Counterstrain?

[TheCOXblocker]

Does anyone else seriously feel that Dr. Lawrence Jones just made some stuff up on the spot when he developed these counterstrain techniques to treat patients? Seriously, how did this guy come up with this stuff and why is this crap even on the boards?

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[Oo Cipher oO]

I've actually had really good results with counterstrain techniques. The diagnosis and treatment makes a lot of physiological sense. There are some thing in OMT that I find pretty dubious but this isn't one of them.

I do have a really hard time remembering all the counterstrain points though.

 

[JeetKuneDo]

Does anyone else seriously feel that Dr. Lawrence Jones just made some stuff up on the spot when he developed these counterstrain techniques to treat patients? Seriously, how did this guy come up with this stuff and why is this crap even on the boards?

I feel the same as you do. It's just something we have to deal with. Just have to rough it out for two years.

 

[TheCOXblocker]

I've actually had really good results with counterstrain techniques. The diagnosis and treatment makes a lot of physiological sense. There are some thing in OMT that I find pretty dubious but this isn't one of them.

I do have a really hard time remembering all the counterstrain points though.

Please do elaborate on that. I seriously cannot understand how tx AC7 which is 3cm lateral to the medial end of the clavicle by having the pt lay supine and using the mnemonic "FSTRA" which stands for flexing the pt's neck, side bending towards the the affected point and rotating away from the affected point and keeping the pt in this position for 90 sec and then slowly, passively return them to neutral, makes any physiological sense.

 

[TheCOXblocker]

I feel the same as you do. It's just something we have to deal with. Just have to rough it out for two years.

I hear you. I honestly came in w/ an open mind about OMM but that's beginning to dwindle away for me. It's just getting harder and harder for me to drink the Kool-Aid.

 

[Dharma]

Please do elaborate on that. I seriously cannot understand how tx AC7 which is 3cm lateral to the medial end of the clavicle by having the pt lay supine and using the mnemonic "FSTRA" which stands for flexing the pt's neck, side bending towards the the affected point and rotating away from the affected point and keeping the pt in this position for 90 sec and then slowly, passively return them to neutral, makes any physiological sense.

Do you feel the tissue loosening when performing the technique? It does make sense in terms of resetting the Golgi tendon reflex which is presumed to be firing pathologically. I pretty much go into most of my OPP classes with a bit skepticism, but this one seems to be working a bit. Granted, it may only work for those few minutes following the treatment (I'm not sure) but I have most definitely noticed TART changes improve on those I work on, as well as when others work on me. And I thought it looked like complete b.s. at first as well.

 

[hallowmann]

I've had good results with counterstrain relieving pain. Jones didn't make it up, it was trial and error (which arguably implies that the point locations could be completely somewhat different on different people). That said, I not too many students in my class have real tender points, so most of the time we are just miming through it.

 

[SLC]

I have had great success with CS on rotations so far. Treated a lady who had intense pain in her rhomboids during my FM rotation (with an MD) and it worked so well it brought her to tears when she got up from the table pain free. It also got me honors on the rotation.

CS and Muscle Energy are legit, Chapman's points and Cranial on the other hand...

 

[ChrisGriffen]

I tried to stay as open minded as possible when it comes to omt, but BS stories (like the one above) that preach miracle results are what make me think its all a load of crap. Even the published studies with placebo controlled cx trials say it can take 1-3 months of treatment for counterstrain to show any sort of benefit.

I keep hearing "i once cured a patient's chronic lumbar pain with one treatment of myofascial release!"... Even the psuedoscientific research doesnt support that kind of claim, and its those kind of claims that make me think there is something funky in the kool aid you have been chugging.

 

[SLC]

I tried to stay as open minded as possible when it comes to omt, but BS stories (like the one above) that preach miracle results are what make me think its all a load of crap. Even the published studies with placebo controlled cx trials say it can take 1-3 months of treatment for counterstrain to show any sort of benefit.

