Craniosacral Therapy and Myofascial Release in Entry-level Physical by wiy19586


									Craniosacral Therapy and Myofascial Release in
Entry-level Physical Therapy Curricula


                           The purposes of this study were 1) to discover the extent to which craniosacral
                           therapy (CST) and myofascial release (MFR) instruction are included in entry-
                           level physical therapy curricula; 2) to determine the amount of faculty and program
                           director interest in such instruction; and 3) to determine what educational mate-
                           rials, if any, are desired. A one-page questionnaire was distributed to the program
                           directors of 109 accredited entry-level physical therapy programs in the United
                           States. Of the 95 respondents, 1 (1%) included a unit on CST only, 14 (15%)
                           included a unit on MFR only, 14 (15%) included units on both CST and MFR, and
                           66 (69%) included neither. The highest percentages of programs with CST and
                           MFR units were entry-level masters' degree programs and programs located in
                           the Pacific Coast and Middle Atlantic regions. All of the units were presented
                           within required courses, usually during the second year; most were taught by
                           physical therapists. The greatest amount of instructional time was allotted for
                           CST laboratory sessions ( = 5.8 hours), and the least amount of time was
                           allotted for MFR lectures ( = 1 . 7 hours). The most frequently cited reason for
                           noninclusion of CST or MFR instruction was inadequate room in the current
                           curricula. The most frequently requested materials were bibliographies and
                           laboratory guides on CST and MFR. Implications of these findings are addressed,
                           and suggestions for further research are given.
                            Key Words: Education: physical therapist, professional; Physical therapy.

   According to the osteopathic literature, craniosacral therapy                   allergies21; neonatal problems22,23; learning disabilities and
(CST) is based on five physiological premises: 1) motility of                      behavioral problems19,23; and psychiatric disorders.24
the central nervous system, 2) rhythmic fluctuation of the                            Research on CST and MFR has been published primarily
cerebrospinal fluid, 3) mobility of the 22 bones of the skull,                     in the osteopathic and dental literature, with no known sci-
4) mobility and continuity of the meninges between the                             entific data that affect clinical care yet available in the physical
cranium and sacrum, and 5) continuity of the meninges with                         therapy literature. Despite this paucity of "hard" data, many
the connective tissues (fasciae) of the rest of the body.1"4                       physical therapists appear to be interested in the concepts of
Myofascial release (MFR) is a kind of extension of CST that                        CST and MFR and to have strong opinions about the role of
concentrates more on peripheral fascial problems. The fun-                         the techniques in physical therapy, based on the number and
damental premise of MFR is that the true source of dysfunc-                        variety of pertinent articles and letters to the editor in selected
tion is often located away from the area of symptom mani-                          physical therapy literature.
festation.5-8 The goal of both CST and MFR is to effect                               Currently, instruction in CST and MFR techniques is avail-
somatic and visceral bodily changes by using these cranial                         able through continuing education courses and seminars.
bone-meningeal-fascial connections, viewing the patient as an                      Little, however, is known about the prevalence of such in-
"integrated totality."1,5,7 Proponents of these two manual tech-                   struction in entry-level physical therapy education programs.
niques state that either CST or MFR, or some combination                           Because physical therapy practice and education must be
of the two, could be effective in the treatment of various                         linked if the profession is to grow, it is important to know
cranial nerve entrapment dysfunctions9-11; headache5,9,12-15;                      whether apparent shifts in clinical interest are reflected in
temporomandibular joint dysfunctions, bruxism, and                                 entry-level curricula. The purpose of this article is to report
malocclusions1316; cranial and facial asymmetries17; scoliosis                     the results of a survey investigating 1) the current state of CST
and other orthopedic problems5-7,9,l3,18-20; uterine inertia20;                    and MFR instruction in entry-level physical therapy curricula;
                                                                                   2) the degree of faculty and program director interest in
                                                                                   including such instruction; and 3) the kinds of materials, if
   S. Ehrett, MS, is Staff Physical Therapist and Athletic Trainer, Department     any, desired by faculty members for the development or
of Physical Medicine, Holy Cross Hospital, 1500 Forest Glen Rd, Silver Spring,     expansion of CST or MFR instruction in program curricula.
MD 20910 (USA). She was a graduate student in physical therapy, University
of Indianapolis, Indianapolis, IN, when this study was completed.
