Letters to the Editor  |   July 2009
Cranial Palpation Pressures Used by Osteopathy Students
Author Affiliations
  • Daniel Kary, DO
    Lewiston, Me
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   July 2009
Cranial Palpation Pressures Used by Osteopathy Students
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 378-379. doi:
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 378-379. doi:
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. 
Zegarra-Parodi R, de Chauvigny de Blot P, Rickards LD, Renard E-O. Cranial palpation pressures used by osteopathy students: effects of standardized protocol training. J Am Osteopath Assoc. 2009;109:79-85. Available at: Accessed May 14, 2009.
Glossary Review Committee for the Educational Council on Osteopathic Principles and the American Association of Colleges of Osteopathic Medicine. Glossary of Osteopathic Terminology. July 2006. Available at: Accessed May 14, 2009.
Becker RE. Foreword. In: Sutherland WG. Teachings in the Science of Osteopathy. Fort Worth, Tex: Sutherland Cranial Teaching Foundation; 1990.