I keep hearing "i once cured a patient's chronic lumbar pain with one treatment of myofascial release!"... Even the psuedoscientific research doesnt support that kind of claim, and its those kind of claims that make me think there is something funky in the kool aid you have been chugging.

Don't get it twisted, I didn't claim to "cure" anything. I just said I did some CS and the lady felt 100% better (her words not mine). I also explained to her that her pain would likely return, and I suggested some things she could do on her own.

I'm just as anti "OMM magic" as the next guy, but some of the stuff works and I'm not going to pretend like it doesn't just because that's the fashionable thing to do.

Seriously people, it seems critical reading skills are a lost art these days.

 

[HopefulOncoDoc]

Honestly, a lot of the problems I have with being at an osteopathic school are very much centered around OMT (Osteopathic Manipulative Treatment). At our school, we have OMM lab scheduled 4-5 hours a week, and we have practicals and finals on the material. It may not seem like much, but that's just ONE of many extra class that we have to take which really limits study time. All of our OMM professors are very passionate about osteopathic medicine. Often times, they talk about their own personal experiences with patients and how they were able to relieve someone who was suffering for 20 years with chronic lower back pain. The stories are always nice to hear, but there's not much scientific back up. Each professor has their own personal experiences, but not much has actually been documented and researched extensively. Many of the case reports that we have to read about in regards to the effectiveness of OMT use no more than 20 subjects at a time. Lastly, one thing that really makes me cringe is that our professors will often say things like "according to the teachings of A.T. Still we should treat "pain A" with technique B"....its times like that where the osteopathic philosophy seems more like a cult following and less like actual medicine.

 

[ChrisGriffen]

I dont discount it because its the fashionable thing to do, i discount it because it is stupid. The theory of "finding the least painful conformation and holding still" is garbage. If that treatment held any water, people would unintentionally treat themselves every time they got comfortable before falling asleep.

 

[abolt18]

I love me some counterstrain, as does my wife and anyone I've done it on. I wasn't much of a believer until I was treated for some majorly killer tenderpoints/messed up ribs.

 

[Oo Cipher oO]

I dont discount it because its the fashionable thing to do, i discount it because it is stupid. The theory of "finding the least painful conformation and holding still" is garbage. If that treatment held any water, people would unintentionally treat themselves every time they got comfortable before falling asleep.

If that's how your school teaches counterstrain as finding the least painful confirmation then I feel you have been given some poor instruction. The point is to passively shorten and loosten the surrounding tissue around the tender point for a defined period of time. This is done with great respect to anatomy and physiologic motion. Barring any underlying pathology causing the pain then this allows the tissue sending the painful nerve impulses to relax.

You know what I think is stupid? Nonspecific pain that causes millions of people to suffer day after day. The tissue has no reason to be in pain. There is no infection, damage, or inflammation that we can measure in a way. And yet people suffer. I think that's stupid. So why is it such a large jump to use the person's own stupid painful muscles positioned in such a way to cause then to shorten and relax to relieve the pain?

 

[SLC]

If that's how your school teaches counterstrain as finding the least painful confirmation then I feel you have been given some poor instruction. The point is to passively shorten and loosten the surrounding tissue around the tender point for a defined period of time. This is done with great respect to anatomy and physiologic motion.

I was going to say this same thing exactly. Well put!

 

[ChrisGriffen]

I was being overly facetious, but you can doll it up however you like, its still BS. If you want to believe that there is a concrete anatomical basis for CS then I would love to hear your explanation of maverick points. Actually I wouldn't. Enjoy your kool aid. Bye.

 

[SLC]

I was being overly facetious, but you can doll it up however you like, its still BS. If you want to believe that there is a concrete anatomical basis for CS then I would love to hear your explanation of maverick points. Actually I wouldn't. Enjoy your kool aid. Bye.

Bye now!

 

[Oo Cipher oO]

Enjoy your kool aid.

