Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae (Osteopathic Manipulative Treatment)

Overview of Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

Many people suffer from neck pain throughout their lives due to a variety of factors, such as bad posture, poor sleep habits, or unexpected injuries. However, only a small percentage of these people opt for a specific therapy known as osteopathic manipulative treatment (OMT).

OMT is a common method used by osteopathic doctors to treat neck pain and other skeletal and muscle related pains. Strain-counterstrain (SCS), also known as positional release therapy, is one of the various techniques used in OMT. Despite being less studied, this gentle treatment has been used for over 50 years and is especially beneficial to patients who didn’t find relief through other treatments. In general, SCS is the fourth most popular OMT technique used by doctors, and it can treat not only neck pain but also many other conditions related to your muscles and skeleton.

Invented by Dr. Lawrence H. Jones in 1955, SCS is mostly used by osteopathic doctors to diagnose and carefully treat areas of your body that aren’t functioning properly. Diagnosis is done with a pain scale and by examining the feel of your tissues. Treatment involves moving affected area away from the direction that limits its movement. This technique aims to reduce pain and improve your life by improving how you function. For example, if a point in your body is tender, your doctor might try to relieve the discomfort by positioning you in a way that reduces the tenderness. They would hold this “comfort” position for about a minute and a half, then gradually bring you back to a Neutral Position.

Following are the basic steps to perform Strain-counterstrain (SCS):

1. Locate a tender point in the body.
2. Use a pain scale to measure the level of tenderness.
3. Gently move the patient into a comfortable position that notably reduces tenderness, making sure to reach at least a 70% decrease in pain with a goal of 100% pain relief.
4. Hold this position for about a minute and a half while continuing to check the patient’s tender point.
5. Gently return the patient to a neutral position.
6. Check for tenderness at the original tender point again.

Anatomy and Physiology of Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

The neck, or cervical spine, is made up of seven bones. The first one, called C1 or the ‘atlas’, is unique because it doesn’t have a pointed process or a body part like the other cervical bones. The second one, C2 or the ‘axis’, has an upward projection that connects with C1. These two bones together allow for the nodding and rotating movements of your head. The remaining cervical bones (C3 to C7) are separated by soft, cushion-like discs.

The top cervical bones (around C2 to C4) primarily allow rotation, while the lower ones (around C5 to C7) mainly enable side-bending. These bones all connect at small joints called ‘facet joints’, which help with movement and can sometimes cause pain or other problems based on their orientation.

When talking about muscle pain, we often refer to ‘tenderpoints’ (TPs), which are thought to be caused by strain or overstretching in the muscles or connective tissues. This strain is sensed by the receptors within the muscle, causing the muscle to contract and generate pain. Tenderpoints are often experienced as small, tender areas near where muscles and tendons attach to bones, and they don’t cause pain to spread to other areas. In contrast, ‘trigger points’ are found within tight bands of muscle or tendon tissue and can cause pain to radiate to other areas.

There are many tenderpoints on the body, with over 200 identified by osteopathic doctors. Interestingly, neck-related nerve pain (cervical radiculopathy) can be associated with tenderpoints on the same side as the pain. In this overview, we’ll focus on the most common cervical tenderpoints that doctors find.

Anterior Cervical (AC) TPs are located as follows:

• AC1: Near the sides of C1, at the back edge of the jawbone.
• AC2-AC6: Near the front and side tips of the corresponding cervical bones.
• AC7: At the top of the collarbone where the neck muscle (sternocleidomastoid or SCM) attaches.
• AC8: At the inner end of the collarbone where the SCM attaches to the breastbone.

Posterior Cervical (PC) Tenderpoints (TPs) are located as follows:

• PC1 midline: Around the ‘inion’ or bump on the back of the skull.
• PC1 lateral: On the skull, halfway between the inion and a bony protrusion behind the ear, called the mastoid process.
• PC2 midline: On the top part of the pointed process of the C2 bone.
• PC2 lateral: On the back of the skull, halfway between the inion and the PC1 tenderpoints on the skull.
• PC3 midline: On the lower side part of the C2 pointed process.
• PC3-PC7 lateral: On the back and side surface of the corresponding joint processes.
• PC4-PC8 midline: On the lower part of the pointed process of the vertebra present just above the corresponding cervical level.

Why do People Need Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

There are several conditions that might need treatment with procedures or therapies. These may include sudden (acute) or long-lasting (chronic) issues with the body’s mechanical system (somatic dysfunctions). Others might need treatment if they have overly tense muscles (hypertonic muscles), or if their bodily issues (somatic dysfunctions) also involve nerve complications. These treatments can be the main way to deal with the health problem, or they might be used alongside other therapies or procedures.

