Strain and Counterstrain

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Strain-Counterstrain was developed in the 1960’s by Lawrence Jones, DO and continues to evolve. If you’ve been receiving physical therapy it may seem that you are starting to plateau with slower improvements, but Strain-Counterstrain is definitely worth looking into. What makes Strain-Counterstrain therapy so different from traditional exercise-based therapies?

Traditional therapy vs. Counterstrain.

While traditional therapies focus on muscles, tendons, bones, and ligaments, Strain-Counterstrain looks at the whole body including the lymphatic system, nerves, fascia, organs, muscles and even the arteries and veins. In the past, you may have gone to therapy, got rid of your problem, and then had it come back. Or your problem improved by 70% but did not improve completely. This can happen if your whole body was not evaluated and treated.

What makes Strain – Counterstrain so effective?

The goal of Strain-Counterstrain is to restore the clogged pump mechanism in the lymphatic system so this system can return to normal, return fascia to normal so it can stretch and move again and relieve muscle and other connective tissue tightness. We need to address multiple systems in the body. The therapist first evaluates the painful area to look for specific tender points. As with all Counterstrain, we will use passive shortening of the problem area to correct the vasospasm or tightness in the area.

Fascia

Fascia is very important and holds the body together by attaching everything to everything. It is part of the muscles, tendons, ligaments, blood vessels and even covers the nervous system. Fascia covers all organs and even attaches them to the abdominal wall and needs to be able to slide and glide with movement. If the ability of fascia to stretch is lost, it will cause pain and even have the potential for organ dysfunction. The fascia can become tight from surgeries, inflammation or just a quick movement like a car accident or fall. In other words, tight fascia can look like back, hip or shoulder pain that does not respond to traditional treatments of massage and exercise.

Circulatory system

Next, let’s take a look at the arteries or veins. They both have smooth muscle in them. If you have inflammation or have an injury with a quick jerk to your body, the smooth muscle in these blood vessels will tighten. That causes constriction (making the vessel smaller) which results in less blood flow to the area that helps healing. That tightness also makes the muscles in the area tighter causing pain and loss of strength. With a gentle glide along that vessel, the smooth muscle tightness goes away and your strength immediately returns along with immediate reduction of pain.

Nervous System

Last of all we can also release the fascia of the nervous system. If the fascia is tight around the nerves you could have shoulder impingement, carpal tunnel, trigeminal neuralgia, balance issues, muscular weakness, all types of spinal pain, nausea, digestive dysfunction, headaches, frozen shoulder and many other conditions.

Lymphatic System

We can use strain and counterstrain for the lymphatics to decrease pain, but what are lymphatics?  The human body has a built in filtration system called the lymphatic system. Arteries turn into capillaries where oxygen and nutrient rich blood bathes our tissues with life sustaining fluid.  Then the smallest veins collect most of the nutrient depleted fluid and return it to the heart to start this process over.  Ten percent of this fluid contains large protein molecules that can’t go through these small veins and must be removed by another system called the lymphatic system. The protein rich fluid collected by the lymphatic system contains dead cells, inflammation, toxins and even cancer cells. Once it’s collected (this fluid is now called lymph) it’s carried back toward the heart through one way valves in the lymph vessels. The lymph flows through lymph nodes that contain immune system cells that kill off harmful micro-organisms like viruses and bacteria contained in the lymph. The lymphatic system essentially cleans the space between the cells.  The lymphatic vessel segments (lymphangions) actually contract and push lymph fluid through valves every 6 seconds.

Lymphatic Dysfunction

Lymphatic vessels which are sensitive to inflammation can be stimulated to contract with these chemicals narrowing the diameter of the vessel and the lymphatic pump becomes less effective. This is lymphatic dysfunction when the fluid stays in the vessel and the inflammatory chemicals stay in those tissues. What are the signs of lymphatic dysfunction? You will have muscle pain and long term tendonitis or bursitis. You could also suffer from fluid accumulation conditions like inflamed sinuses, ringing in the ears and migraine headaches. People with fibromyalgia, Lyme’s disease, chronic fatigue syndrome, surgeries, injuries and car accidents typically present with a significant amount of these lymphatic tender points.

