Counterstrain

Coimterstrain Technique. Counterstrain techniques are used by osteopaths to treat joint dysfunction and relieve pain. These techniques place the affected joint... 

Lawrence Jones was a general practitioner in Oregon when he undertook the treatment of a patient with severe psoas spasm and, serendipitously, obtained information that led him to the development of the theories and techniques of strain/cormterstrain. He first published this information in The DO in 1960 and later in a book, Strain/Counterstrain. 

Lawrence Jones, an osteopathic family practitioner in Oregon, developed the counterstrain techmcpie. In 1955, he chanced on its discoveiy during the treatment of a patient with severe psoas spasm who had not responded to previous chiropractic or conventional osteopathic manipulation. After positioning the patient into a position of comfort, he left him on the table for a time and, when the man arose, he was pain-free. Dr. Jones spent many years perfecting the technique before introducing it to the profession. 

In his text, Strain and Counterstrain, Jones offers two definitions of the technique ... 

In counterstrain, the diagnosis is made by finding reflex "tender points." Each involved ligament, joint, or muscle has its own specific tender points, anterior or posterior, depending on the joint somatic dysfunction. The point may he in the shortened muscle or in a more distant area to which it has been referred reflexively. It is a palpable tissue texture change and comprises a tense, fibrotic area approximalely the size of a dime. It is tender to an amount of pressure that would not normally cause pain. The tender points may very well be related to trigger points (Travell points) and acupuncture points there are marked similarities in distribution. 

Counterstrain treatment is an extremely effective and non-tranmatic treatment. It is especially good for elderly or hospitalized patients, and ary others for whom gentleness is desirable. Patients who have experienced an acnte strain respond... 

Jones LH. Strain and Counterstrain. Indianapolis, IN American Academy of Osteopathy, 1981. 

Jones LH, Kusimose R, Goering E.Jones Strain-Counterstrain. 

Yates HA, Glover JC. Counterstrain Handbook of Osteopathic Technique. Tulsa, OK Y Knot Publishers, 1995. 

Counterstrain is a myofascial release technique originally described as "spontaneous release by positioning." A tender point is noted on palpation and the region or entire bo is positioned into freedoms for the pittpose of shortening mnscles. The positions ate typicahy held for 90 to 120 seconds or imtil a mobile point reaction is noted. Snbseqnent tissne softening and/or reduced tenderness ate noted. 

The treatment of tender points by the Jones counterstrain method requires that the patient be completely relaxed. The goal is to shorten the involved muscle, hold it in this shortened position for 90 seconds, and then return the patient to a neutral position. 

Once the acute inflammation has subsided, some tissue tension will still remain. Range of motion will improve but may still be limited. The patient may now be treated with appropriate osteopathic manipulative techniques to the injured area or wherever somatic dysfunction is found. Muscle energy, counterstrain, lymphatic drainage techniques, cranial, and facilitated positional release techniques may be used judiciously. Thrusting techniques should not be used until the soft tissues are no longer boggy and warm. If necessary, they may be used to correct stubborn somatic dysfunctions with firm barriers to motion. 

Alyssa was treated with gentle soft tissue techniques and muscle energy techniques at the first visit. Counterstrain was used on a tender point found at C3 on the left. The mother was shown how to gently stretch the neek into side bending to the left and was instrueted to do this several times during the day. On eaeh return visit, Alyssa showed gradual improvement. There was no evidence of contracture of any muscles, which could have led to permanent disability. 

Some of the counterstrain tenderpoints correspond to vertebral segment dysfunctions. As in other areas of the body, when counterstrain treatment is used in the thoracic spine, the positions are held for 90 seconds. The patient is returned to a neutral position slowly, without any muscle contraction on his part, and the tender point is reassessed. 

FIG. 39-2 Counterstrain technique for anterior tender points upper thoracic spine. 

FIG. 39-4 Counterstrain technique for anterior TIO tender point knees rotated to side of tender point. 

FIG. 39-7 Counterstrain technique for posterior tender point mid-thoracic spine. Tender point is to the right siight rotation is induced to the ieft. 

FIG. 39-8 Counterstrain technique for tender point of lower thoracic spine. 

She was treated with gentle myofascial, soft-tissue teehniques to the paravertebral muscles and all tender points were treated with counterstrain techniques. She was given gentle stretching and flexibility exercises. She was given instructions on care of the back, especially how and what she could lift, and how to prevent falls. She was given a prescription for alendronate. She was treated with osteopathic manipulation weekly for 3 weeks, then every 2 weeks for 2 months. The somatic dysfunctions resolved and she had less back pain. 

The counterstrain tender points of the lumbar spine are named for the dysfunctional lumbar vertebrae. Anterior tender points are treated with the patient supine and posterior tender points are treated with the patient prone. Many of the counterstrain techniques for lumbar somatic dysfunctions are facilitated by slight rotation of the patient s thighs and pelvis, and by resting some part of the patient s leg on the physician s thigh or knee. 

Clinically, there are typical findings that occur. There are some common counterstrain... 

FIG. 62-2 Counterstrain treatment for low ilium/ante-rior sacral tender point. 

FIG. 62-4 Counterstrain treatment for an inguinal ligament tender point. 

FIG. 62-7 Counterstrain treatment for a midpole sacral tender point. 

FIG. 62-8 Counterstrain treatment for a high flare-out sacroiliac tender point. 

Jones LH, Kusunose R, Goering E- Strain-Counterstrain. Bois ID Jones Strain-Counterstrain, Inc., 1995. 

Muscle strengih in external rotation and abduction is generally normal but may exhibit some decrease. The muscle and Its attachments are tender to palpation. There are three counterstrain lender points associated wiih piriformis syndrome mid-pole sacrum, piriformis muscle, and the posteromedial trochanteric point. 

Counterstrain and facilitated positional release techniques are most useful. Each of the three tender points must be treated, if they are present, to be effective. Any dysfunction of sacral motion should also be corrected. A piriformis stretching exercise should be prescribed for use at home. 

Left piriformis syndrome was diagnosed and was treated with osteopathic manipulation. The sacral shear was treated with a muscle energy technique and the tender points were treated with counterstrain. She was given a piriformis stretch to perform at home three time daily. She experienced immediate improvement after the treatment. 

She was treated with mobilization of the coccyx during the rectal examination and the lender point was treated with counterstrain. She was advised to get a "doughnut" cushion to keep weight off the coccyx when sitting. 

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