When a Person Should Avoid Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

Strain-counterstrain (SCS) is a type of treatment often used in osteopathy, which involves treating health problems by moving, stretching, or applying pressure on certain parts of the body. While it’s usually considered a safe option, there are still situations when it might not be appropriate. These situations, or “contraindications,” can be divided into two categories: absolute and relative.

Absolute contraindications mean the treatment should not be performed at all. This could be because the patient does not have the specific type of body tension the treatment is intended to ease (somatic dysfunction), the patient does not agree to or cannot follow the treatment, or there is a broken bone or torn ligament in the region to be treated.

Relative contraindications, on the other hand, mean that the treatment may be performed, but with caution depending on the situation. These include conditions like cervical vertebral artery disease (a condition affecting the arteries in the neck), severe osteoporosis (a bone disease that makes bones weak), rheumatic conditions like rheumatoid arthritis (conditions causing pain, swelling, and stiffness in the joints), ligamentous instability (when the ligaments, which connect bones together, are weak or unstable), severe illness, or when a patient is unable to relax their muscles voluntarily.

Equipment used for Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

If you’re going in for osteopathic manipulative treatment, the doctor will use the following items:

– An osteopathic treatment table: This is a specially constructed piece of furniture where the patient lays for their procedure.

– Stool: The doctor will often sit on a mobile stool while performing the treatment to allow for optimal control and flexibility.

Preparing for Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

Using a method known as strain-counterstrain (SCS) to diagnose conditions involves looking at the patient’s health history and observing their overall body condition. Before using this method, the doctor needs to make sure it’s safe for the patient. Once a possible issue is identified, the doctor will check the area for pain and any unusual feel to the skin or muscle tissue.

The doctor should only apply as much pressure as you would need to turn your fingernail white. If they use too much pressure, it may cause pain and the patient might incorrectly think they have found a problem area, also known as a “TP” or a “tender point”.

Here are some useful tips to keep in mind when using SCS:

• For problem areas at the front of the body, bending forward is typically required.
• For problem areas at the back of the body, bending backwards is usually needed.
• Points in the middle of the body generally need you to bend forwards or backwards.
• Points on the side of the body typically require more bending to the side and twisting.
• To find the best treatment position, it’s best to use both changes in tissue feel and tenderness.
• When the muscle or skin tissue relaxes properly, you’ll typically feel a “release” or easing of tension.

How is Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae performed

Strain-Counterstrain (SCS) is a technique used by physical therapists to treat tender points (TPs) in your body. “Anterior Cervical C1-C8 (AC1-8) TPs” and “Posterior Cervical C1-C8 (PC1-8) TPs” refers to the region in your neck where the TPs are located. Here’s a simplified version of how the therapist conducts the treatment for each region:

For Anterior TPs (front side of your neck):

1. You’ll need to lie on your back on the treatment table, with the therapist standing at the head of the table.
2. The therapist will then identify the tender point (TP), which is a specific spot that causes pain when pressure is applied.
3. To understand your level of discomfort, your therapist will ask you to rate your pain on a scale of 1 to 10, with 10 being the most painful.
4. They will then gently move your head in various directions to a position where you feel the most comfort and less pain. The goal is to reduce your pain to at least 3 out of 10 or even lesser. They will keep your head in this position for 90 seconds, without lifting their hand from the TP.

After 90 seconds, your therapist will gently move your head back to a neutral position and will then check to see if you still feel tenderness at the TP.

For Posterior TPs (back side of your neck):

1. You’ll again lie on your back and the therapist will find the TP.
2. The therapist will ask you to rate your pain, aiming to understand how much the TP hurts.
3. They will then carefully turn your head in different directions until you feel comfortable and your pain has reduced significantly.
4. The therapist will keep your head in this comfortable position for 90 seconds, all the while keeping their hand on the TP.

After 90 seconds, they will gently return your head to a normal position and check if the TP still feels tender. There are some exceptions to this technique for certain points along the midline of the neck, in this case, only flexion (bending the neck forward) may be used without the side-bending or rotation.

Possible Complications of Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae

Major problems seldom occur with a treatment method called cervical strain-counterstrain (SCS). Any issues that may occur are likely related to the position of the patient during the procedure. It is advisable to not use positions that cause discomfort, dizziness, anxiety, or nerve-made pain (such as quick turning and extending of the upper neck region). A minor aftereffect may be pain in the muscles opposing the ones being treated. However, this is usually short-lived and most patients can cope with it well.

What Else Should I Know About Osteopathic Manipulative Treatment: Counterstrain Procedure – Cervical Vertebrae?

Using a technique called cervical strain-counterstrain, which is a kind of physical therapy, can be a successful and less aggressive way to treat neck pain. It can be used alongside, or as an alternative to, other methods of treatment.