Lymphatic Counterstrain

The Counterstrain approach to lymphatic treatment is done on a lymphatic vessel wall with a diagnostic tender point.  This tender point tells us that the lymphangion is in a chronic state of contraction.  When this happens, the vessel becomes hard and causes the muscles around the area to become tight and loose strength. To treat it, we shorten the lymphatic vessel to take it out of spasm.  Once it is treated, the lymphatic pump mechanism is restored, allowing the lymphatic system to function normally and cleanse the area of chemical irritants.  After this treatment, patients report immediate relief in pain and tension in that body part.  The treatment for hip bursitis actually drains the bursa of swelling which immediately improves the hip motion and you can now lie on that side.  If you feel you have lymphatic dysfunction, you can set up an evaluation with one of our Counterstrain Physical Therapists.

Counterstrain Viscera

Research: Visceral dysfunction is highly resistant to manipulation, massage, exercise and medications. (This may be why traditional treatment does not help you.)  It can be changed with physical therapy treatment called Counterstrain.

Counterstrain Fascia

How does fascia become tight?  Fascia can be restricted from surgeries, an inflammation in your body like bronchitis or digestive issues, falls on ice or in sports and even car accidents. Fascia covers our organs and along with ligaments anchors our organs to the skeleton. Fascia can become restricted following a surgical procedure and is well documented in medical literature. Fascia can also become tight from stress in your life.  If it becomes tight you will have pain. What is also documented in medical literature and is much less likely known is that fascia is CONTRACTILE.  We know this from a great deal of research on fascia that has come out of Europe over the past ten years. [Reference: Fascia is able to contract in a smooth muscle like manner and influence musculoskeletal mechanics.  (Schleip, Klinger)]

When Fascia Contracts

Fascia contains myofibroblasts. These smooth muscle cells are in the fascia and are attached to an extensive “lattice like” network of collagen fibers that allows fascia to contract. When fascia contracts is can cause pain and restriction just like muscles do. Even more interesting is that when fascia contracts it is capable of stimulating muscle stretch receptors (muscle spindles) and this will cause long term musculoskeletal pain. In other words, the pain from the contracted fascia can look like a common case of back, hip, shoulder or neck pain that does not respond to traditional treatments like massage, traditional physical therapy, medication and exercise.

How does Physical Therapy Counterstrain work on these deep fascial structures?

We gently push the involved organ to “shorten” the anchoring fascia that hooks to the skeleton. A detailed knowledge of visceral anatomy and its anchoring system is an essential part of Visceral Counterstrain.

Visceral Counterstrain Can Impact Organ Function?

Yes it can, because the visceral fascia is innervated (fed by) the same nerves that lead to the organs themselves. Irritation of these nerves can cause minor organ complaints such as urinary urgency, chronic constipation or unknown abdominal pain, back, neck and shoulder pain. Visceral Counterstrain is only recommended for organ complaints that have first been thoroughly evaluated by your doctor.

Nerves

In treating the nerves, we are looking at the fascial dysfunction around the nerves. The nervous system is enveloped entirely in deep fascia with over 50% of every nerve made up of fascia. The fascia also covers and brain and spinal cord and is called the dural membranes.

The nervous system is arguably the most powerful and important system in the body.  If dysfunction exists in the nervous system you will have the potential for altered function in any of the body’s systems.  The nervous system controls: movement, sensation, digestion, pain perception, cognition, vascular flow, temperature sense, proprioception, strength, dexterity, vision, hearing and even our emotional responses to stimuli.

How do you treat a nerve that has a dysfunction?

We slacken the nerve by gliding on it. By slackening the fascia around the nerve, that will drain out the inflammation and swelling and therefore decrease the tightness in the nerve. If nerves are tight you are going to have pain.

Some symptoms of nerve dysfunction: Tight muscles, sciatica, tendonitis in the elbow, shoulder or knee; carpal tunnel, digestive dysfunction, nausea, coccyx pain, frozen shoulder, anxiety, PTSD, complex regional pain syndrome, weakness, loss of balance, headaches, depression (by working on vagus nerve), burning, tingling, neck, head/face, arm, leg and back pain.

