Strain Counterstrain Technique Research Articles

Trigger point dry needling versus strain-counterstrain technique for upper trapezius myofascial trigger points: a randomised controlled trial.

Treatment of active myofascial trigger points includes both invasive and non-invasive techniques. To compare the effects of upper trapezius trigger point dry needling (DN) and strain-counterstrain (SCS) techniques versus sham SCS. Randomised controlled trial. 34 study subjects with active trigger points were randomly assigned to one of three treatment groups, and received either three sessions of DN (n=12), six sessions of SCS (n=10), or sham SCS (n=12) over a 3-week period. Subjective pain response and subjects' own ratings of perceived disability were measured. The analysis of variance mixed model showed a significant time effect for pain (p<0.001), elicited pain (p<0.001), pain pressure threshold (p<0.01), and neck disability index (p=0.016). Pain at rest decreased in all groups, as follows: DN 18.5 mm (95% CI 4.3 to 32.7 mm); SCS 28.3 mm (95% CI 12.4 to 44.1 mm); sham SCS 21.9 mm (95% CI 3.5 to 40.1 mm). Reductions in disability score (points) were significant in the SCS group (5.5, 95% CI 1.6 to 9.4) but not in the DN (1.4, 95% CI -4.9 to 2.1) or sham SCS (1.8, 95% CI -6.4 to 2.7) groups. There was no significant group×time interaction effect for any variables studied. There were no differences between the sham SCS, SCS, and DN groups in any of the outcome measures. DN relieved pain after fewer sessions than SCS and sham SCS, and thus may be a more efficient technique. Future studies should include a larger sample size. NCT01290653.

A randomized double-blinded study of effectiveness of strain counter-strain technique and muscle energy technique in reducing pain and disability in subjects with mechanical low back pain

Aims: To determine the efficacy of strain counterstrain (SCS) technique and muscle energy technique (MET) in limiting pain and disability among individuals with mechanical low back pain. To identify an effective treatment for earlier recovery from mechanical back pain to prevent further aggravation of the condition. Settings and Design: Randomized double-blinded study design in which 90 subjects were recruited using simple random sampling from 180 community dwelling mechanical low back pain subjects. Forty-five subjects randomized into each groups. Mean age of Groups A and B subjects were 37 and 40 years, respectively. Double blinded baseline and post interventional assessment was performed. Intervention includes moist hot pack for both groups, with group A receiving SCS and group B receiving MET. Outcome measures were visual analog scale (VAS), Modified Oswestry Disability Index, and lumbar flexion range of motion (ROM) using modified Schober's test. Statistical Analysis and Results: Data was coded and entered using EPI INFO version 3.5.1 and exported to Statistical Package for Social Sciences (SPSS) version 16. Statistical evidences suggest that Group B (MET) showed significant prognostic changes with all outcomes (P <0.0001) at 3 months. But, Group A (SCS) showed significant changes only with Schober's test and no trends favoring treatment were found with VAS and Modified Oswestry Disability Index. Conclusion: Hot moist pack with MET was effective in alleviating mechanical low back pain in terms of pain, increases in lumbar ROM, and reduces disability.

Effectiveness of Strain Counterstrain Technique on Quadratus Lumborum Trigger Point in Low Back Pain

Quadratus lumborum (QL) myofascial trigger points (MTrP) are well documented in low back pain (LBP) patients. There is a Growing body of evidence suggesting that Strain counterstrain technique (SCS) is an effective treatment for the pain associated with MTrP. Literature is sparse regarding the effectiveness of SCS on MTrP in QL in LBP subjects. We studied the immediate effects of SCS on pain intensity & functional outcome in subjects having LBP with MTrP in QL. 40 subjects were randomly allocated into two groups. The Control group (CG) received moist heat, & the Experimental group (EG) received moist heat & SCS technique. Outcome measures were Visual Analogue Scale (VAS) & Patient Specific Functional Scale (PSFS).Pain scores(VAS) Showed Statistically significant differences within the groups (P<0.0001), while clinically significant improvement was seen only in EG with mean difference (3.75) , 95% confidence interval (4.17,3.04), PSFS also showed significant improvement in EG.

Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: A systematic review with meta-analysis

Strain counterstrain (SCS) is an indirect osteopathic manipulative technique that uses passive positioning to relieve tender point (TP) palpation pain and associated dysfunction. The purposes of this systematic review with meta-analysis were to 1) determine the pooled effect of SCS on TP palpation pain compared to a control condition and 2) assess the quality of the overall evidence. A search conducted using the MEDLINE with AMED, PUBMED, CINAHL, and SCOPUS databases for publications from January 2002 and April 2012 yielded 29 articles for eligibility screening. Included studies were limited to randomized control trials comparing TP palpation pain after isolated SCS treatment compared to control conditions assessed with a visual analog scale. Other study designs or manipulative treatments were excluded. Two reviewers adhered to a predetermined study protocol following current Cochrane Collaboration recommendations to independently extract the data with standardized extraction forms and assess studies for methodological quality and determine risks of bias. Five randomized control trials were included for qualitative and quantitative analysis. The pooled effect of SCS was a reduction of TP palpation pain (p<0.001, 95% CI -0.291 to -0.825). The overall evidence quality was low: while all studies met at least 8 of 12 methodological quality criteria, most were low quality. This systematic review and meta-analysis found low quality evidence suggesting that SCS may reduce TP palpation pain. Future studies with larger samples of better quality studies with patient populations that assess long-term pain, impairment, and dysfunction outcomes could enrich the literature.

COMPARISON OF TWO MANUAL THERAPY TECHNIQUES ON PAIN AND FUNCTION IN SUBJECTS WITH NECK PAIN

Introduction: Neck pain is of the common musculoskeletal disorders. Physical maltreatment may have caused disability and socioeconomic repercussions. However, manual therapy techniques are less costly, with least side effects in treatment of neck pain, but there is a lack of evidence about the efficacy of these methods or a comparison of treatment to suggest the best technique. Materials and Methods: Thirty subjects with neck pain, aged 18-35 years old, were participated in this study. All individuals were randomly classified into two groups. One group received massage therapy and the other strain-counter strain technique. Participants had three therapy sessions every other day. Pain was accessed via pain numerical rating scale (PNRS) and neck disability index (NDI) questionnaire was used to measure the level of functional disability just before and immediately after each technique. Paired and sample t-tests were used to analyze the data. Results: There was a significant improvement in pain intensity and disability level after massage therapy (PNRS = 0.001, NDI = 0) and strain counter-strain (PNRS = 0, NDI = 0.03). Nevertheless no significant differences were found just after intervention in NDI between both groups (P > 0.05). Differences in NRS between both intervention groups were statistically found (P < 0.05). Conclusion: Both massage and Strain-Counter strain alleviate pain and improved function in patients with neck pain, although massage therapy was more effective in these patients. Keywords: Neck pain, Massage, Strain-Counter strain technique, Functional disability

Sham Manual Medicine Protocol for Cervical Strain-Counterstrain Research

To describe the development of a sham manual medicine protocol. An academic physical medicine and rehabilitation clinic. Twenty-six persons with cervical tender points were included in the pilot study. Exclusion criteria entailed cervical disk herniations or diskitis, cancer, current incarceration, or any condition that prevented small-range passive neck movements. Subjects were also excluded if, in the past 3 months, they had received cervical or thoracic spine surgery, osteopathic manipulation, or workers' compensation benefits. The subjects were sequentially assigned to receive either sham or strain-counterstrain treatment. The subjects filled out pre- and posttreatment questionnaires. Fifteen subjects were in the sham group, and 11 were in the treatment group. Outcome measures included subject tolerance of manual medicine, change in pain level, and ability to accurately determine receipt of strain-counterstrain or sham technique. Statistical significance was set at P < .05. There were no adverse effects of the sham or treatment protocols. There was no statistically significant change in pain as a result of the sham manual medicine protocol (P = .222) in contrast to the strain-counterstrain group, which did have decreased pain (P = .014). The subjects were unable to determine whether they had received sham or strain-counterstrain technique (P = .850). The sham protocol developed for this study was well tolerated. The small study size and design limitations do not yet allow the sham protocol developed in this pilot study to be definitively validated as a manual medicine tool, but there are early indications that it may be useful. Larger studies that validate this sham protocol by addressing inter- and intra-rater reliability are needed, followed by studies that evaluate strain-counterstrain as a treatment modality.

