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The concept of adaptive radiation, an expanding branching proliferation of variations upon variations, is not limited to organic evolution. We see it in cultural evolution as well, such as the history of human languages. Unfortunately we also see it in the proliferation of dubious medical interventions, especially those unmoored to a rigorous dedication to science and evidence. This makes our job challenging, because new versions of questionable treatments are constantly being created.

For example, I was recently asked by a regular reader here about Structural Energetic Therapy (SET), which they could not find on the SBM website. The thing is – all the basic components of SET have been covered extensively on SBM, but this is just a new branding of old ideas, adding its own new “twist” (a pun you will appreciate shortly). Here is how SET practitioners describe it:

Structural Energetic Therapy is the only therapy that releases the spiral twist, found in everyone, into a weight-bearing support, which then relieves the stresses on joints, spine, and discs that lead to pain and body dysfunction. This is achieved using unique cranial/structural techniques and myofascial protocols, found nowhere else, to release patterns that maintain painful conditions in the body. By further integrating energetic healing techniques, we are able to release stresses and emotional blockages to alleviate sources of pain.

You don’t have to read between the lines too much to see what they are basically talking about. Reading further, it’s clear that they are incorporating some version of craniosacral therapy (which they call “cranial osteopathic mobilization”). We have covered craniosacral therapy here before. Multiple times. It is not a legitimate medical science. The short version is – the cranial bones are fused completely by the time we are adults, and there is no way to subtly manipulate them. Further, there is no valid evidence that the brain has it’s own rhythm of pulsations.

But I can imagine that an SET proponent would argue that what they do is different, citing some irrelevant distinction. This is like arguing about sun sign astrology vs stellar astrology – it doesn’t matter, they are both astrology.

They also integrate “energetic healing techniques”, and elsewhere specifically mention acupressure. We have similarly covered energy medicine before, both in general terms and specific manifestations. Again, short answer – there is no human energy field, life energy, vital force, innate intelligence, chi, or whatever. This was always a prescientific idea (a placeholder) that we slowly discarded as we figured our how biology actually works. Modern attempts to demonstrate its existence, let alone any alleged benefits from manipulating the non-existence force, have essentially failed.

Likewise, we have covered acupuncture exhaustively on SBM. There is no reason to believe that acupoints even exist – and if they don’t exist, then acupuncture and acupressure are not real.

So already SET proponents are building their claims on a house of cards – craniosacral therapy, energy medicine, acupoints. They appear to be building these claims around a core of massage therapy, and in fact the person who initial asked me about SET was referred to one while looking for massage therapy.

Massage itself is a legitimate practice. It can relax muscles, may help with muscle soreness, and appears to have positive emotional effects. I have no problem with someone getting a professional massage, if they enjoy it and/or find that it helps helps with their muscle symptoms. However, “message therapy” can incorporate a large number of dubious claims not supported by good science. The role of “trigger points” is questionable. There is no evidence that deep tissue massage releases toxins.

Myofacial release, the idea that you can loosen tight myofacia through specific massage techniques, is thoroughly in the gray area of science. It’s like meditation, in my opinion. There are plausible versions of what it is, but the research has not clearly separated it from just massage. Does myofacial release work better than just massage? This is similar to asking – does meditation work better than just relaxing? Here is a typical systematic review, this one for chronic low back pain:

The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.

This is a source (both the researchers and journal) that I would consider friendly to such therapies. The results are typical – mixed results with the subjective outcomes improved but not many of the more concrete outcomes. And the overall conclusion is that the quality of the science is very low. The core problem, as I see it, is that controls are never adequate. Just as meditation is poorly defined operationally, and rarely adequately controls for things like just relaxation time, studies of myofacial release usually don’t adequately control for the non-specific effects of just hands-on therapy, and the known effects of muscle massage.

SET therapy takes all this and adds the concept of the “spiral twist”. This is the notion that almost everyone’s body is just a little off kilter, a tad askew, and could benefit from being properly aligned. They give a long list of ailments that can benefit from untwisting the body, which they say is not the full list – whatever bothers you, give us a call.

It includes things like frozen shoulder, which is a specific physical condition. Frozen shoulder is adhesive capsulitis, caused by fibrous tissue forming in the shoulder joint. The treatment is physical therapy, slowly breaking down the adhesions over months and restoring range of motion. It is not caused by any body misalignments, and cannot be relieved by massage. So what are SET therapists doing? I don’t know – either they are doing nothing helpful, or they are doing standard physical therapy plus their added layers of dubious interventions which likely do nothing, or they tell their clients to get standard physical therapy for frozen shoulder which SET will help work better. But you cannot cure frozen shoulder with anything like SET.

There is a good rule of thumb in SBM – if an intervention is claimed to treat everything, it probably treats nothing. Their list includes migraines, herniated discs, and nerve entrapments. These are diverse entities with multiple causes, which brings up another SBM rule of thumb – the old saying that if your only tool is a hammer, then every problem looks like a nail.

A search on PubMed turned up no studies supporting any benefits for SET, or the existence of the spiral twist. General searches online also did not turn up any scientific studies. The SET website has their own library of articles – all commentary or case studies (i.e. anecdotal). If there were any well-designed scientific studies (positive ones, anyway) I imagine they would be listed there.  SET seems to be unmoored to scientific evidence, which is consistent with the claim that it can treat a long list of problems and that anyone can benefit. Good for marketing – not for science-based practice.


  • Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking – also called The Skeptics Guide to the Universe.

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