“90 second” clinical ! strain- counterstrain
TRANSCRIPT
“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!#