 

[hallowmann]

I gotta be honest, I not currently nor was I all about OMT when I started, and I certainly don't believe it can cure everything on everyone (I'm pretty sure we are past that type of panacea mentality). That said, I think the main issue with OMT is that there is no really effective way of knowing when it will "work" on someone to relieve their pain. I don't think our methods of knowing when to apply it are fine tuned. That said, at this point in time after witnessing some people actually benefit from it, I am not going to reject it blindly (nor am I going to accept it blindly).

Also with regards to the comment that if it were really effective then people would be treating themselves all the time, how do you know they haven't been? Before I even knew what a DO was, let alone CS, I would try to get myself into a position of comfort (as most people would). Sometimes it would work, sometimes it wouldn't. Unfortunately, sometimes it requires some help from another person to do that. It also requires being motivated enough to do it, when say you are too tired to fix your mild discomfort and would rather just sleep, because you need to wake up early for work/school/life.

People could also keep themselves healthy by eating right, or exercising, or keep their immune system up by just sleeping more regularly, yet simply because they can do those things, doesn't mean that they do do them, especially when they have other problems or responsibilities to deal with.

 

[TheCOXblocker]

I gotta be honest, I not currently nor was I all about OMT when I started, and I certainly don't believe it can cure everything on everyone (I'm pretty sure we are past that type of panacea mentality). That said, I think the main issue with OMT is that there is no really effective way of knowing when it will "work" on someone to relieve their pain. I don't think our methods of knowing when to apply it are fine tuned. That said, at this point in time after witnessing some people actually benefit from it, I am not going to reject it blindly (nor am I going to accept it blindly).

Also with regards to the comment that if it were really effective then people would be treating themselves all the time, how do you know they haven't been? Before I even knew what a DO was, let alone CS, I would try to get myself into a position of comfort (as most people would). Sometimes it would work, sometimes it wouldn't. Unfortunately, sometimes it requires some help from another person to do that. It also requires being motivated enough to do it, when say you are too tired to fix your mild discomfort and would rather just sleep, because you need to wake up early for work/school/life.

People could also keep themselves healthy by eating right, or exercising, or keep their immune system up by just sleeping more regularly, yet simply because they can do those things, doesn't mean that they do do them, especially when they have other problems or responsibilities to deal with.

Therein lies my issues w/ learning OMT. At my institution, we spend about 4 hrs/wk dedicated to OP&P. I just think it's ridiculous that we spend that much time learning OMT when there really is no effective way of learning whether or not it adequately addressed the patient's pain and symptoms. There are professors at my school that are so obsessed w/ popping ribs back in place and all this crap and I kid you not, we had one professor who stated that he had a patient once that was having a heart attack, and while he was waiting for the cardiac enzymes, he was so hell bent on popping the patients posterior rib angle back into place. It's this kind of crap that drives me nuts and like one of the above posters stated, it makes it seem more like a cult following and less like actual medicine.

 

[Petypet]

To add to the discussion, something that our school preaches is evidence based medicine. We routinely have classes that harp EBM, EBM, EBM! Where is the evidence for OMT, minus the anecdotal/visual examples. Sure it works when our prof's treat us, and it feels great too, but the profession is doing itself an injustice with the lack of research. For a methodology that consumes 1/5th of my education (omm is about 1 day a week with lectures/lab/quizes/tests/practicals), there is sure a lack of evidence.

Some of my profs have addressed this, "there's no funding, there's no way to have a placebo", yada yada yada. One thing I learned in my PhD, is if you want something bad enough, it gets done. Its just an inherent laziness by our predecessors to adopt EBM, and it is putting us in a position to just blindly accept the methodology.

 

[maddogmurphy]

Just to add, physical therapists also use counter strain. There is a good amount of overlap between the two for msk techniques and treatments, but may have a different name.