  This research was completed in partial fulfillment of the requirements for       METHOD
Mrs. Ehrett's Master of Science degree at the Krannert Graduate School of
Physical Therapy, University of Indianapolis.
  The results of this study were presented at the Sixty-Third Annual Conference
                                                                                     A one-page mailed questionnaire, consisting of one filter
of the American Physical Therapy Association, San Antonio, TX, June 2 8 -          and a combination of closed and open questions, was used
July 2, 1987, and at the 1987 State Conference of the Indiana Chapter of the       for data collection (Appendix). Items were chosen to assess
American Physical Therapy Association, Indianapolis, IN.
   This article was submitted October 21, 1986; was with the author for revision   program demographics and curriculum offerings and to
26 weeks; and was accepted August 5, 1987. Potential Conflict of Interest: 4.      determine respondent interest in the areas of CST and

534                                                                                                                          PHYSICAL THERAPY
MFR instruction in accredited physical therapy education          TABLE 1
programs.                                                         Percentage of Returns (R) Versus Possible Returns (PR) for
   I distributed the questionnaires in February 1986 to the       Entry-Level Programs that Include Units on Craniosacral
109 accredited physical therapy programs in the United States     Therapy (CST) or Myofascial Release (MFR)
listed in the October 1985 issue of PHYSICAL THERAPY.25                                                       Units Included (%)
Program directors or their designated faculty members com-
pleted the questionnaire. Four weeks after the initial mailing,         Program Type       R/PR       CST      MFR
                                                                                                                        Both    Neither
I sent a follow-up letter and questionnaire to those program                                          Only     Only
directors who had not responded. One additional month was           Baccalaureate          82/91       0.0     15.9     13.4     70.7
allowed for the return of questionnaires before analyzing the       Certificate             4/6        0.0      0.0     25.0     75.0
data.                                                               Entry-level master's    9/12      11.1     11.1     22.2     55.6
                                                                    TOTAL                  95/109      1.1     14.7     14.7     69.5
   The program directors of 95 (87%) of the 109 programs          TABLE 2
returned completed questionnaires. Of the 95 programs rep-        Percentage of Returns (R) Versus Possible Returns (PR) for
resented, 80 (84%) were baccalaureate degree programs only;       Craniosacral Therapy (CST) and Myofascial Release (MFR) Units
4 (4%) were certificate programs only; 7 (7%) were entry-level    by Program Location
masters' degree programs only; 2 (2%) had both baccalaureate
                                                                        Geographic                            Units Included (%)a
degree and certificate curricula, but the program directors                                   R/PR
responded in reference to the baccalaureate degree curriculum             Region                         CST          MFR      Neither
only; and 2 (2%) had both baccalaureate degree and entry-         Pacific Coast
level masters' degree curricula, and the program directors          (CA, OR, WA)               8/11      25.0         37.5      50.0
responded in reference to both.                                   Rocky Mountain
                                                                    (CO, ID, MT, NV,
Level of Program                                                    UT, WY)                    3/3           0.0      33.3      66.7
  Of the 95 respondents, 1(1%) included a unit on CST only          (AZ, NM, OK, TX)          10/10      10.0         20.0      80.0
in the program's entry-level curriculum, 14 (15%) indicated       Midwestern
inclusion of an MFR unit only, 14 (15%) included units on           (IL, IN, IA, KS, Ml,
both CST and MFR, and 66 (69%) stated that they included            MN, MO, NE, ND,
neither CST nor MFR. Table 1 depicts the percentage of each         OH, SD, Wl)              27/30       14.8         25.9      74.1
of the three kinds of entry-level programs that included CST
                                                                    (AL, AR, DE, FL, GA,
or MFR in their curricula. The entry-level masters' degree          KY, LA, MD, MS, NC,
programs had the greatest percentage of CST units, followed         SC, TN, VA, WV, DC)      24/25       16.7         33.4      66.7
by certificate and baccalaureate degree programs, respectively.   Middle Atlantic
The baccalaureate degree programs had the most units on             (NJ, NY, PA)              16/20      25.0         43.8      56.2
MFR, and the certificate programs had the highest percentage      New England
with neither CST nor MFR.                                           (CT, ME, MA, NH,
                                                                    Rl, VT)                    7/10          0.0       0.0     100.0
Geographic Distribution                                             a
                                                                      Totals may exceed 100% because of programs that included
                                                                  units on both CST and MFR.
