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Clinical Strain-

Counterstrain OMT
William H. Devine, D.O.
Clinical Professor
OMM Department
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 the barriers for indirect treatment
approaches.
• Compare and contrast counterstrain, myofascial
release, functional techniques and indirect balancing
techniques.
• Describe the principles of Strain-Counterstrain and to
teach basic Clinical Applications and OMT
Indirect OMM is Passive,
Relaxing and “Laid Back”

Indirect OMT rebalances tissue by calming down


mechanoreceptors in the fascia and muscle tendon receptors.
Indirect OMM Requires
Visualization of Anatomy
It Requires Continuous
Balance and Attention for
Results
Indirect Technique
• The Barrier Concept
• Position away from the restrictive barrier into the position of
free motion.
• New neutral point or center of range of motion is created.
• It rebalances mechanoreceptors and adaptations.
• Is 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.
• Is very effective in acute and painful somatic dysfunction as well
as inflammatory pathological conditions.
Fascia
• 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.
Structure of Fascia
• Elastic

• Ground Substance
• Specialized Mechanoreceptors-
Proprioceptors & nociceptors
Relationship of Fascia to Somatic
Dysfunction

(T).A.R.T.
chronic
irritant
abnormal movement
(biomechanics) macrophages activated

shrinkage of connective tissue increased vascularity

increased myofibroblastic
activity increased fibrolastic
activity
increased production of connective
tissue (fibrosis)
Goal of Indirect OMT is to rebalance somatic
dysfunction:
Indirect Myofascial Release:

• Is very gentle, with no activation of the nociceptive


pathways
• Dampens down the mechanoreceptors in the system
by reflex inhibition and mechanical relaxation of
strain patterns in the proprioceptive system
• Is one of the most valuable techniques for spasm,
pain and inflammation as it relaxes and decongests
tissue and promotes healing
It works by :
• Relaxing the strain patterns in the Peripheral Sensory
System, which reduces the proprioceptor and
nociceptor signal, assisting the removal of the
chemical mediators present, and muscle guarding
reflexes
• There is a resultant improvement in the local vascular
and interstitial circulation that helps the above and
healing
Strain Counterstrain OMT
• Is one of the most significant paradigms of OMT that
a clinician can utilize.
• It is perfect for OMT in the ED or hospital as it is safe
and therapeutic and can be diagnostic.
• Basic treatment is with an acute somatic dysfunction
and moving fascia and muscles into adaptive
positions exaggerated in patterning.
Strain-Counterstrain
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 false strain reflex; this is accomplished by use of
the specific point of tenderness related to this
dysfunction followed by specific directed positioning
to achieve the desired therapeutic response.
Laurence Jones, D.O., FAAO

Strain Counterstrain Posterior 3rd Rib


Lawrence H. Jones, D.O.,
FAAO
• 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 and others using the
Nociceptive & Proprioceptive Models
Lawrence H. Jones, D.O.,
FAAO
• The discovery of strain counterstrain was an
accident with a very observant clinician
• Ontario, Oregon-town of 15,000, with only one DO
general practitioner. No hospital staff privileges,
confined to an office practice.
• Two cases within a short time….
• Later Janet Travell, M.D. published her work on
Myofascial Pain Syndromes and he finally
collaborated with her years later in Arizona.
Counterstrain

Passive positioning away from barrier


to point of comfort- often toward the
point of original injury
Jones “Tenderpoints”
TENDER POINTS ARE
SENSORY
MANIFESTATIONS OF A
NEUROMUSCULAR
OR MUSCULOSKELETAL
DYSFUNCTION.
COUNTERSTRAIN
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 THINKING IS DIRECTED
ESPECIALLY TO THE
NEUROMUSCULAR REFLEXES
RATHER THAN THE TISSUE STRESSES,
and requires monitoring the
“Tenderpoints”
RATIONALE FOR STRAIN
COUNTERSTRAIN
WHAT MAINTAINS THE
SOMATIC DYSFUNCTION?
COUNTERSTRAIN THINKING IS
DIRECTED ESPECIALLY TO THE
NEUROMUSCULAR REFLEXES
RATHER THAN THE TISSUE STRESSES
Agonist -Antagonist muscles:
IN THE ILLUSTRATION THAT FOLLOWS
“A” IS THE ORIGINALLY STRAINED MUSCLE WHILE
“B” IS THE REFLEXLY
SHORTENED MUSCLE REGISTERING
A FALSE AND CONTINUING MESSAGE
OF STRAIN (or a VISERAL SOMATIC REFLEX
SOURCE…)
Strain
• Injury to a joint occurs
• Attempts to return to normal position are
inhibited by muscular tension (splinting)
• Muscle splinting prevents further movement
toward the barrier, but does not preclude
movement in the direction of free motion
• Both agonists and antagonists are affected.
Reciprocal Inhibition of Antagonists
Decrease the Nocioceptive
Input- by Positioning

FINDING THE POSITION


OF COMFORT
General SCS Rules:
◊ Hold position 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 rotation 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 extremities are usually on
the opposite side of the pain
◊ Warn the patient of “post treatment flair”.
◊ There is to be no pain in the position of SCS.
◊ No contraindication to SCS if rules followed
“Clinical Applications of
Counterstrain”
• A suggested textbook by Harmon
Myers, DO. Is available which utilizes 26
years of experience in counterstrain and
addresses tenderpoints on specific
muscle and anatomical structures.
• It addresses clinical conditions and
myofascial pain patterns related to the
tenderpoints for the first time.
We are all waiting for the
OMM Lab…
Arizona Sunrise with Moon Eclipse
ANY QUESTIONS?
Thank you for your kind attendance!

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