Strain Counterstrain is a gentle indirect technique for treating the painful patient. Indirect techniques do not directly engage barriers of motion. It was developed by the osteopathic physician Lawrence Jones in 1955 who said it was a “lucky accident” that led to his discovery. While perplexed with how to help a young patient, who had suffered for 4 months of severe back pain, he tried to help the patient find a comfortable position for sleeping. He then left the patient in that contorted position while he attended to another patient. When he returned and the man slowly stood up, the debilitating pain was almost completely gone. From there Dr. Jones began investigating how to find a “position of comfort” for his other patients that quite often turned into their treatments. He found that “tenderpoints” within the muscles could help him identify the problem and categorize the solution. Tender points are small, discrete, edematous areas on the body that elicit pain when palpated by the practician. Monitoring the tender point, the practitioner positions the patient to minimized the tenderness to palpation.*
Mechanism of Treatment: The involved tissue is “slackened” causing a relaxation of the “spasm” which, in turn, allows local areas of inflammation, trapped within the painful tissue to dissipate. The tenderpoint is thought to be related to a reflex arch and by shortening the muscle, the clinician has removed the aberrant afferent(incoming sensory) signals that are part of the reflex arc that has not allowed the muscle to relax and has disturbed normal lymphatic drainage from the region. Impeded lymphatic drainage causes an acidic environment that also irritates the nervous system perpetuating the “spasm”.
A successful treatment is signified by an immediate reduction of tension and tenderness in the involved tissue. Over more than 20 years, Jones developed a powerful system of evaluation and treatment that is used throughout the world. SCS is a treatment used to combat myriad musculoskeletal conditions such as: sciatica, headaches, myofascial pain, tendinitis, and chronic back and neck pain.
This all seems logical and simple. By shortening the muscle, you decrease the nervous impulses that are entering the spinal segment. This greatly decreases the incoming messages of a protective reflex arc that is maintaining a hypertonic (“spasm”) state. Interrupt the protective reflex and tone and circulation normalize. But it isn’t quite that simple. The mechanism of treatment above stated the ‘tissue is slackened’. It is very easy to picture that as being the same as ‘muscle is shortened’. But it is more complex. One example would be the headache patient. There are Jones tenderpoints that can be treated to alleviate headaches (even some diagnosed as migraine) when there is no discrete muscle that is shortened during treatment. As with much of manual therapy, or medicine in general, the theory behind a treatment that works is often an assumption based on the current knowledge of physiology.
* Wong, CK (2012). 2011 “Strain counterstrain: current concepts and clinical evidence”. Manual Therapy 17 (1): 2–8.