“90 Second” Clinical !Strain- Counterstrain

William H. Devine, D.O. Clinical Professor OMM Department

OPTI Program Director OPP Program Director, DME NMM OMM Residency

Midwestern University Arizona College of Osteopathic Medicine

Objectives •  Describe Strain Counterstrain OMT and describe its

relationship to somatic dysfunction and mechanoreceptors, fascia and neuromuscular reflexes.

•  Discuss methods for rapid diagnosis and treatment using Strain Counterstrain OMT

•  Compare and contrast counterstrain, myofascial release, functional techniques, facilitated release and indirect balancing techniques.

•  Describe the principles of Strain-Counterstrain and to Clinical Applications for rapid location of points and selection of treatment sites.

This presentation is with the generous permission and assistance of Author, Harmon Myers, D.O. and his new textbook: “Clinical Approach to Counterstrain”. We are grateful for his kind contributions and permission. Dr. Myers and I are both very grateful to Laurence Jones, D.O., FAAO, the originator of the medical contribution of “Strain Counterstrain Osteopathic Manipulative Treatment” to the world.

It#is#not#how#you#say#it,#it#is#how#fast#you#arrive#at#it…#

…And#how#you#can#diagnose#and#treat#rapidly9#Using#History#and#Myofascial#Pain#Pa>erns#

A#few#considera*ons#first#are#needed#for#rapid#diagnosis#and#treatment:#

If#you#don’t#diagnose#and#treat#rapidly#and#accurately#you#do#not#pay#off#your#

school#loans#

There#are#so#many#counterstrain#points,#how#do#you#find#and#treat?#•  ####By#listening#to#the#history#carefully:#

•  “What#makes#is#worse?”#•  “What#makes#it#be>er?”#By#Watching#the#paLent#describe#the#Pain#Pa>erns#and#observing#the#paLent’s#hands#and#other#cues#such#as#gait,#body#posiLon,#geMng#into#and#off#the#chair.#

Myofascial#Pain#Pa>erns#Speed#the#diagnosis#and#treatment:#

•  Headache:#

THINGS#AREN�T#ALWAYS#WHAT#THEY#SEEM#WITH#PAIN1

##THERE#ARE#CHEST1PAINS1AND#�CHEST#PAINS�##

CHEST#AND#SHOULDER#MF#PAIN#

PECTORALIS MINOR

CHEST#AND#SHOULDER#MF#PAIN#

CHEST#AND#SHOULDER#MF#PAIN#

PECTORALIS MAJOR –MID FIBERS

Low#Back#Pain#MFP#Pa>erns9#others#to#follow#with#OMT#lab#

Low#Back#Pain#MFP#Pa>erns9#others#to#follow#with#OMT#lab#

Indirect#Techniques#–Especially*SCS9#Require#a#History##

Indirect OMM is Passive, Relaxing and “Calming”

Indirect OMT rebalances tissue by calming down mechanoreceptors in the fascia and muscle tendon receptors.

Indirect#OMM#Requires#VisualizaLon#of#Anatomy#

It#Requires#ConLnuous#Balance#and#A>enLon#for#Results#

Indirect Techniques •  The Barrier Concept

•  Position away from the restrictive barrier into the position of free motion, ease and comfort.

•  New neutral point or center of range of motion is created. •  Rebalances mechanoreceptors and adaptations at

electrical, chemical and mechanical (strain) levels •  Are accomplished by diagnosing a maladapted pattern, and

interactively moving fascia reducing strain patterns, and reducing mechanoreceptor protective reflexes by positioning to a position of balance or ease.

•  Are very effective and safe in Acute and painful somatic dysfunction as well as inflammatory pathological conditions. But work as and adjunct to Chronic conditions.

Fascia Considerations

•  Definition •  Dense regular connective tissue arranged in

layers; ubiquitous and should be viewed in 3-D. •  All the connective tissue of the body that has a

supportive function, including ligaments, tendons, dural membranes and the linings of body cavities.

Indirect#Myofascial#Release:#•  Is#very#gentle,#with#no#acLvaLon#of#the#NocicepLve#Pathways#

•  Dampens#down#the#mechanoreceptors#in#the#system#by#reflex#inhibiLon#and#mechanical#relaxaLon#of#strain#pa>erns#in#the#propriocepLve#system#

•  Is#one#of#the#most#valuable#techniques#for#spasm,#pain#and#inflammaLon#as#it#relaxes#and#decongests#Lssue#and#promotes#healing.#

It#works#by#:#

•  Relaxing#the#strain#pa>erns#in#the#Peripheral#Sensory#System,#which#reduces#the#proprioceptor#and#nociceptor#signal,#assisLng#the#removal#of#the#chemical#mediators#present,#and#muscle#guarding#reflexes#

•  There#is#a#resultant#improvement#in#the#local#vascular#and#intersLLal#circulaLon#that#helps#the#above#and#healing#