Efficacy of Muscle Energy Technique in Combination with Strain-counterstrain Technique on Deactivation of Trigger Point Pain

Objective: To establish the best possible long term effective choice of treatment program for deactivating MTrP's by using the combination of muscle energy technique with strain-counterstrain technique Design: Pretest-Posttest control group design Setting: Outpatient physiotherapy department, Taneja Hospital, Preet Vihar New Delhi. Patients: Fourty five subjects (only male) with Myofascial Trigger Points Pain. Subjects were randomly placed into three groups: Experimental group A (n=15), Experimental group B (n=15) and a Control group C (n=15). Intervention: The experimental group A received muscle energy technique in combination with straincounterstrain technique and experimental group B received muscle energy technique alone whereas control group received conventional treatment only. Main Outcome Measures: Pain pressure threshold was assessed with the pressure threshold meter (PTM). Pain and functional status of the patients were measured by a visual analogue scale (VAS) and the Neck Disability Index scores respectively. Results: Within group analysis revealed significant improvement in pain pressure threshold, functional status and reduction in pain intensity in all groups. Between group analysis revealed significant difference between group A, group B and group C. Further post hoc analysis revealed significant difference between group A and B, group A and C and group B and C for all variables even after one week of follow up after the termination of intervention. Conclusion: The combination of muscle energy technique with strain-counterstrain has been shown to produce greater improvement in pain pressure threshold on pressure threshold meter, function status on neck disability index scores and reduction in pain intensity on visual analogue scores even after one week of the termination of intervention. This shows the long term effectiveness of combination of two manual techniques deactivating the myofascial trigger point's pain.

An Interactive Educational Exchange: Sharing Innovative Teaching Materials and Methods (429): Online Interprofessional Training on Spiritual and Cultural Aspects of Palliative Care

drug-drug interactions and may provide immediate relief. Most osteopathic techniques require significant specialized education and supervised practice over time to achievemastery. However, a few techniques are easy to reproduceby anon-osteopathic practitioner, occasionally even by the patient themself. Myofascial release, soft tissue stretching and strain-counterstrain techniques specifically are easy to learn and reproduce inmany different areas of HPM practice (home to inpatient settings). Since learning these techniques does require practice, this presentation will encourage the attendee to participate in supervised use of the techniques in small groups with a partner. This symposium will serve as an introduction to simple OMT techniques that can be reproduced by both novices and skilled learners.

The effect of strain counterstrain (SCS) on forearm strength compared to sham positioning

Objective Determine the effect of strain counterstrain (SCS) techniques on forearm pronation and supination muscle strength compared to passive sham positioning. Design Randomized, blinded, sham-controlled study. Subjects 12 healthy right-handed subjects (4 men, 8 women) with 19 included forearms (6 right, 13 left). Each forearm was individually and randomly assigned to the SCS or control group (9 SCS, 10 control). Methods Subjects attended 3 sessions within 3 weeks. Initial forearm pronation and supination strength was assessed at the first session. Forearm muscle strength was assessed in a stable seated position using a hydraulic dynamometer with doorknob-shaped handle. Pre- and post-treatment strength was assessed during the second session, with the SCS group receiving 1 SCS treatment to the pronator and supinator muscles and the control group receiving passive sham positioning between assessments. The third session consisted of a 1-week follow-up forearm strength. Results At baseline, the SCS and control groups were comparable with respect to age, gender, height, weight, hand dominance, and initial pronator and supinator strength ( p > 0.05). After treatment, control group strength remained unchanged ( p > 0.05) while the SCS group increased pronation strength by 8.3% ( p = 0.009) and supination strength by 11.9% ( p = 0.046) from pre-treatment to follow-up 1 week later. SCS group strength increased more compared to the control group for pronation ( p = 0.045) and supination ( p = 0.059). Conclusions Forearm strength increased after SCS in a healthy population with muscle tenderness, with greater strength increase apparent than after passive sham positioning.

