the articles by Fry-mann 5,6may not have specified cranialOMM, anyone remotely familiar withFrymanns work knows she performedcranial OMM on every patient; during acranial course she was directing about adecade ago, I heard her publicly statethat she did. In the study by Mills et al, 7treatment included balanced membra-nous tension (according to the teachingsof William Garner Sutherland, DO, andothers), referring to Osteopathy in theCranial Field by Magoun.8 Clearly, cranialOMM was used in that study.

Two articles published subsequentto the Jkel and von Hauenschild sys-tematic review 2 specify cranial OMMand report beneficial outcomes. 1,9In thestudy by Shi et al, 1 cranial OMM pro-duced measurable physiologic effectsthat contribute to our understanding ofpossible mechanisms of action for cranialOMM. In the study by Lopez et al, 9 spe-

cific cranial OMM procedures weredescribed in the treatment protocol, anddata showed improved balance andequilibrium in healthy elderly adults.

Jkel and von Hauenschild 2 were justified in their approach, but I wouldlike the osteopathic medical professionand the scientific community at large toknow that much more research has beendone that suggests benefit for the clinical

application of cranial OMM. Perhapsthe pieces are now in place for a fullerreview and explication of cranial OMM.

References1. Shi X, Rehrer S, Prajapati P, et al. Effect of cranialosteopathic manipulative medicine on cerebraltissue oxygenation. J Am Osteopath Assoc . 2011;111(12):660-666.

2. Jkel A, von Hauenschild P. Therapeutic effects ofcranial osteopathic manipulative medicine: a sys-tematic review. J Am Osteopath Assoc . 2011;111(12):685-693.

3. King HH. As the twig is bent, so grows the tree:part 2 [review of Lessard S, Gagnon I, Trottier N.Exploring the impact of osteopathic treatment oncranial asymmetries associated with nonsynostoticplagiocephaly in infants. Complement Ther ClinPract . 2011;17(4):193-198]. J Am Osteopath Assoc .2012;112(1):11-12.

4. Zubcevik N. Cranial palpation pressures used byosteopathy students [letter]. J Am Osteopath Assoc .2009;109(7):379-380. http://www.jaoa.org/content

/109/7/379.2.full. Accessed December 29, 2011.

5. Frymann V. Learning difficulties of childrenviewed in the light of the osteopathic concept. J AmOsteopath Assoc . 1976;76(1):46-61.

6. Frymann VM, Carney RE, Springall P. Effect ofosteopathic medical management on neurologicdevelopment in children. J Am Osteopath Assoc .1992;92(6):729-744.

7. Mills MV, Henley CE, Barnes LL, Carreiro JE, Degen-hardt BF. The use of osteopathic manipulative treat-ment as adjuvant therapy in children with recurrentacute otitis media. Arch Pediatr Adolesc Med . 2003;157(9):861-866.

8. Magoun HI. Osteopathy in the Cranial Field . 3rded. Kirksville, MO: Journal Printing Co; 1976.

9. Lopez D, King HH, Knebl JA, Kosmopoulos V,Collins D, Patterson RM. Effect of comprehensiveosteopathic manipulative treatment on balance inelderly patients: a pilot study. J Am Osteopath Assoc .2011;111(6):382-388.

EDITORIAL

Cranial Osteopathic Manipulative Medicines Growing Evidence Base

Hollis H. King, DO, PhD

Dr King is a section editor of and regular con-tributor to The Somatic Connection and is amember of the JAOA Editorial Board.

Financial Disclosures: None reported.Address correspondence to Hollis H. King,

DO, PhD, Program Director/Director of MedicalEducation, University of Wisconsin Departmentof Family Medicine, Osteopathic Residency Pro-

gram, 1100 Delaplaine Ct, Madison, WI 53715-1840.E-mail: hollis.king@fammed.wisc.edu