Counterstrain

Counterstrain is a technique used in osteopathic medicine and osteopathy to treat somatic dysfunction. It is a system of diagnosis and treatment that considers the dysfunction to be a continuing, inappropriate strain reflex, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the reflex; this is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response.^[1] The Australian and French osteopathic practitioners use the terms: Jones technique, (correction spontaneous by position), spontaneous release by position. Counterstrain was developed by Lawrence Jones in 1955 and was originally called “Spontaneous Release by Positioning,” before being termed “strain-counterstrain.”^[2]

Technique

In this technique, the clinician identifies a point of musculoskeletal pain, called a tender point. Tender points are small, discrete, edematous areas on the body that elicit pain when palpated by the physician. Monitoring the tender point, the physician positions the patient such that the tenderness to palpation at the counterstrain point is minimized.^[3] The physician holds the patient in the maximally relaxed position for 90 seconds and then slowly returns the passive patient to a neutral body position. Success of treatment is evaluated by reassessing both the tender point and any accompanying loss of range of motion.

Physiological basis

Tender points are foci of hypertonicity resulting from inappropriate reflexive muscular contracture due to the compensation of the antagonist muscle in response to agonist muscle over-lengthening. Over-lengthening of the agonist muscle causes a reflexive contraction in the agonist muscle itself. To allow this reflexive contraction, the antagonist muscle must lengthen. This over-lengthening causes the antagonist muscle to reflexively contract as well, resulting in a maintained hyper-shortened antagonist muscle. The physician breaks the reflex cycle by positioning the patient in such a way that the hypertonic tissue is maximally relaxed. This position eliminates or minimizes stimulation leading to reflex-mediated contraction. Relaxation results in restoration of range of motion and resolution of somatic dysfunction.

Indications

• Myofascial pain syndrome
• Low back pain
• Osteopathic manipulative medicine
• Restless legs syndrome

References

1. DiGiovanna, Eileen; Stanley Schiowitz; Dennis J. Dowling (2005) [1991]. "Counterstrain (Chapter 14)". An Osteopathic Approach to Diagnosis and Treatment (Third ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 86–88.
2. "Glossary of Osteopathic Terminology" (PDF). American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 25 August 2012.
3. Wong, CK (2012). "Strain counterstrain: current concepts and clinical evidence". Manual Therapy 17 (1): 2–8. doi:10.1016/j.math.2011.10.001. PMID 22030379.

Sources

• Ward, Robert C. et al.; Foundations for Osteopathic Medicine (2nd ed.). Philadelphia: Lippincot Williams and Wilkins. ISBN 0-7817-3497-5.