  Entry-level programs were categorized geographically ac-
cording to the regions of the United States described in the
World Book Encyclopedia.26 Table 2 indicates the number of        nesiology, or comprehensive back care. None of the respond-
program respondents by region, and the percentage of those        ents indicated a separate MFR or CST course. Of the 15
respondents who reported having a unit on CST or MFR in           programs having CST units, 3 (20%) presented the material
their curriculum. The two regions that had the highest per-       to first-year students and 12 (80%) presented it to second-
centages of programs with CST units, the Pacific Coast (25%)      year students. Twelve (43%) of the 28 programs with MFR
and Middle Atlantic (25%) areas, also had the highest per-        units included the material in a first-year course, and 16
centages of programs with units on MFR (38% and 44%,              (57%) included it in a second-year course.
respectively). The Pacific Coast region, however, also had one
of the lowest response rates. The areas that had the lowest
percentages of programs with CST were the Rocky Mountain          Clock Hours Allotted
and New England regions (each with 0%), and the areas that
had the lowest percentages of programs with units on MFR             Table 3 indicates the range, standard deviation, and average
were the New England (0%) and Southwestern (20%) regions.         number of clock hours allotted for lecture and laboratory
Fifty percent to 100% of the programs in each of the regions      instruction for CST, MFR, and combined units of CST and
offered neither CST nor MFR.                                      MFR. The number of hours allotted for the units varied
                                                                  greatly among programs, ranging from 0 to 25 hours. For
                                                                  either CST or MFR, or for the two combined, more time was
Level of Units
                                                                  allotted for laboratory instruction ( = 4.6 hours) than for
  AH of the programs with CST or MFR units in their               lecture ( =3.5 hours), with the greatest amount of time (
curricula included the units in required courses, such as         = 5.8 hours) allotted for CST laboratory instruction and the
massage, modalities, senior seminar, therapeutic exercise, ki-    least amount of time ( =1.7 hours) allotted for MFR lecture.

Volume 68 / Number 4, April 1988                                                                                                         535
Unit Instructors                                                            in the next two to three years. Sixty-four (80%) did not expect
                                                                            to add a unit, 6 (8%) were undecided, and 5 (6%) did not
  Thirteen (87%) of the 15 programs with CST units and 22                   respond.
(79%) of the 28 programs with MFR units had instructors                        Of the 67 programs that did not include a unit on MFR, 3
who were both physical therapists and faculty members. Five                 (4%) were planning to add a unit during the 1986 to 1987
(33%) of the programs with CST units and 9 (32%) of the                     academic year, including one entry-level masters' degree pro-
programs with MFR units had instructors who were physical                   gram. Two others (3%) reported plans to add a unit after the
therapists but not faculty members. One program (4%) re-                    development of entry-level masters' degree programs within
ported that their unit on MFR was taught by an osteopathic                  the next few years. Fifty-seven (85%) did not plan to add a
physician, but no programs with CST indicated use of such                   unit, 2 (2%) were undecided, and 3 (5%) did not respond.
an instructor.                                                              One program had no plans for adding a unit, but indicated
                                                                            plans to gradually expand on the concept of MFR within the
Initiation of Units                                                         context of a therapeutic exercise course during the 1986 to
                                                                             1987 academic year.
  Before 1983, only 2 entry-level programs included a unit
on CST and only 1 had a unit on MFR. Between 1983 and
the spring of 1986, units were added by 13 of the 15 respond-               Materials Desired for Expansion or Development
ing programs with CST instruction and 27 of the 28 respond-                 of Units
ing programs with MFR instruction.
                                                                              All 29 of those programs with units on CST or MFR
                                                                            responded to the question, "Which of the following would be
Plans to Add Units                                                          of help to you in the expansion of your unit?" The results are
                                                                            presented in Table 4. A bibliography on CST or MFR and a
  Of the 80 programs that did not include a unit on CST, 3                  laboratory guide of introductory CST or MFR techniques
(4%) reported plans to add such a unit during the 1986 to                   were the most frequently requested materials, followed by
1987 academic year, including one entry-level masters' degree               lecture notes or slides for classroom use and slides or cassette
program. Two others (3%) mentioned plans to add a unit                      tapes for audiotutorial use. Materials mentioned under the
when their entry-level masters' degree programs are developed               category "other" were case studies of clinical outcomes of
                                                                            MFR and CST and any new materials or texts on the subjects.
