A Proposal for the Use of Craniosacral Therapy in Firefighter Cadets to Decrease Cortisol Levels and Improve Postural Stability—A Randomized Trial

Background: Stress is a physiological response to the mental, emotional, or physical challenges that people encounter. Reactions to stress are also associated with increased secretion of numerous hormones including; glucocorticoids, e.g., cortisol, catecholamines. Methods: The research aimed to check whether craniosacral osteopathic therapy performed over a period of five weeks would affect the values of cortisol level and postural stability amongst sixty firefighter cadets (aged 18–24; 21.63 $\pm$ 1.41), involved in rescue operations at traffic accidents (the firefighter cadets underwent qualified paramedic training). The participants were divided into two groups: craniosacral therapy experimental group (30 people) and a control group (27 people). Results: The obtained results show that craniosacral therapy can lead to lower levels of cortisol p $<$ 0.001. It is difficult to state unequivocally that craniosacral osteopathic therapy influenced the values of postural stability; it was noted for the ellipse area in the group subjected to craniosacral therapy for the lower limbs with eyes open p-value = 0.0002. Conclusions: Craniosacral therapy may have a beneficial effect in reducing high cortisol levels.

cortisol; postural stability; firefighter cadets; craniosacral therapy

[1] Kim JI, Oh S, Park H, Min B, Kim JH. The prevalence and clini-cal impairment of subthreshold PTSD using DSM-5 criteria in a national sample of Korean firefighters. Depression and Anxiety. 2020; 37: 375–385.

[2] Lebeaut A, Tran JK, Vujanovic AA. Posttraumatic stress, al-cohol use severity, an alcohol use motives among firefighters: The role of anxiety sensitivity. Addictive Behaviors. 2020; 106: 106353.

[3] Teoh KRH, Lima E, Vasconcelos A, Nascimento E, Cox T. Trauma and work factors as predictors of firefighters’ psychi-atric distress. Occupational Medicine. 2019; 69: 598–603.

[4] Herman JP, McKlveen JM, Ghosal S, Kopp B, Wulsin A, Makinson R, et al. Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Comprehensive Physiology. 2016; 6: 603–621.

[5] Myers B, McKlveen JM, Herman JP. Glucocorticoid actions on synapses, circuits, and behavior: Implications for the energetics of stress. Frontiers in Neuroendocrinology. 2014; 35: 180–196.

[6] Della Valle R, Mohammadmirzaei N, Knox D. Single prolonged stress alters neural activation in the periaqueductal gray and midline thalamic nuclei during emotional learning and memory. Learning and Memory. 2019; 26: 403–411.

[7] Ouanes S, Popp J. High Cortisol and the Risk of Dementia and Alzheimer’s Disease: A Review of the Literature. Frontiers in Aging Neuroscience. 2019; 11: 43.

[8] Wellman CL, Moench KM. Preclinical studies of stress, extinc-tion, and prefrontal cortex: intriguing leads and pressing ques-tions. Psychopharmacology. 2019; 236: 59–72.

[9] Cherian K, Schatzberg AF, Keller J. HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clin-ical symptomatology, and cognition. Schizophrenia Research. 2019; 213: 72–79.

[10] Hong W, Zhang Q. Biological Rhythms Advance in Depres-sive Disorder. Advances in Experimental Medicine and Biology. 2019; 1180: 117–133.

[11] Mayer SE, Lopez-Duran NL, Sen S, Abelson JL. Chronic stress, hair cortisol and depression: a prospective and longitudinal study of medical internship. Psychoneuroendocrinology. 2018; 92: 57–65.

[12] Qin DD, Rizak J, Feng XL, Yang SC, Lü LB, Pan L, et al. Pro-longed secretion of cortisol as a possible mechanism underly-ing stress and depressive behavior. Scientific Reports. 2016; 6: 30187.

