Strain Counterstrain

Having worked in outpatient clinic, I have learned the use of strain counterstrain–the passive positional release in treatment for LBP, ankle sprains, fibromyalgia, osteoarthritis, any myofascial pain, and other contitions.

In order to better understand the technique and make it a common practice amongst therapist who are interested here is a little information I gathered from my experience and through texts, to make a better understanding behind the use of this technique. For many years, the scientific principles behind this type of work were not understood. Irwin Korr’s work on muscle spindles and facilitated segments, written in the 70s, provides a theoretically grounding for this concept. The short version of the theory goes something like this: The counterstrain point is on the opposite side of a strained or suddenly stretched joint. This is the overshortened side – suddenly shortened and then rapidly returned toward normal length. The shortening quiets the proprioceptive activity from the muscle spindles. The gamma gain is instantly set to accommodate this shortened position. On the strained side, the muscle spindles are called into play to protect the rapidly lengthening muscle from damage, creating an immediate reflex contraction. On the overshortened side, this is experienced as a sudden lengthening following the shortening. This muscle then reports itself as being strained, even before it reaches its neutral length.

This muscle is now stuck in a functionally short position, but reports to the nervous system that it is strained. This nociceptive reflex can last forever, not just the six to eight weeks during which the original strain heals.  Any sudden, unguarded motion (not just a severe strain) can cause formation of a counterstrain point. (Incidentally, the classic chiropractic adjustment – a high-velocity thrust – rapidly stretches the joint. Usually, this is therapeutic, but occasionally a patient reports that he or she hurts more after the adjustment. We must be aware not to worry about a treatment reaction that lasts 12-36 hours, but if the post adjustment pain is ongoing, something is wrong. Perhaps one iatrogenically created a counterstrain point via the rapid stretch. Even though the joint may feel even more fixated, a repeat adjustment will not solve this problem. The answer here may well be counterstrain, to one side or the other of the affected area. The truth is, a therapist does not really create true tissue pathology or tear anything with the initial adjustment; however a noxious neuromuscular reflex is created at times by the therapist. It is therefore our responsibility to know that this is a possibility, and to know how to correct it or to whom to refer the patient for further treatment. The tender points in counterstrain are not the lesion or subluxation itself. They are a sensory manifestation of the dysfunction; a referred pain zone; an indicator. Counterstrain does not actually treat these points, but uses them as indicators. Keep your hand lightly on the tender point once you find the position of ease, just to monitor. This is somewhat counterintuitive. As a novice therapist using this technique many of us have made the error of continuing to press on the tender point. These tender points, “Jones points” or counterstrain points, are qualitatively different from trigger points. Travell trigger points will tend to refer to another location, to which counterstrain points do not refer. Travell points feel like a band or a fibrotic “glump.” Jones points are small and discreet; can feel thick and dense; and the tender point often is found in a hole. Travell trigger points are tender to the touch, whereas Jones trigger points are exquisitely tender, and may make the patient almost jump off the table.

Clinical Application

How does a PT use counterstrain? One way is “fullblast,” making this your primary technique; another way is to use this method when all of your other tools fail or don’t completely resolve the problem; a third way is to use the Jones tender points as a map. The map gives you a way to keep score: It is a record of tender points that indicate some kind of neuromuscular dysfunction. Use your usual tools, and return to see if these tender points have resolved spontaneously. If some of the tender points remain, it may indicate that you are not resolving the whole of the problem and need to look deeper, using

counterstrain or other methods to resolve the reflex dysfunction.

Strain Counterstrain technique to release piriformis muscle:

 We use the counterstrain via a slacking or “fold-and hold” Method in order to shorten the piriformis in order to release it. One can use this when the usual trigger-point work and adjustments are not resolving a sacroiliac problem, and the piriformis tightness continues to recur. Have the prone patient move near the edge of the table, as you sit on a stool. Find the tender point somewhere in the belly of the piriformis, and monitor this with moderate pressure. Take the patient’s leg into approximately 90 degrees of flexion, and about 30 degrees of abduction. Support the bent leg on your thigh. Remember, you are asking the patient for a percentage feedback on the degree of diminishing of the tenderness. You are also feeling for a softening of the dense hard point. Fine-tune the position with flexion and abduction. You can also add internal/external rotation via moving the tibia. Hold for 90 seconds, then slowly, passively return the patient’s leg to neutral. Recheck the point; it should be nearly pain-free and soft. The patient also can use this as a rest-and-relief position if the piriformis tender point continues to recur. The more tools you have in your toolbox, the better you can help your patients. Sometimes, you just need to look at a problem with completely new eyes – a “beginner’s mind.” Counterstrain, with its focus on the opposite side of the original strain, its indirect methodology, and its tender points, is a completely different type of technique from what one may have learned. Counterstrain is designed to correct traumatically induced aberrant reflex changes that can cause subluxations or keep them recurring.

References

1. Jones Strain-CounterStrain course, Randall Kusunose, Medford, Oregon, March 2003

2. Lawrence Jones, Randall Kusunose, Edward Goering. Jones Strain-CounterStrain. 1995,

Jones Institute.

3. D’Ambrogio and Roth. Positional Release Therapy: Assessment and Treatment ofMusculoskeletal Dysfunction, Mosby, 1996.