                                                                            Responses of those programs that did not have units on CST
                                                                            or MFR to the question, "Which of the following would be
TABLE 3                                                                     of help to you in the development of such a unit?" followed
Clock Hours Allotted for Units on Craniosacral Therapy (CST)                the same order of frequency as those programs considering
and Myofascial Release (MFR)                                                expansion (Tab. 4).
                                Lecture Hours
             Unit                                          Hours
                                      s    Range           s    Range       Reasons Given for Noninclusion of Units
CST (n = 4)                    4.0   3.4   (2-9)   5.8    4.2   (3-12)        Eighty (84%) of the 95 entry-level programs did not include
MFR(n = 17)                    1.7   0.9   (0-3)   3.2    2.7   (0-10)      a unit on CST in their curricula, and 67 (70%) did not include
CST and MFR combined
                                                                            a unit on MFR. The data in Table 5 summarize the reasons
 (n=11)                        4.6   7.1   (1-25) 5.0     5.5   (0-20)
                                                                            for noninclusion cited by program respondents.

Percentage of Programs Indicating Materials Desired for the Expansion or Development of Craniosacral Therapy (CST) or Myofascial
Release (MFR) Unitsa
                                                                                               To Expand (%)           To Develop (%)
                                           Materials                                        CST Unit   MFR Unit    CST Unit    MFR Unit
                                                                                            (n = 15)   (n = 28)    (n = 80)    (n = 67)
Bibliography on CST or MFR                                                                    80.0        71.4        59.7        57.5
Laboratory guide of introductory CST or MFR techniques                                        80.0        71.4        55.2        55.0
Lecture notes or slides for classroom use as an introduction to CST or MFR                    73.3        67.9        50.8        51.2
Slides or cassette tapes for audiotutorial use as an introduction to CST or MFR               46.7        46.4        35.8        37.5
   Clinical evidence                                                                           0.0         3.6        11.9        11.2
   Faculty with expertise                                                                      0.0         0.0         7.5         6.2
   Continuing education                                                                        0.0         0.0         1.5         1.2
   Texts                                                                                       0.0         3.6         1.5         2.5
None                                                                                           0.0         3.6         3.0         2.5
No response                                                                                    0.0         0.0        22.4        23.8
      Columns add up to more than 100% because of instruction to "circle all that apply."

536                                                                                                                 PHYSICAL THERAPY
TABLE 5                                                            to students must be scientifically proven (indeed much of PT
Reasons Cited for Noninclusion of Craniosacral Therapy (CST)       [physical therapy] is not so); however, I do believe in being
or Myofascial Release (MFR) Unitsa                                 healthfully skeptical about new ideas. . . .Research efforts
                                                                   must be published and presented for further scholarly critique
                                 Programs Not    Programs Not
                                                                   rather than to continue to be disseminated solely through
           Reason                Including CST   Including MFR
                                  (n = 80) (%)    (n = 67)(%)
                                                                   clinical, anecdotal (and high-cost) workshops."
                                                                      Noninclusion of myofascial release units. The reasons cited
Have no room in current                                            by respondents of the 67 programs that did not include a
     curriculum                      51.2            55.2
                                                                   MFR unit followed the same order of frequency as those cited
Do not believe it is an entry-
     level skill                     38.8            40.3
                                                                   by respondents whose programs did not include CST. Four
Do not believe it is a proven                                      of the respondents who chose the response "do not believe it
     mode of evaluation and                                        [MFR] is an entry-level skill" stated that they believe MFR
     treatment                       31.2            34.3          to be an important concept that should be mentioned but not
Have not had time to develop                                       taught in-depth. As with the CST unit, several of the respond-
     such a unit                     23.8            20.9          ents who chose "do not believe it [MFR] is a proven mode of
Other                                                              evaluation and treatment" stated that they would consider
  No faculty with expertise          11.2             9.0          teaching a basic introduction to MFR if they could be con-
  Concepts mentioned in other                                      vinced of the scientific validity of the technique. Three re-
     courses                          5.0            11.9
                                                                   spondents expressed concern that therapists' credibility will
Believe it would duplicate the
     services of other
                                                                   be weakened by "jumping on the bandwagon" of MFR too
     professions                      0.0             0.0          fast, and one wanted to see research "sorting out the scientific
No response                           7.5             6.2          basis of MFR and CST from the powerful 'laying-on-of-the-
                                                                   hands' effects." Other comments in this section ranged from
     Columns add up to more than 100% because of instruction to    "we must be intellectually skeptical of people who speak of
"circle all that apply."