[13] Baeza-Velasco C, Genty C, Jaussent I, Benramdane M, Courtet P, Olié E. Study protocol of a multicenter randomized controlled trial of mindfulness-based intervention versus relaxation to re-duce emotional exhaustion in medical students in France: the “must prevent” study. BMC Psychiatry. 2020; 20: 115.

[14] Denkova E, Zanesco AP, Rogers SL, Jha AP. Is resilience train-able? An initial study comparing mindfulness and relaxation training in firefighters. Psychiatry Research. 2020; 285: 112794.

[15] Kejonen P, Kauranen K, Vanharanta H. The relationship be-tween anthropometric factors and body-balancing movements in postural balance. Archives of Physical Medicine and Rehabili-tation. 2003; 84: 17–22.

[16] Błaszczyk JW, Lowe DL, Hansen PD. Age-related differences in performance of stereotype arm movements: movement and posturę interaction. Acta Neurobiologiae Experimentalis. 1997; 57: 49–57.

[17] Pata RW, Lord K, Lamb J. The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. Journal of Bodywork and Movement Therapies. 2014; 18: 361–367.

[18] Sobhy AM, Asmaa AA. Effect of core stability exercise on pos-tural stability in children with down syndrome. International Journal of Medical Research and Health Sciences. 2018; 5: 213–222.

[19] Brown ML. Integrative Approaches to Stress, Anxiety, and Re-silience. Pediatric Annals. 2019; 48: e226–e230.

[20] Stub T, Kiil MA, Lie B, Kristoffersen AE, Weiss T, Hervik JB, et al. Combining psychotherapy with craniosacral therapy for se-vere traumatized patients: a qualitative study from an outpatient clinic in Norway. Complementary Therapies in Medicine. 2020; 49: 102320.

[21] Cabanas-Valdés R, Toro-Coll MD, Cruz-Sicilia S, García-Rueda L, Rodríguez-Rubio PR, Calvo-Sanz J. The Immediate Effect of Informational Manual Therapy for Improving Quiet Standing and Bodily Pain in University Population. International Journal of Environmental Research and Public Health. 2021; 18: 4940.

[22] Deodato M, Guolo F, Monticco A, Fornari M, Manganotti P, Granato A. Osteopathic Manipulative Therapy in Patients with Chronic Tension-Type Headache: A Pilot Study. Journal of Os-teopathic Medicine. 2019; 119: 682–687.

[23] Fornari M, Carnevali L, Sgoifo A. Single Osteopathic Manip-ulative Therapy Session Dampens Acute Autonomic and Neu-roendocrine Responses to Mental Stress in Healthy Male Partic-ipants. Journal of the American Osteopathic Association. 2017; 117: 559–567.

[24] Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Cran-iosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2019; 21: 1.

[25] Wójcik M, Dziembowska I, Izdebski P, Żekanowska E. Pilot randomized single-blind clinical trial, craniosacral therapy vs control on physiological reaction to math task in male athletes. International Journal of Osteopathic Medicine. 2019; 32: 7–12.

[26] Dixon L, Fotinos K, Sherifi E, Lokuge S, Fine A, Furtado M, et al. Effect of Osteopathic Manipulative Therapy on Generalised Anxiety Disorder. Journal of the American Osteopathic Associ-ation. 2020; 120: 133–143.

[27] Hamidovic A, Karapetyan K, Serdarević F, Choi SH, Eisenlohr-Moul TA, Pinna G. Higher Circulating Cortisol in the Follicu-lar vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis. Frontiers in Endocrinology. 2020; 11: 311.

[28] Liem T. Cranial Osteopathy. Eastland Press: Oxford, England. 2009.

[29] Liem, T. Praxis de Kraniosakralen Osteopathie. Thieme: Stuttgart, Deutschland. 2019. (In German)

[30] R Development Core Team. A language and environment for sta-tistical computing. R Foundation for Statistical Computing. Vi-enna. Austria. 2020. Available at: http://www.r-project.org (Ac-cessed: 20 September 2021).