X-ray"

Strain#Counterstrain#OMT##•  Is#one#of#the#most#significant#paradigms#of#OMT#that#a#clinician#can#uLlize.#

•  According#to#one#European#source,#is#now#the#4th#most#common#type#of#manual#treatment#used#in#the#world.#

•  It#is#perfect#for#OMT#in#the#ED#or#hospital#as#it#is#safe#and#therapeuLc#and#can#be#diagnosLc.#

•  Basic#treatment#is#with#acute#somaLc#dysfuncLon#and#by#moving#joint#mechanoreceptors,#fascia,#tendons,#ligaments#and#muscles#into#adapLve#posiLons#exaggerated#in#pa>erning.#

Laurence#Jones,#D.O.,#FAAO#

Strain Counterstrain Posterior 3rd Rib

Lawrence H. Jones, D.O., FAAO •  Took 19 years to create Strain

Counterstrain OMT. •  1955 started the work after discovery. •  Korr’s work separately explained how it

worked utilizing the muscle spindle. •  Now is being explained by Drs. Frank

Willard, Edward Goering, Richard Van Buskirk, Kuchera, Fossum and others using the Nociceptive & Proprioceptive Models

Counterstrain#

Passive positioning away from barrier to point of comfort- often toward the point of original injury

A PASSIVE POSITIONAL PROCEDURE THAT PLACES THE BODY IN A POSITION OF

GREATEST COMFORT, THEREBY RELIEVING PAIN BY REDUCTION AND ARREST OF

INAPPROPRIATE PROPRIOCEPTOR ACTIVITY THAT MAINTAINS SOMATIC DYSFUNCTION

COUNTERSTRAIN

Inten%on1of1Treatment:#

COUNTERSTRAIN THINKING IS DIRECTED ESPECIALLY TO THE

NEUROMUSCULAR REFLEXES RATHER THAN THE TISSUE STRESSES,

and requires monitoring the “Tenderpoint”

Most Recently described by: Richard Van Buskirk, DO, PhD, FAAO

-Available in FOM and Myers texts

RATIONALE FOR STRAIN COUNTERSTRAIN

Decrease#the#NociocepLve#Input9#by#PosiLoning#and#Rebalancing#PropriocepLve#Reflex#AcLvity#

“FINDING THE POSITION

OF COMFORT” or

“Make crooked “crookeder””

General#SCS#Rules:#

•  Hold#posiLon#of#ease#90#seconds#or#more.#•  Return#to#neutral#slowly.#•  Anterior#Points#are#usually#treated#in#flexion#•  Posterior#Points#are#usually#treated#in#extension.#•  Midline#Tenderpoints#are#treated#with#more#extension#of#flexion.#

•  Tenderpoints#lateral#to#midline#are#treated#more#with#rotaLon#and#sidebending.#

General#Rules:#

•  Treat#the#most#tender#in#a#region#first.#•  If#points#are#in#a#row,#treat#the#one#in#the#middle#first.#

•  Tenderpoints#in#the#extremiLes#are#usually#on#the#opposite#side#of#the#pain#

•  Warn#the#paLent#of#“post#treatment#flair”.#•  There#is#to#be#no#pain#in#the#posiLon#of#SCS.#•  No#contraindicaLon#to#SCS#if#rules#followed#

“Clinical Applications of Counterstrain”

•  A#reference#textbook#by#Harmon#Myers,#DO.#Is#available#which#uLlizes#26#years#of#experience#in#counterstrain#and#addresses#tenderpoints#on#specific##muscle#and#anatomical#structures.##

•  It#addresses#clinical#condiLons#and#myofascial#pain#pa>erns#related#to#the#tenderpoints#for#the#first#Lme.##

We are all waiting for the OMM Lab…

Chest#and#Shoulder#CondiLons#

Headache#and#Other#CondiLons#

Thoracic#and#Low#Back#CondiLons#

Hip#and#Lower#Extremity#

Suggested#Readings:#

!  Founda2ons*of*Osteopathic*Medicine,#3rd#Ed.,#Chilla,#Chapters#on#Counterstrain#and#Indirect#ManipulaLon,##

!  Clinical*Applica2ons*of*Counterstrain,*Myers,#H.;#Devine,#W.;#TOMF#Publishing,#2012.#IntroducLon,#Physiology,#Principles#and#DefiniLons#

! References:#! We#once#again#wish#to#thank#Dr.#Harmon#L.#Myers#for#excerpts#from#Clinical*Applica2ons*of*Counterstrain,*Compendium#EdiLon.#2012,#TOMF#Publisher.#

Author:#Harmon#L.#Myers,#D.O.,##ContribuLng#Author/#Editor:#William#H.#Devine,#D.O.#

ANY#QUESTIONS?#

Thank#you#for#your#kind#a>endance!#