Counterstrain is an indirect and passive osteopathic manipulative technique that places the patient in a position of ease to relieve pain at a tender point.

A tender point is a specific anatomical location that exhibits acute tenderness when palpated by the physician. Tender points are manifestations of a somatic dysfunction in a specific muscle, and are often located at the musculotendinous junction or belly of a muscle. Tender points may develop due to rapid stretching of one muscle and the resultant rapid contraction and spasm of the opposing muscle.

Counterstrain decreases inappropriate nociceptive and proprioceptive activity by shortening the involved muscle and / or connective tissue. Placing the patient in their position of ease and slowly returning them to neutral allows for the normalization of the spastic muscle. With counterstrain, we allow the CNS at the spinal cord level to reset muscles back to normal resting length and tension levels, thus removing pressure from the affected vasculature. The treatment allows for optimal blood and lymphatic flow to and from the affected region while decreasing sympathetic nervous system tone.

Successful counterstrain treatment is achieved by the following:

1. Identifying the tender point
2. Positioning the patient in a position of ease while continuously monitoring the tender point to achieve a reduction in tenderness of 70% or more
3. Holding the therapeutic position for a minimum of 90 seconds
4. Slowly returning the patient back to a neutral position and reassessing tenderness