Osteopathic decapitation: Why do we consider the head differently from the rest of the body? New perspectives for an evidence-informed osteopathic approach to the head

Abstract

The osteopathic management of the head was initially founded on a biomechanical model which has since proved to be highly controversial. The current call for the evidence-informed practice of osteopathy, and the level of critical reasoning we expect from our students, are no longer compatible with Sutherland's ideas on cranial osteopathy.Meanwhile, an interesting field has developed called tissue mechanics. This may provide osteopaths with useful evidence to develop a treatment model of the head that fits better with current knowledge. Biomechanics is not limited to kinematics to the human body. It includes tissue mechanics that aims to describe the way living tissues distort under different types of loading. It has been extensively applied to understand the role and development of cranial sutures and the distribution of stresses and strains over the skull.Even though it is among the hardest materials in the body, bone distorts during normal function and more obviously during trauma. Bone tissues undergo stresses and strains when loaded, like any other material, and cranial bones are no exception to this rule.

Making Sense of Cranial Osteopathy: An Interpretative Phenomenological Analysis

“…The mechanism of the PRM is a speculative construct. It informs the educational framework of the SCCO and other teaching programmes (Gabutti and Draper-Rodi, 2014), yet scientific evidence of its plausibility remains lacking, despite attempts to establish its biological basis and to assess the diagnostic reliability of cranial osteopaths' palpatory assessment of a purported indicator of the PRM -the 'cranial rhythmic impulse' (Hartman and Norton, 2002;McGrath 2015).…”

The Intraosseous Dysfunction in the Osteopathic Perspective: Mechanisms Implicating the Bone Tissue

“…Although it is one of the most rigid structures in the human body, bone tissue deforms during body movements and also during trauma imposed on it. Some important conditions that directly influence the mechanical properties of bone are highlighted [21]: its deformation is not proportional to the load imposed on it; its mechanical properties vary according to the pace of the load; its mechanical behavior is dependent on the fluid present in bone tissue; bone is composed of different types of bone tissue with different mechanical properties; its mechanical properties are not identical in all directions; it is in constant remodeling and has different properties in different periods of life. Mineralized matrix components promote strength, and collagen fibers that are resistant to tension and traction ensure the flexibility of bone tissue and supply its energy absorption capacity.…”

The enigmatic case of cranial osteopathy: Evidence versus clinical practice

“…22 Other critical appraisals of Sutherland's model have been proposed that are supported by current scientific evidence, such as the mechanical properties of cranial bones and sutures with muscle contraction are the main cause of skull deflection and may be amenable to palpation. 23 In conclusion, because we value and encourage reports such as the one published by CORTECS and because we give credit to its conclusions regarding OCF, we would like to encourage authors to give readers, especially those clinicians who are unfamiliar with recent methodologies used to evaluate the effectiveness of manual treatments, access to tools that can evaluate the process that led to such conclusions. Since clinicians are now trained to use critical appraisal skills of the scientific evidence and to incorporate them into their daily practice, they may be faced with the dual challenge of appraising guidelines and individual papers.…”