                                                                   'releasing past experiences' through MFR" to "certainly there
                                                                   is room for greater appreciation of the existence/function and
   Noninclusion of craniosacral therapy units. Of the 80 pro-      dysfunction of fascia....We just need to know more." Six of
grams that did not have a unit on CST, the largest number of       the 13 respondents who indicated "other" mentioned that
respondents indicated that a lack of room in the current           they had no faculty members with expertise in the MFR
curriculum was the major factor limiting inclusion of such a       technique. Two of these six respondents, however, stated that
unit. Two respondents stated that they briefly mention the         they had faculty members currently taking courses and indi-
concept of CST and provide a small demonstration, but              cated they would add an MFR unit after completion of the
currently have no space in their curricula for a full teaching     courses. Eight of the 13 respondents stated that MFR is
unit.                                                              mentioned briefly in other courses, with one of those com-
    Several of the respondents citing the response "do not         menting that physical therapists "today are afraid to use the
believe it [CST] is an entry-level skill" indicated that CST       term 'massage' based on its often dubious social connotations,
should be mentioned to expose students to the idea, but stated     hence the popularity of 'myofascial release,' which sounds
that an actual unit would be more appropriate at the post-         very impressive."
graduate level. One respondent commented that "CST re-
quires more manual therapy experience than entry-level stu-        DISCUSSION
dents have," and another stated that "an extensive review of
the skull would need to be presented before introducing CST           One objective of this research was to determine the current
techniques," thus making such a unit impractical for an entry-     state of CST and MFR instruction in entry-level physical
level program.                                                     therapy curricula. Of the 95 programs responding, those with
   The response "do not believe it [CST] is a proven mode of       entry-level master's degree curricula had the highest percent-
evaluation and treatment" drew the most additional com-            age of units on CST and the highest percentage of units on
ments. Three respondents stated that they would consider           MFR. The majority of those programs that were planning to
teaching a basic introduction to CST if they could be con-         add units on CST or MFR in the near future were also entry-
vinced of its scientific validity, two stated that they believed   level master's degree programs. These findings may indicate
CST had clinical merit and reported that they mention the          a greater acceptance of nontraditional physical therapy con-
idea but do not teach the technique, and two others stated         cepts at this level, a desire to give students in entry-level
that "CST has absolutely no scientific validity." One of the       master's degree programs exposure to a wider variety of
latter two respondents believed that "any reduction in pain        therapeutic approaches, or a greater availability of time and
that the patient reports is secondary to relaxing while recum-     space for such units at this level.
bent and to the inhibitory effect of oscillation on afferent          Geographically, the highest percentages of CST and MFR
receptors...similar to the effect of [Maitland's] Grades I and     units were found in the programs of the Pacific Coast and
II joint mobilization." The same respondent also commented,        Middle Atlantic regions. Although the Pacific Coast was one
"If we clinicians are to use CST on our patients, it is our        of the regions with the highest percentages of CST and MFR
responsibility to prove the efficacy of it through legitimate      units and the only region with a program that had a unit in
clinical research. Otherwise, the use of such techniques and       CST only, it also had one of the lowest responses rates, a
others...will severely hamper our progress toward becoming         finding that may suggest selective mortality. That is, possibly
a legitimate scientific profession." Other comments in this        only those program directors who included CST or MFR
section were similar to that of another respondent who stated,     instruction in their curricula were interested enough in the
"I have no philosophical conviction that all material presented    subject to respond to the questionnaire. I was unable to

Volume 68 / Number 4, April 1988                                                                                              537
determine, however, whether the high percentages of the            in these two nontraditional methods of manual therapy. Be-
Pacific Coast programs were attributable to selective mortal-      fore 1983, only 2 entry-level programs had a unit on CST,
ity, particularly because the New England region showed the        but between 1983 and the spring of 1986, 13 more programs
opposite finding-a low response rate and no programs hav-          added such a unit and 3 others indicated plans to do so during
ing CST or MFR units. Another interesting finding was that,        the 1986 to 1987 academic year. A similar trend was found
although the Midwestern region had one of the highest per-         for MFR instruction. Only two programs had a unit on MFR
centages of programs with neither CST nor MFR units, pro-          before 1983, but 27 others added such a unit between 1983
gram respondents from this region had the greatest percentage      and the spring of 1986 and 3 more had plans to add one
of comments supporting further investigation into the two          during the 1986 to 1987 academic year. Whether this trend is
concepts.                                                          an indication of "jumping on the bandwagon of fads," as one
   As with other therapeutic modalities, no consensus exists       respondent commented, or evidence of an actual long-term
regarding the basic principles of both CST and MFR. Because        increase in teaching nontraditional physical therapy remains
no truly universal definitions exist, I made no attempt to         to be determined.
