Osteopathic Thoracic Treatment: Counterstrain Techniques

by Tyler Cymet, DO, FACOFP

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    00:00 Another soft technique that people like is called counterstrain technique.

    00:06 And what that is, is finding the points that relates to decrease in motion or decrease in the ability to use the musculoskeletal system.

    00:16 There are counterstrain points posteriorly and anteriorly.

    00:20 And they're treated a little bit differently.

    00:22 Let's talk about the posterior counterstrain points first.

    00:25 The posterior counterstrain points are gonna relate to the vertebral level, for T1, for T12.

    00:33 It could be on the spinous process or just lateral to the spinous process on the transverse process.

    00:39 A counterstrain point is in the area of softness, boggyness and the indentation in the muscle that generally elicits a sense of discomfort or dis-ease in a patient.

    00:49 So you find an area and you ask, "Is that tender?" And if it's tender they'll let you know and that's an area you want to treat.

    01:00 When you find a tender point to treat, you monitor it.

    01:05 You push in until you cause pain and I'm gonna move your neck a little bit now to try and ease some of the tenderness and pain.

    01:11 And you monitor it with your finger, feeling for the tenderness, feeling for blood flow, pulsations and you side bend, you rotate, you twist until you have a decrease in the pain.

    01:28 "Does that feel better? Yes, that feels better." At this point I'm gonna have to hold this for 90 seconds.

    01:35 After about 45 to 60 seconds, you'll start feeling some easing up, maybe some pulsations on that area.

    01:42 And then at the end of the 90 seconds, you return them and say, "How much better is that?" Typically you want 70 percent relief.

    01:50 You wanna be able to push in it and no longer have them wince, no longer have them feel the discomfort.

    01:56 And that's how you treat a tender point.

    01:58 Again, posterior tender points T1 through T12, either on the spinous processes or just lateral the spinous processes.

    02:05 Now maybe flip over? Anterior counterstrain points usually start anteriorly in the midline, in the center of the chest.

    02:19 T1 is where the first rib attaches with the sternum.

    02:23 T2, T3 and I'm just walking down the ribs.

    02:26 T4, T5, T6 and T7.

    02:31 T7 actually has 3 points.

    02:33 One is midline, one lateral on each side.

    02:37 So there are three T7 points.

    02:39 T8 is lower, T9 is just above the umbilicus, T10 below the umbilicus, T11 even lower and T12 is by the ASIS, just superior to the anterio-superior iliac spine.

    02:52 Now I'm gonna talk about treatment of the counterstrain points.

    02:56 So we've identified all 12 counterstrain points anteriorly.

    02:59 When you're treating T1 through T4, it's generally easy with little bits of motion.

    03:06 And the motion is gonna be from up top from the head, finding the area of ease.

    03:11 And once we find the tender point, find an area where the pain goes away and the tenderness goes away.

    03:17 That's T1 through T4.

    03:20 If you get to T5, 6, 7 and 8, then the patient is gonna have to move a little bit more.

    03:27 And you may want to get your knee behind it and move them up a little bit.

    03:31 You may wanna induce some side-bending and rotation.

    03:35 In order to make sure that you get the pain to be relieved and the tenderness to go away in that point.

    03:40 So I often use my knee under the back, in order to support him while I'm doing this.

    03:46 And make sure that you get a position of comfort.

    03:50 So if I feel a tender point in the abdominal area, like a T9 or T10, I'll find the tender point.

    03:59 Make sure that's the area that feels a little bit uncomfortable, correct? Can we have you bend your knees? and then I'll take the knees and bend it to relax the rectus abdominis, twist it or find the area of comfort where it tends to go away and it tends to feel more comfortable as this? Feels like the place that's gonna be the most comfortable.

    04:25 and then you'll hold it for 90 seconds or until you feel the pulsation and you feel the relaxation.

    04:31 And at the end of the 90 seconds, you reset and re-monitor and say, "Does it feel better?" So that area has been treated.

    About the Lecture

    The lecture Osteopathic Thoracic Treatment: Counterstrain Techniques by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Osteopathic Thoracic Treatment: Counterstrain Techniques

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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