At the conclusion of this chapter, the reader will be able to:
Identify the origins of strain-counterstrain (SCS).
Discuss the anatomical underpinnings believed to be responsible for protective muscle spasms and the mechanisms by which SCS may address these issues.
Define protective muscle spasm, facilitated segment, myotatic reflex arc, release phenomenon, position of comfort, and tender point.
Discuss how muscle hypertonicity/spasm may lead to tender points, postural aberrations, and restrictions in motion.
Discuss the difference between direct and indirect techniques.
Discuss how SCS differs from other soft tissue approaches to orthopaedic manual physical therapy.
The foundational origins of strain-counterstrain (SCS), or what is sometimes termed positional release therapy, have similarities to other intervention paradigms that are currently in use.1 The practice of SCS involves an appreciation of postural deviations that may result from hypertonic muscle(s). Approaches such as yoga (see Chapter 21), Feldenkrais's awareness through movement (see Chapter 20), and tai chi, among others, focus on the practice of optimizing body position for the purpose of enhancing function.1 These approaches each share the belief that optimal function flows from optimal positioning of body parts relative to one another. These positions are designed to stretch some regions while placing others in a position of relaxation.2
The concept of the tender point is not germane to SCS. Acupuncture points, which closely relate to the location of tender points used in SCS, have been used in the management of musculoskeletal pain syndromes for over 5,000 years.1 Perhaps, the most widely used exposition of the existence of such tender points comes from the work of Travell and Simons,3 who have systematically mapped the location of such tender points, along with various strategies designed to reduce their presence (see Chapter 16).
In 1954, Dr. Lawrence H. Jones was treating a patient suffering from a 4-month episode of severe low back pain who was not responding to conservative management. The patient experienced psoas spasms with a resultant analgesic posture and was having difficulty sleeping. Jones attempted to find a position that would allow the patient the ability to sleep more comfortably. Trial and error led to the discovery of a position in which the patient experienced maximal comfort, after which Jones allowed his patient to rest for 20 minutes. The patient was slowly released from this position and was able to attain an erect standing posture that was uninhibited by pain.4-7
Since that time, the art and science of this approach has culminated in the development of a myriad of remarkable techniques, some of which are presented in this chapter. Jones's initial discovery that precise positioning eliminated pain and disability has led to the persistent search for additional applications of these concepts. Jones also ...