Massage therapy decreases frequency and intensity of symptoms related to temporomandibular joint syndrome in one case study

Objective This study investigated the ability of massage therapy to mitigate the frequency and intensity of headaches, jaw clicking and masticatory pain associated with temporomandibular joint syndrome (TMJ). Methods The subject reported 3 years of masticatory pain, clicking, teeth grinding, reduced jaw opening and headaches prior to the study. A log was kept documenting frequency, intensity and type of pain. Pre- and post-treatment jaw opening was recorded. Western massage techniques combined with strain–counterstrain techniques targeted the upper torso, cervical region and oral cavity twice weekly for 30min each over 3 weeks. Results TMJ-related pain decreased and maximal jaw opening increased by almost a third. Jaw clicking decreased fourfold to once monthly. Teeth grinding was unchanged. Conclusion The results suggest that western massage and strain–counterstrain techniques can improve jaw range of motion, alleviate the intensity and reduce the frequency of TMJ-related pain without surgical or pharmacological intervention. This study investigated the ability of massage therapy to mitigate the frequency and intensity of headaches, jaw clicking and masticatory pain associated with temporomandibular joint syndrome (TMJ). The subject reported 3 years of masticatory pain, clicking, teeth grinding, reduced jaw opening and headaches prior to the study. A log was kept documenting frequency, intensity and type of pain. Pre- and post-treatment jaw opening was recorded. Western massage techniques combined with strain–counterstrain techniques targeted the upper torso, cervical region and oral cavity twice weekly for 30min each over 3 weeks. TMJ-related pain decreased and maximal jaw opening increased by almost a third. Jaw clicking decreased fourfold to once monthly. Teeth grinding was unchanged. The results suggest that western massage and strain–counterstrain techniques can improve jaw range of motion, alleviate the intensity and reduce the frequency of TMJ-related pain without surgical or pharmacological intervention.

Reliability, Validity and Effectiveness of Strain Counterstrain Techniques

This study examined the reliability and validity of a tender-point palpation scale (TPPS) and the effect of Strain Counterstrain (SCS) on painful tender-points (TP). The experimental design employed a convenience sample of 49 volunteers with bilateral hip TPs, randomly assigned to three groups each receiving SCS, Exercise (EX), or SCS and EX. Pain before and after intervention was assessed with the TPPS and visual analog scale (VAS). Pre-intervention reliability of the TPPS was poor for the hip abductors (kappa = .327) and adductors (kappa = .228). TPPS concurrent validity as compared to VAS was weak (Spearman r=.233 to .709). Even weaker reliability and validity estimates can be assumed for a sample not limited to those with TPs, such as a general clinical population. Interventions were performed twice over two weeks. By study end, all groups demonstrated significant pain decreases in both muscle groups demonstrated with the VAS and TTPS (Wilcoxon: SCS and SCS+EX p<.001; EX p<.01). The SCS groups tended toward greater pain reductions than the EX group for hip abductors and adductors (Kruskal Wallis: VAS p<.05 and p=.06; TPPS p=.09 and p<.001 respectively). However, low TPPS reliability and validity preclude any conclusions based on this assessment method.

Counterstrain and traditional osteopathic examination of the cervical spine compared

This study addresses five questions: what is the inter-examiner reliability of diagnostic tests used in strain-counterstrain (S-CS) technique; how does this compare with the reliability of the traditional osteopathic examination (‘TART’ exam); how reliable are different aspects of the TART exam; do positive findings of Jones's points correlate with positive findings of spine dysfunction; are osteopathic students more reliable with S-CS diagnosis or TART tests? Two blinded examiners examined S-CS ‘Jones's points’ located in the upper cervical region in 18 subjects—either symptomatic patients with chronic neck pain or non-symptomatic control subjects. TART tests studied here included palpation for restriction of motion (ROM), local tissue texture changes (TTC) and joint capsule tenderness (JT). Reliability was computed using per cent agreement and Cohen's kappa ratio (κ). The results show that S-CS diagnosis is more reliable than traditional (TART) tests when evaluating symptomatic patients. S-CS produced 72.7% agreement (κ = 0.45) between examiners, whereas TART scored 67.5% (κ = 0.38). But S-CS is less reliable than TART when evaluating non-symptomatic patients. Among the three TART tests, JT was the most reliable (76.9%, 0.529), followed by TTC (70.4%, 0.190) and ROM (66.7%, 0.344). At individual vertebral levels, agreement was greatest at C 0-C 1 (75.9%, 0.49) and poorest at C 2−C 3 (63.9%, 0.24). Few of the Jones's points correlated well with the cervical articulations which they ostensibly represent. Second-year osteopathic students performed much better at S-CS diagnosis (64.2%, 0.20) than TART diagnosis (56.2%, 0.12).