Mériaux François, Stubbe Laurent, Guyon Alice
Animal Osteopath, 33 Rue Colonel Bougault, 38100 Grenoble, France.
ESO-Paris Recherche, Ecole Supérieure d'Ostéopathie-Paris, F-77420 Champs Sur Marne, France.
Healthcare (Basel). 2024 Dec 11;12(24):2503. doi: 10.3390/healthcare12242503.
Cranial Rhythmic Impulse (CRI) or Primary Respiratory Mechanism (PRM), movement felt on the scalp or the rest of the body, respectively, is a fundamental concept used by osteopaths in their practice for their diagnosis and treatment. However, the physiological basis of this phenomenon remains unclear. Sutherland, the founder of cranial osteopathy, proposed in 1939 that PRM was due to the movement of the cranial bones pulled by the meninges, themselves pushed by the fluctuation of cerebrospinal fluid and the motility of the central nervous system. Since then, Sutherland's theory has become dogma, despite scientific progress refuting it, and few osteopaths have attempted to find better explanations.
This systematic review of Medline, Science Direct and the Cochrane Library indexed electronic databases explores current knowledge of the physiological mechanisms underlying the Primary Respiratory Movement (PRM) or Cranial Rhythmic Impulse (CRI).
We entered the following identified keywords: "osteopathy in the cranial field"; "cranial rhythmic impulse"; and "primary respiratory mechanism". We identified 193 studies, evaluated 115, and identified 28 articles that fulfilled our criteria. We classified the studies in terms of methodological rigor, types of studies and tools used. No study had three good-level items, and only five studies had two good-level items corresponding to the type of study and tools used. The protocol of the review has been registered on PROSPERO-CRD42023488497.
Out of the 28 articles, 20 referenced at least one of Sutherland's hypotheses, often quoting the model to critique or challenge it, while 25 of them refer to other hypotheses and/or mechanisms underlying PRM/CRI: 11 concern vasomotion in blood vessels (7) and lymphatic vessels (6), 20 THM waves, 14 heart rate variability, 9 ventilation rate, 2 the extra-cellular matrix and 1 oxidative metabolism.
Although Sutherland's theory remains prevalent in general beliefs, in scientific literature, THM waves driven by autonomous system activity have gained prominence, emerging as the leading hypothesis. The results from this systematic review confirm the need for a paradigm shift for the CRI/PRM in osteopathy, and for more rigorous evaluation and communication on a model in step with evolving scientific data.
颅骨节律性冲动（CRI）或初级呼吸机制（PRM），分别指在头皮或身体其他部位感觉到的运动，是整骨疗法医生在其诊断和治疗实践中使用的一个基本概念。然而，这一现象的生理基础仍不清楚。颅骨整骨疗法的创始人萨瑟兰在1939年提出，PRM是由于颅骨被脑膜牵拉而产生的运动，而脑膜又受到脑脊液波动和中枢神经系统运动性的推动。从那时起，尽管科学进展对其进行了反驳，但萨瑟兰的理论已成为教条，很少有整骨疗法医生试图寻找更好的解释。
本对Medline、Science Direct和Cochrane图书馆索引的电子数据库进行的系统综述探讨了初级呼吸运动（PRM）或颅骨节律性冲动（CRI）背后生理机制的当前知识。
我们输入了以下确定的关键词：“颅骨领域的整骨疗法”；“颅骨节律性冲动”；以及“初级呼吸机制”。我们识别出193项研究，评估了115项，并确定了28篇符合我们标准的文章。我们根据方法的严谨性、研究类型和使用的工具对研究进行了分类。没有一项研究有三个良好水平的项目，只有五项研究有两个与研究类型和使用的工具相对应的良好水平的项目。该综述方案已在PROSPERO-CRD42023488497上注册。
在这28篇文章中，20篇至少引用了萨瑟兰的一个假设，经常引用该模型进行批评或挑战，而其中25篇提到了PRM/CRI背后的其他假设和/或机制：11项涉及血管（7项）和淋巴管（6项）中的血管运动，20项涉及THM波，14项涉及心率变异性，9项涉及通气率，2项涉及细胞外基质，1项涉及氧化代谢。
尽管萨瑟兰的理论在一般观念中仍然普遍存在，但在科学文献中，由自主系统活动驱动的THM波已变得突出，成为主要假设。这项系统综述的结果证实，整骨疗法中CRI/PRM需要进行范式转变，需要对与不断发展的科学数据同步的模型进行更严格的评估和交流。