define the two concepts in the cover letter or questionnaire.         A second indication that CST and MFR might be gaining
Three respondents criticized this approach, stating that a         acceptance slowly within the academic community was the
formal definition of both should have been included to vali-       response to the question "Why is CST or MFR not included
date the findings. I chose not to do so because the intent of      in your curriculum?" The reason most frequently given was
this study was not to determine each school's particular           "have no room in current curriculum" which seems to imply
philosophical approach to the concepts, but rather to deter-       that the majority of respondents desire to add a CST or MFR
mine the number and general characteristics of entry-level         unit, but that the capacity to do so is logistically difficult. The
programs having instructional units under the broad cate-          second-highest percentage of program respondents believed
gories of CST and MFR. Because of the recent increase in the       that CST and MFR are not entry-level skills, but several
number of continuing education courses on CST and MFR              respondents indicated that entry-level students should receive
and the growing controversy over the two concepts, I assumed       instruction in the two concepts in preparation for later study.
that most program directors would be familiar enough with          The respondents' comments associated with this question,
the basic principles of both treatment modalities to complete      combined with other findings about the level of program most
the questionnaire reliably. One weakness of the study was an       likely to have or add units on CST or MFR, suggest that the
inability to determine accurately the number of respondents        respondents perhaps are more accepting of this type of instruc-
who were unfamiliar with the CST and MFR concepts. Based           tion in an entry-level master's degree curriculum.
on the respondents' comments, however, this limitation did            Although one purpose of the survey was to determine the
not appear to be a problem. Only two respondents indicated         extent of respondent interest in CST and MFR instruction,
obvious misconceptions about CST and MFR techniques.               many respondents expressed an interest in research that would
Suggestions for further study include examining the preva-         substantiate the efficacy of the two techniques. This finding
lence of specific theories about the basic principles of both      was not particularly surprising when considering the relative
CST and MFR among entry-level or postgraduate education            absence of published physical therapy literature in the areas
programs and examining the amount of time devoted to               of CST and MFR. The apparent trend toward the introduction
particular content areas within each unit.                         of these concepts in entry-level curricula found in this study
   A second objective of this study was to determine the           may indicate a possible solution to the problem of lack of
approximate amount of program director or faculty interest         research into CST and MFR. Regardless of whether the
in developing or expanding a unit on CST or MFR. Although          students who receive an introduction to these concepts even-
the questionnaire was not designed specifically to assess atti-    tually go on to learn more specific CST or MFR techniques,
tudes, I asked questions about dates of initiation of units,       an awareness of these controversial concepts could increase
plans to add MFR or CST units, and reasons for noninclusion        their understanding of the current state of physical therapy
of units and tabulated the respondents' comments to deter-         and simultaneously stimulate their interest in further research.
