To the Editor:  

I read with interest the original contribution by Rafael Zegarra-Parodi, DO (England), MEd, and colleagues¹ in the February issue of JAOA—The Journal of the American Osteopathic Association. Contrary to the authors' claim, “craniosacral therapy” is not a technique that is widely used among osteopathic physicians. Rather, osteopathy in the cranial field, first described by William Garner Sutherland, DO,² is the system of diagnosis and treatment using the primary respiratory mechanism and balanced membranous tension that is an accepted part of the history and practice of osteopathic medicine. 

The forces required in osteopathic manipulative treatment (OMT) are dictated by each patient's needs, responses, and medical condition—as well as by information that the treating individual's hands and mind perceive while conducting the treatment. Standardizing palpation is not possible with so great a range of patient variables and training levels among practitioners. Variance among “experienced cranial manipulation practitioners” (in the words of the authors¹) would likely be great, as would—I expect—variance among different types of practitioners. Thus, I agree with the authors that OMT does not lend itself well to outcome studies. 

However, the authors' lack of distinction among “techniques” practiced by massage therapists, chiropractors, physical therapists, foreign-trained osteopaths, and US-trained osteopathic physicians is of concern.¹ The failure to make such a distinction suggests a lack of understanding regarding the variations of training and thought process among these different practitioners. 

Dr Sutherland³ meant osteopathy in the cranial field to be applied to treatment of the whole body when he wrote, “Allow physiologic function within to manifest its own unerring potency rather than apply a blind force from without.” Other kinds of craniosacral therapies used by non-DO practitioners do not necessarily share this holistic concept. 

I feel strongly that upholding the historic teaching standards of osteopathic medicine remains important, or else there is no distinction between the treatments that we provide as osteopathic physicians and the techniques that are applied by other kinds of practitioners. Our teachers must continue to be held to these high standards.