Overview of Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
The lower back, or lumbar spine, has many important jobs, including helping us move and protect our spine’s nerves. Because it’s always working and is near a lot of nerves, it can often cause low back pain. Most adults in the United States will have low back pain at some point in their lives – in fact, some experts think as many as 84%!
There’s a type of treatment for lower back pain called Osteopathic Manipulative Treatment (OMT) that’s been shown to really help reduce this pain.
There are many types of OMT, but we’re going to talk about two in particular: counterstrain (CS) and facilitated positional release (FPR). Both of these types of treatment avoid the painful area and instead focus on relieving muscle tension. In CS, the therapist finds a muscle that’s too tense and causing discomfort. They then place the muscle in a position where it’s at ease for a while, which helps relieve the tension. FPR is kind of like CS. It also involves placing the tense muscle in a neutral position, but then adds a pressing or twisting force.
When treating low back pain, it’s not only important to focus on the muscles in the lower back. It’s also crucial to look at and treat the areas around it, like the middle back, the bone at the base of the spine (the sacrum), and the pelvis. This helps alleviate current back pain but can also prevent further discomfort.
So there you go, a closer look at two treatment methods for lower back pain! The goal here is to help you understand the counterstrain and facilitated positional release techniques used in Osteopathic Manipulative Treatment.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
The spine is composed of thirty-three individual bones known as vertebrae. These vertebrae are unique in shape and are categorized into five different types: cervical, thoracic, Lumbar, sacral, and coccygeal.
The lumbar spine is the segment that consists of especially sturdy vertebrae. Between each vertebra, a disc made from a special kind of cartilage is present, providing a sort of cushion. The front surface of the bone, or the body, carries most of the load from the spinal column. As the lumbar vertebrae are located towards the tail-end of the spine, they hold a significant amount of body weight and are therefore thicker than the cervical and thoracic vertebrae.
The vertebra arch forms the rear surface of the vertebrae, simultaneously crafting an opening where the spinal cord runs throughout the spine. Several structures are attached to this arch. The arch also has two extensions, one on each side, known as transverse processes. It also has a rounded spinous process towards the center at the back and has four connecting processes that attach to the vertebrae above and below. These attachments allow for the significant mobility of the lumbar vertebrae.
Given this high mobility of the lumbar spine, individual lumbar segments can occasionally move out of alignment, causing some degree of pain due to surrounding muscle and nerves connections.
One of the key roles of the spinal vertebrae is to protect the spinal cord. Several nerves run through the spinal cord, exiting via openings between the vertebrae. In the lumbar spine, there are five nerve pairs, responsible for movement and sensation, which emerge from the spinal cord. These nerves exit below their corresponding vertebrae and provide sensation to areas surrounding the spine. Understanding where each nerve root exits and what it influences, can help medical practitioners to diagnose and treat pain issues more effectively.
In terms of treatment techniques like Counterstrain (CS) or Facilitated Positional Release (FPR), a health professional identifies an area on the body that is unusually tender, usually in a muscle, tendon, or ligament. The medical practitioner then repositions the body such that the tenderness decreases. For a CS technique, the position is held for 90 seconds, whereas, for an FPR technique, additional compression or rotation force is added for three seconds. These methods are considered effective because they help to reduce pain, rebalance muscles, and adjust the signals sent to the central nervous system.
Why do People Need Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
If you are experiencing problems in your lower back or lumbar region, a type of hands-on therapy known as Osteopathic Manipulative Treatment (OMT) might be recommended. This is usually suggested when there’s what is known as somatic dysfunction, which refers to the impaired function of your body’s framework including the spine, muscles and joints. OMT can help to improve movement and reduce pain.
There are two main types of OMT methods – direct and indirect techniques. Indirect techniques, such as Counterstrain (CS) and Facilitated Positional Release (FPR), are gentler options. These involve moving the muscle or spine to a comfortable position, making them suitable for almost all patients, including children and seniors.
For patients with acute somatic dysfunction, which is a sudden onset of symptoms usually caused by a trauma such as a car accident or fall, indirect techniques are generally preferred. These methods focus on relieving tension and easing discomfort, enabling patients to move with less pain.
When a Person Should Avoid Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
There are situations where certain treatments can’t be given to a person. These are often called “absolute contraindications”:
– If the person doesn’t have any physical conditions that can be treated or if the body is healthy in the way the treatment is targeted.