mine the general level of interest.                                The small amount of objective research on CST and MFR
   The prevalence of a high level of interest in the concepts of   techniques to date has been conducted in the field of osteo-
CST and MFR is indicated by the large number of question-          pathy. Additional research is necessary if the value of such
naires returned and the spectrum of opinions expressed re-         techniques for physical therapy is to be determined. First, a
garding the importance of the two techniques in physical           critical review of the existing CST and MFR literature is
therapy. The respondents' opinions were strong at both ex-         needed. Second, in addition to clinical efficacy studies, edu-
tremes, emphasizing the controversial nature of the two treat-     cational-attitudinal studies that might prove useful include 1)
ment modalities. The majority of the comments, however,            a comparison between therapists' level of knowledge about
indicated an apparent open-minded interest on the part of          CST and MFR and their attitudes toward the two techniques;
respondents, even those respondents from programs that did         2) a comparison between the attitudes of students who have
not include CST or MFR units and had no immediate plans            had an introductory unit on CST, MFR, or another nontra-
to implement them.                                                 ditional concept and students who have not had such a unit;
   Concerning respondent interest in actual CST and MFR            or 3) an assessment of attitudes toward and level of use of
instruction, several findings deserve comment. Although the        CST or MFR techniques by therapists who have taken con-
percentages of entry-level programs that contained a unit on       tinuing education courses on the subjects.
CST (1%), MFR (15%), or both (15%) were small when                    The third objective of this study was to determine what
compared with the percentage of programs that included             educational materials, if any, are most needed for the devel-
neither (69%), the growth in the number of programs adding         opment or expansion of CST or MFR units. The desire for
such instructional units over the past few years seems to          substantiating research was emphasized by the fact that the
indicate increasing interest within the academic community         most frequently requested material, both by respondents from

538                                                                                                         PHYSICAL THERAPY
programs with a unit on CST or MFR and by those from                          ments about these concepts indicated a high level of respond-
programs without an instructional unit in either technique,                   ent interest. The majority of respondents did not believe that
was "a bibliography on CST or MFR." "A laboratory guide                       entry-level students should be taught the specific techniques
of introductory CST or MFR techniques" was another fre-                       of CST and MFR, but many, particularly those in the Pacific
quent response, and other respondents indicated an interest                   Coast and Middle Atlantic regions and those from entry-level
in case studies, clinical evidence, and text books. Numerous                  master's degree programs, believed that students should re-
respondents commented that faculty members with expertise                     ceive an introduction to the ideas. Further research is neces-
in CST or MFR techniques is what they need most. The                          sary to investigate and clarify the clinical value of the CST
results of this aspect of the study may be of particular interest             and MFR techniques to determine their value in entry-level
to proponents of the CST and MFR concepts.                                    physical therapy education programs.
                                                                                Acknowledgments. I thank each of the respondents for
CONCLUSION                                                                    the time spent to complete and return the survey; Sam Keg-
                                                                              erreis, MS, PT, ATC, for his instruction in both traditional
  Although this study found that only a small percentage of                   and nontraditional orthopedics; Elizabeth Domholdt, EdD,
entry-level physical therapy education programs had units on                  PT, for her advice, encouragement, and constructive critique
CST (16%) or MFR (29%), the growth in the number of such                      of this study; and Terry Malone, EdD, PT, ATC, for his
programs since 1983 and the spectrum and number of com-                       assistance in the development of the research question.

                                    Craniosacral Therapy (CST)-Myofascial Release (MFR) Questionnaire

       Q-1    What is the level of your physical therapy program? (Please circle number.)
               1 Bachelor's degree
               2 Master's degree (entry-level)
               3 Certificate (           months)
       Q-2    In what state is your school located? (Please fill in state.)
       Q-3    Which of the following are included as units in your curriculum?
               1 CST and MFR (Please answer questions Y-4 through Y-10.)
               2 CST but not MFR (Please answer questions Y-4 through Y-10 regarding CST and N-4 through N-7 regarding MFR.)
               3 MFR but not CST (Please answer questions Y-4 through Y-10 regarding MFR and N-4 through N-7 regarding CST.)
               4 Neither CST nor MFR (Please answer questions N-4 through N-7.)

Y-4   When was the unit added to your curriculum?                             N-4 Why is CST or MFR not included in your curriculum? (Please
                    (semester-year)                                               circle all that apply.)
                                                                                      1 Have no room in current curriculum
Y-5   Is the unit: (Please circle all that apply.)
         1 Included in a required course?                                             2 Have not had time to develop such a unit
         2 Included in an elective course?                                            3 Do not believe it is an entry-level skill
                                                                                      4 Believe it would duplicate the services of other professions
         3 Offered as a specific MFR or CST elective?
                                                                                      5 Do not believe it is a proven mode of evaluation and
         4 Other (Please explain on reverse.)
Y-6   How many clock hours are allotted:                                              6 Other (Please specify on reverse.)
