“90 second” clinical ! strain- counterstrain
TRANSCRIPT
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“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
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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.
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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.
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It#is#not#how#you#say#it,#it#is#how#fast#you#arrive#at#it…#
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…And#how#you#can#diagnose#and#treat#rapidly9#Using#History#and#Myofascial#Pain#Pa>erns#
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A#few#considera*ons#first#are#needed#for#rapid#diagnosis#and#treatment:#
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If#you#don’t#diagnose#and#treat#rapidly#and#accurately#you#do#not#pay#off#your#
school#loans#
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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.#
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Myofascial#Pain#Pa>erns#Speed#the#diagnosis#and#treatment:#
• Headache:#
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THINGS#AREN�T#ALWAYS#WHAT#THEY#SEEM#WITH#PAIN1
##THERE#ARE#CHEST1PAINS1AND#�CHEST#PAINS�##
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CHEST#AND#SHOULDER#MF#PAIN#
PECTORALIS MINOR
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CHEST#AND#SHOULDER#MF#PAIN#
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CHEST#AND#SHOULDER#MF#PAIN#
PECTORALIS MAJOR –MID FIBERS
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Low#Back#Pain#MFP#Pa>erns9#others#to#follow#with#OMT#lab#
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Low#Back#Pain#MFP#Pa>erns9#others#to#follow#with#OMT#lab#
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Indirect#Techniques#–Especially*SCS9#Require#a#History##
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Indirect OMM is Passive, Relaxing and “Calming”
Indirect OMT rebalances tissue by calming down mechanoreceptors in the fascia and muscle tendon receptors.
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Indirect#OMM#Requires#VisualizaLon#of#Anatomy#
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It#Requires#ConLnuous#Balance#and#A>enLon#for#Results#
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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.
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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.
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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.#
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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"
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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.#
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Laurence#Jones,#D.O.,#FAAO#
Strain Counterstrain Posterior 3rd Rib
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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
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Counterstrain#
Passive positioning away from barrier to point of comfort- often toward the point of original injury
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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
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Inten%on1of1Treatment:#
COUNTERSTRAIN THINKING IS DIRECTED ESPECIALLY TO THE
NEUROMUSCULAR REFLEXES RATHER THAN THE TISSUE STRESSES,
and requires monitoring the “Tenderpoint”
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Most Recently described by: Richard Van Buskirk, DO, PhD, FAAO
-Available in FOM and Myers texts
RATIONALE FOR STRAIN COUNTERSTRAIN
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Decrease#the#NociocepLve#Input9#by#PosiLoning#and#Rebalancing#PropriocepLve#Reflex#AcLvity#
“FINDING THE POSITION
OF COMFORT” or
“Make crooked “crookeder””
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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.#
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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#
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“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.##
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We are all waiting for the OMM Lab…
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Chest#and#Shoulder#CondiLons#
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Headache#and#Other#CondiLons#
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Thoracic#and#Low#Back#CondiLons#
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Hip#and#Lower#Extremity#
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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#
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! 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.#
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ANY#QUESTIONS?#
Thank#you#for#your#kind#a>endance!#
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