“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#
 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
 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
 Inten%on1of1Treatment:#
COUNTERSTRAIN THINKING IS DIRECTED
ESPECIALLY TO THE
NEUROMUSCULAR REFLEXES
RATHER THAN THE TISSUE STRESSES,
and requires monitoring the “Tenderpoint”
RATIONALE FOR STRAIN
COUNTERSTRAIN
Most Recently described by:
Richard Van Buskirk, DO, PhD, FAAO
-Available in FOM and Myers texts
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!#