        For lecture?            (hours)
                                                                              N-5   Are your planning to add a unit on CST or MFR within the next
        For laboratory?             (hours)
                                                                                    school year?
Y-7   At what level are students who take this unit?                                  1 Yes
        1 First-year (junior)                                                         2 No
        2 Second-year (senior)
                                                                              N-6   Which of the following would be of help to you in the develop-
        3 Certificate (            months into program)
                                                                                    ment of such a unit? (Please circle all that apply.)
Y-8   Who teaches the unit? (Circle all that apply.)                                 1 Lecture notes or slides for classroom use as an introduc-
       1 Physical therapist-faculty member                                              tion to CST or MFR
       2 Physical therapist-nonfaculty member                                        2 Laboratory guide of introductory CST or MFR techniques
       3 Osteopathic physician                                                       3 Slides or cassette tapes for audiotutorial use as an intro-
       4 Other (Please specify                                      .)                  duction to CST or MFR
Y-9   Which of the following would be of help to you in the expansion                4 Bibliography on CST or MFR
      of your unit? (Circle all that apply.)                                         5 Other (Please specify on reverse.)
         1 Lecture notes or slides for classroom use as an introduc-                 6 None of the above would be of help
           tion to CST or MFR                                                 N-7   Please write any additional comments on the reverse.
         2 Laboratory guide of introductory CST or MFR techniques
         3 Slides or cassette tapes for audiotutorial use as an intro-
           duction to CST or MFR
         4 Bibliography on CST or MFR
         5 Other (Please specify on reverse.)
         6 None of the above would be of help
Y-10 Please write any additional comments on the reverse.

Volume 68 / Number 4, April 1988                                                                                                               539
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    Press, 1983, pp5-25                                                                pathic Annals 7(6):232-241,1979
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    Co, 1951, pp 16-19                                                             16. Gillespie BR: Dental consideration of the craniosacral mechanism. Journal
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    pathic Annals, Cranial Concepts and Therapy. New York, NY, Insight             17. Harakal JH: Manipulative medicine in dentistry: A new potential for diag-
    Publishing Co, 1976, pp 20-22                                                      nosis and treatment. Journal of Craniomandibular Practice 3(1):63-68,
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    23, 45, 51                                                                     18. Magoun HI: Practical Osteopathic Procedures. Kirksville, MO, Journal
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    Paoli, PA, Pain and Stress Control Center, 1986, pp 1-45                       19. Frymann VM: The trauma of birth. In Magoun HI (ed): Osteopathic Annals,
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    ment. J Am Osteopath Assoc 78:336-347,1979                                         1976, pp 8-14
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                                                                                   20. Magoun HI: The cranial concept in general practice. In Magoun HI (ed):
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    therapy. In Cathie A (ed): Academy of Applied Osteopathy Yearbook.             21. Frymann VM: The osteopathic approach to the allergic patient. D.O.
    Newark, OH, Academy of Applied Osteopathy, 1974, pp 81-84                          10:159-164,1970
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    67:643-652, 1963                                                                   symptomatology of the newborn: Study of 1,250 infants. J Am Osteopath
10. Magoun HI: Entrapment neuropathy of the central nervous system: Part               Assoc 65:1059-1075,1976
    2. Cranial nerves l-IV, VI-VIII, XII. J Am Osteopath Assoc 67:779-787,         23. Woods RH: Structural normalization of infants and children with particular
    1963                                                                               reference to disturbances of the CNS. J Am Osteopath Assoc 72:903-
11. Magoun HI: Entrapment neuropathy of the central nervous system: Part               908,1973
    3. Cranial nerves V, IX, X, XI. J Am Osteopath Assoc 67:889-899,1963           24. Woods JM, Woods RH: A physical finding related to psychiatric disorders.
12. Magoun HI: Trauma: A neglected cause of cephalgia. J Am Osteopath                  J Am Osteopath Assoc 60:988-993,1961
    Assoc 74:400-410, 1975                                                         25. Educational programs leading to qualifications as a physical therapist. Phys
13. Magoun HI: The temporal bone: Troublemaker in the head. J Am Osteopath             Ther 65:1576-1579, 1985
    Assoc 73:825-835,1974                                                          26. World Book Encyclopedia. Chicago, IL, World Book Inc. 1983

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