– If the person cannot or does not want to agree to the treatment.
– If there is a recent and severe break or fracture in the area where the treatment would be applied.
Similarly, there are “relative contraindications”, which means that the treatment may not be the best option but can still be considered:
– If positioning the person for the treatment would make a blood vessel or nerve condition worse.
– If the person has severe spondylosis (hardening of the spine) with local fusion (joints in the spine fused together) and cannot move at the level being treated.
– If the person has severe hip osteoporosis, a condition that weakens the hip bones and makes them fragile.
– If the person has previously dislocated their hip.
– If the person is unable to give feedback about how the treatment feels or if it’s working.
Equipment used for Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
To carry out this procedure, we’ll need two key pieces of equipment. First, we have an OMT table; this is a special table where you, the patient, can comfortably sit or lie down. Second is a stool, but this is for the doctor performing the procedure to sit on.
Who is needed to perform Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae?
The methods of CS (Cervical Spondylosis) and FPR (Functional Positional Release) involve techniques that can be carried out by a single healthcare professional. Therefore, the only person you’ll directly interact with during these processes is this practitioner, a trained medical expert skilled in these specific treatment methods.
Preparing for Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
Before starting any medical procedure, your doctor will talk with you about what it involves, including any potential risks and benefits. They will also discuss any available alternatives to the procedure. This is an important conversation and you must provide your consent before the procedure can begin.
After you understand everything and give your consent, your doctor will then conduct a full evaluation of the lower part of your back, known as the lumbar spine. This assessment will include rating your pain, visually examining your back, testing your muscle strength, and checking how much you can move your back in different directions. The results from these tests will help monitor your recovery progress after the procedure. As part of the evaluation, an osteopathic examination may also be done to check for any abnormalities in the structure or function of your spine.
How is Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae performed
Lumbar counterstrain is a technique used to relieve pain in the lower back. This is done by a medical professional who applies pressure to certain points on your back that relate to your vertebrae, or the small bones that make up your spine. The professional will then move your body in certain ways to reduce the pain coming from these points by at least 70%. You would hold this position for 90 seconds before going back to a neutral, or natural, position to see if the pain has been reduced.
There are specific techniques for different points on your back, related to your first to fifth vertebrae (L1 to L5). Here is a general description of how these techniques are performed:
If the painful point is at the front of your body (anterior tender point), you would lie on your back, and the professional would lightly press on the painful point while moving your knees and hips into a position to reduce the pain. Sometimes, they would also rotate your hips or side bend your spine to enhance the pain relief. After 90 seconds, they would then return your legs to a neutral position and check the pain level at the initial painful point.
If the pain point is at the back of your body (posterior tender point), you would start by lying face down. The professional would locate the pain point and then lift your leg on the same side as the painful point into a position that reduces your pain. After 90 seconds, they would return your leg to the neutral position and reassess the painful point.
The process is similar for different points along your lower back, but the professional might need to slightly modify the positions depending on the exact location of the pain point.
Lumbar facilitated positional release is a similar technique, which is used to decrease muscle tension in your lower back. You would also lie face down, and the professional would locate the area of muscle tension, then move your legs and apply a specific type of pressure to reduce this tension.
These techniques can be helpful in relieving lower back pain and are usually performed by trained professionals.
Possible Complications of Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae
Cranial Sacral (CS) and Fascial Release (FPR) are considered to be two of the most gentle methods used in osteopathy, a type of alternative medicine that emphasizes physical manipulation of muscle tissue and bones. It’s not uncommon for patients to experience some soreness and stiffness in the treated area, as this typically happens when the body is trying to heal a problem area.
Doctors should always inform their patients about this aspect. They should also create realistic expectations about the results of the treatment. Some patients may need to come back for more treatments, depending on their unique condition and how it responds to therapy.
What Else Should I Know About Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure – Lumbar Vertebrae?
Low back pain is a common reason why people visit their doctor. In fact, in wealthier countries, up to 70% of people may suffer from this condition. Treating back pain can sometimes be expensive as it may require diagnostic tests such as scans, high-cost procedures, medications, and physiotherapy.
Beyond causing a financial strain, lower back pain can also take a toll on a person’s mental health, leading to feelings of sadness or emotional distress. A treatment called Osteopathic Manipulative Treatment (OMT) can provide immediate care and potential relief from pain, and it can also help reduce the cost of care for people who are trying to avoid surgery or other expensive procedures.