[31] Mardia KV, Kent JT, Bibby JM. Multivariate Analysis. Aca-demic Press: London, England. 1979.

[32] Jäkel A, von Hauenschild P. A systematic review to evaluate the clinical benefits of craniosacral therapy. Complementary Ther-apies in Medicine. 2012; 20: 456–465.

[33] King HH. Craniosacral Therapy Shown Beneficial in Manage-ment of Chronic Neck Pain. Journal of Osteopathic Medicine. 2016; 116: 486–487.

[34] King HH. Manual Craniosacral Therapy May Reduce Symp-toms of Migraine Headache. Journal of the American Osteo-pathic Association. 2017; 117: 59.

[35] Matarán-Peñarrocha GA, Castro-Sánchez AM, García GC, Moreno-Lorenzo C, Carreño TP, Zafra MDO. Influence of Cran-iosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia. Evidence-Based Complementary and Alternative Medicine. 2011; 2011: 178769.

[36] Edwards DJ, Toutt C. An evaluation of osteopathic treatment on psychological outcomes with patients suffering from chronic pain: a prospective observational cohort study collected through a health and well-being academy. Health Psychology Open. 2018; 5: 2055102918774684.

[37] Girsberger W, Bänziger U, Lingg G, Lothaller H, Endler P. Heart rate variability and the influence of craniosacral therapy on au-tonomous nervous system regulation in persons with subjec-tive discomforts: a pilot study. Journal of Integrative Medicine. 2014; 12: 156–161.

[38] Lee DY, Kim E, Choi MH. Technical and clinical aspects of cor-tisol as a biochemical marker of chronic stress. BMB Reports. 2015; 48: 209–216.

[39] Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ash-wagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine. 2019; 98: e17186.

[40] Antonelli M, Barbieri G, Donelli D. Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. International Journal of Biometeorology. 2019; 63: 1117–1134.

[41] Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. International Journal of Neuro-science. 2005; 115: 1397–1413.

[42] Linnemann A, Ditzen B, Strahler J, Doerr JM, Nater UM. Music listening as a means of stress reduction in daily life. Psychoneu-roendocrinology. 2015; 60: 82–90.

[43] Linnemann A, Wenzel M, Grammes J, Kubiak T, Nater UM. Music Listening and Stress in Daily Life—a Matter of Timing. International Journal of Behavioral Medicine. 2018; 25: 223–230.

[44] Akbari M, Karimi H, Farahini H, Faghihzadeh S. Balance prob-lems after unilateral lateral ankle sprains. Journal of Rehabilita-tion Research and Development. 2006; 43: 819–824.

[45] Błaszczyk JW, Michalski A. Ageing and postural stability. Stud-ies in Physical Culture and Tourism. 2006; 13: 11–14.

[46] Peterka RJ. Sensory integration for human balance control. Handbook of Clinical Neurology. 2018; 169: 27–42.

[47] Cooper N, Cant I, White MD, Meyer GF. Perceptual assessment of environmental stability modulates postural sway. PLoS ONE. 2018; 13: e0206218.

[48] Tuthill JC, Azim E. Proprioception. Current Biology. 2018; 28: R194–R203.

[49] Bennett PJ, Patterson C, Wearing S, Baglioni T. Development and validation of a questionnaire designed to measure foot-health status. Journal of the American Podiatric Medical Asso-ciation. 1998; 88: 419–428.

[50] Feldman AG. The Relationship between Postural and Move-ment Stability. Advances in Experimental Medicine and Biol-ogy. 2016; 957: 105–120.

[51] Herrington L, Hatcher J, Hatcher A, McNicholas M. A com-parison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. The Knee. 2009; 16: 149–152.

[52] Koshino Y, Samukawa M, Chida S, Okada S, Tanaka H, Watan-abe K, et al. Postural Stability and Muscle Activation Onset dur-ing Double- to Single-Leg Stance Transition in Flat-Footed In-dividuals. Journal of Sports Science and Medicine. 2020; 19: 662–669.