|image courtesy of openi beta|
While OMPT Training at the University of St. Augustine and going through their DPT program, I met an Australian Physiotherapist who loved a technique called Strain Counterstrain.
He was convinced it was the next big thing and even completed a doctoral dissertation on studying the technique. He shared his research with me a while back, but I have misplaced it. I find the official SCS Technique and Assessment a bit too specific, but using positional release for acute injuries like ankle sprain, and even acute MVA happens to work well. Here is a brief overview of how to positionally release a tender point and when you should consider it.
Positional Release - What is it?
- using passive painless positioning to improve increased tone and tenderness
- slacking the muscle where there are tender points located as opposed to "stretching" it
How is it done?
- find a tender point, normally with increased tone
- if there are several along a certain area or pattern of tissues, trying releasing the most tender and/or proximal one first
- palpate the tender point (with or without referral/twitch) lightly
- "If this is 100% tender, let me know when it is about 30% tender."
- "I will try to find a position of ease by moving your (insert body part here)."
- "Do not help me."
- slack the muscle according to it's action slowly and passively
- it should not hurt, nor should it case pain anywhere else
- if it works well, a decrease in palpable tone should be accomplished along with a decrease in palpable pain
- if you can find a position that makes the tenderness 30% of what it originally was - or hopefully gone altogether, continuing holding it passively for 30-90 seconds (depending on what technique you're following, I do 60 on average)
- "Do not help me on the way back. I am very slowly going to return your limb to it's resting position (neutral)."
- this has to be passive, otherwise the tone will return
- the theory is that passive will avoid previously overactive GTOs
- if active those GTOs will fire the previously abnormal signal and the tone/tenderness will return
- upon return, the pain/tone should stay improved, and overall pain free motion should be increased
- release other tender points along the agonist and the antagonist
- i.e. cervical paraspinals and SCM, scalenes
When Do I Use It?
- there is a lack of evidence apparently for even reliably detecting TrPs, that is why I am not a fan of Strain Counterstrain's exact points of tenderness - there are 8 exact cervical points anteriorly and posteriorly and some of them are often millimeters apart - what if you have fat fingertips?
- I use it when a patient comes in after an acute MVA, ankle sprain, etc... and wants more treatment than go home and rest
- in other words, someone unable to move, AFTER a trauma, or major exacerbation that now has hypersensitivity to all but light palpation and slow passive movement
- the last MVA that came in 1 day after a major acceleration/deceleration accident - cleared for instability by x-rays - had limited ROM/pain in all directions
- light touch and counterstrain to several points along her cervical paraspinals, SCM, upper traps improved her pain free ROM in all directions by at least 25%, from 0 degrees with pain in all directions
- that's not a huge improvement but got her moving a bit and significantly reduced pain
- acute ankle sprain - moved into the slacked position of the peroneal musculature, palpating for decrease in pain/tone, holding for 60 seconds, then slowly passively returning the foot/ankle to neutral
- patient coming in with a HA exacerbation and not being able to tolerate manual techniques to the occiput, cervical paraspinals, distraction etc...
- often they will have very tender points with increased tone in the upper cervical area
- releasing these by passive movement into upper cervical extension, with slight SB/rot depending on the side, often greatly decreases pain, increases ROM, then they may tolerate other techniques like the subcranial shear distraction after
It's not a technique I use often, but it does have it's uses, especially when a patient typically needs to rest after acute traumatic injury or has an exacerbation and allodynia to previously tolerated manual techniques or active exercises.
Keeping it Eclectic....