Dural/Cranial Strain and Counterstrain

One of the many benefits of the Strain and Counterstrain (SCS) approach is that the technique can be used to treat dysfunction which occurs in different tissues and systems of the body. This includes what is called the craniosacral system.

Understanding the Craniosacral System

The human skull or cranial vault consists of multiple cranial bones lined by a continuous connective tissue membrane called the dura mater or dural membrane. In essence, the bones of the skull can be seen functionally as hard areas inside a continuous connective tissue membrane that encompasses and protects the brain.

The dural membrane also called the ‘dural tube,’ descends through the foramen magnum (opening at the base of the skull), attaches to the first 3 cervical (neck) vertebrae and anchors to the bottom of the spine (sacrum.)  Inside the dural tube, is a substance called cerebral spinal fluid which is a serum like fluid that circulates through the cavity of the spinal cord functioning as a shock absorber. This physiologic system which includes: cerebrospinal fluid, cranial connective tissues, cranial bones, sutures, and vessels is collectively called the craniosacral system.

Musculoskeletal Pain Caused by Chronic Contraction

The dura mater itself is made predominantly of collagen and elastic fibers that are embedded in extracellular ground substance, in other words, the dura mater is made of “fascia.” In fact, the dural membrane is the body’s deepest layer of fascia.

This is an important fact because, as discussed in other parts of the website, we now know that fascia is a contractile tissue that can go into a state of chronic contraction sufficient to cause musculoskeletal pain and dysfunction. [Reference: Fascia is able to contract in a smooth muscle like manner and influence musculoskeletal mechanics (Schleip and Klinger).

Significance of Cranial Tender Points

The existence of a cranial tender point indicates that the dura mater, epicranial fascia, temporoparietal fascia or one of the superficial muscles of the cranium (frontalis, temporalis or occipitalis) is in a state of chronic dysfunction. Stated simply, the fascia of the cranium can tighten chronically causing both a diagnostic tender point and a wide variety of medical conditions.

These conditions include: tension headaches, sinus problems, generalized nerve sensitivity (Allodynia), TMJ dysfunction, chronic back / neck pain, facial pain, migraine headaches etc. The allopathic medical community calls pain or scalp tenderness originating from the fascia of the cranium “nummular” or “ponytail headaches.”

Alleviating Tender Points with Cranial SCS

Traditional Craniosacral Therapy which is focused on correcting a perceived cranial “pulse” or “rhythm” inside the craniosacral system, is quite controversial due to poor inter-examiner reliability and a lack of scientific evidence to support the proposed mechanism.

Cranial SCS, however, uses objective tender points associated with the muscular and fascial tissues of the cranium in order to diagnose dysfunction. The proposed mechanism of cranial SCS is simply the well accepted and documented existence of myofascial pain syndrome. [References: Signs and symptoms of the MPS: A national survey of Pain management Providers. Harden SP Bruehl, Journal of Pain 2000; Myofascial Pain. Joanne Borg-Stein, David Simmons Archives of Physical Medicine and Rehab. See Research Articles.]

Cranial Strain and Counterstrain

Cranial tender points once identified, are alleviated utilizing the simple concepts of positional release as is the case with all SCS treatments. The only difference between traditional SCS and cranial SCS is that with cranial tender points, the myofascial tissues (muscular and connective tissues) of the cranium are manipulated versus the myofascial tissues of the spine or extremities.

Can this treatment help anxiety?

With inflammation cortisol and epinephrine are released and a person cannot calm down. By treating the nerve, it will lessen anxiety.

Can it help digestion?

You treat the dysfunctional nerve that sends a message to that organ.

Can it improve strength?

You can treat the cranial nerves and dural membranes (deep fascia) and have an immediate increase in strength of the arms, legs or back by decreasing the tightness in the nerve.

Can it improve sleep?

If the sympathetic and parasympathetic nervous systems are both ramped up at the same time, you will have difficulty getting to sleep at night.

What can receiving a Counterstrain treatment do for you?

After receiving a Counterstrain treatment, patients typically report an immediate pain reduction. In the past, you may have had therapy where your pain went away but it eventually can back. That’s why it is so important for us to look at the whole body and not just the sore area. By treating the whole body, you have a better chance of the pain going away and staying away!

Special Thanks and Recognition to Becky Clark for permission to use