 

[Oo Cipher oO]

Therein lies my issues w/ learning OMT. At my institution, we spend about 4 hrs/wk dedicated to OP&P. I just think it's ridiculous that we spend that much time learning OMT when there really is no effective way of learning whether or not it adequately addressed the patient's pain and symptoms. There are professors at my school that are so obsessed w/ popping ribs back in place and all this crap and I kid you not, we had one professor who stated that he had a patient once that was having a heart attack, and while he was waiting for the cardiac enzymes, he was so hell bent on popping the patients posterior rib angle back into place. It's this kind of crap that drives me nuts and like one of the above posters stated, it makes it seem more like a cult following and less like actual medicine.

So now we are just ranting about OMM in general? ok...

I think we might go to the same school cause I am familiar with that story but I remember it differently. As I remember it the posterior rib angle and the TART changes in the upper posterior thoracic area tipped him off to ordering the cardiac enzymes. Even if its not why is it inappropriate to perform OMM while you wait for test results to determine your next course in therapy?

I get you don't like OMM but you did decide to go to a DO school. It's part of the curriculum and will be on the boards you have to pass to graduate. Vent as much as you want but at the end of the day you are going to need know enough to pass and then you don't ever have to do it again if you don't want to.

 

[TheCOXblocker]

So now we are just ranting about OMM in general? ok...

I think we might go to the same school cause I am familiar with that story but I remember it differently. As I remember it the posterior rib angle and the TART changes in the upper posterior thoracic area tipped him off to ordering the cardiac enzymes. Even if its not why is it inappropriate to perform OMM while you wait for test results to determine your next course in therapy?

I get you don't like OMM but you did decided to go to a DO school. It's part of the curriculum and will be on the boards you have to pass to graduate. Vent as much as you want but at the end of the day you are going to need know enough to pass and then you don't ever have to do it again if you don't want to.

Yep I'm sure we both go to the same institution. Don't get me wrong, at the end of the day you're right, I'm going to be a DO and I'm more than happy and humbled to get the opportunity to become a physician. I honestly came in with an open mind about OMM and that has just dwindled away. I started this thread ranting about counterstrain b/c I do think it's a load of hogwash. Hell the OMM department expects us to know every single cs point and the tx position for each of those in exquisite detail and I remember one of the faculty evaluating me on the practical exam had to check the manual to see if I was in the correct tx position.

Anyways, I'm not going to rant about that particular physician's use of OMT in that type of situation but all I'm going to say is that I think viscerosomatics is also a load of bull along w/ the pattern and the so called "linkage" to look for. I'm only venting b/c I do care about the success and future of this institution that we're a part of. W/ the lack of evidence and research behind OMT that hell even the AOA recognized along w/ the fact fewer and fewer DO's are choosing not to utilize OMT for obvious reasons that I'm not going to dwell on, it only makes sense to curtail the OP&P curriculum and testable content on the COMLEX. Alright I'm done, we both have a respiratory exam to prep for.

 

[NeuroLAX]

Sounds like you need some OAD and rib raising.

 

[TheCOXblocker]

Sounds like you need some OAD and rib raising.

Nahhh...actually I could use a pedal or abdominal pump right about now

 

[bajastapler]

To add to the discussion, something that our school preaches is evidence based medicine. We routinely have classes that harp EBM, EBM, EBM! Where is the evidence for OMT, minus the anecdotal/visual examples. Sure it works when our prof's treat us, and it feels great too, but the profession is doing itself an injustice with the lack of research. For a methodology that consumes 1/5th of my education (omm is about 1 day a week with lectures/lab/quizes/tests/practicals), there is sure a lack of evidence.

Some of my profs have addressed this, "there's no funding, there's no way to have a placebo", yada yada yada. One thing I learned in my PhD, is if you want something bad enough, it gets done. Its just an inherent laziness by our predecessors to adopt EBM, and it is putting us in a position to just blindly accept the methodology.

^ this is the one major thing that bugs me about OMT. Very well put 🙂