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Osteopathic Manipulative Treatment: Counterstrain Procedure - Cervical Vertebrae


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Osteopathic Manipulative Treatment,Fascial

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
2022 Aug 1.


Michael O. Bazzi  , Shane R. Sergent 


Neck pain is a frequent complaint among the general population and may be attributed to improper posture, inadequate sleep positioning, an acute injury, among other causes. It has been reported that about half of all individuals will suffer from neck pain at some point in their life. While numerous treatment options exist for neck pain, only a handful of patients seek osteopathic manipulative treatment (OMT).

OMT remains one of the staples of the osteopathic medical school curriculum and is widely used among practicing osteopathic physicians today for the treatment of neck pain and other musculoskeletal pain. As one of the more gentle techniques within the scope of OMT, strain-counterstrain (SCS), also known as positional release therapy, is an effective and safe alternative treatment option for patients experiencing cervical pain. Despite little research being conducted on this technique, SCS has been utilized clinically by osteopathic physicians for over a half-century. The technique has shown promise in patients who have failed to achieve relief of symptoms from other treatment methods. Among the approximately 25 OMT techniques that exist, SCS was reported as the fourth most commonly used by a survey of osteopathic providers. Aside from cervical pain, SCS can be used to treat several medical conditions, especially those involving the musculoskeletal system.

Founded in 1955 by Lawrence H. Jones, D.O., the strain-counterstrain (SCS) model has been primarily utilized by osteopathic physicians as a procedure performed to aid in the diagnosis and indirect treatment of a patient's somatic dysfunction. Diagnosis is achieved through a pain scale and tissue texture abnormalities found at associated myofascial tenderpoints (TPs). Examples of tissue texture abnormalities include asymmetry, restriction, changes in tone, or temperature. As an indirect technique, SCS attempts to move the affected region in the direction opposite of the restrictive barrier. Treatment is performed by positioning the patient to achieve spontaneous tissue release while the physician simultaneously monitors the TP. In essence, the TP should be relieved by placing the patient in a position-of-comfort, holding this position for 90 seconds, and slowly returning the patient to a neutral position. SCS, along with all OMT techniques, aims to reduce pain, enhance function, and improve a patient's quality of life. This review will discuss the use of SCS, particularly involving the cervical vertebrae.

The basic steps required to perform strain-counterstrain (SCS) in any region of the body are as follows:

Find a TP.

Assess the tenderness using a pain scale.

Passively and gently place the patient in a position-of-comfort that results in the greatest reduction of tenderness at the TP. Approximate the position first, then fine-tune through small arcs of movement. Aim to achieve at least 70% tenderness reduction, with the goal of 100%.

Maintain the position for 90 seconds while continuing to monitor the patient's TP.

Passively return the patient to a neutral position.

Re-test for tenderness at the TP.

Publication Date: 

2022 Aug



Bazzi, OM., Sergent, RS. (2022) 'Osteopathic Manipulative Treatment: Counterstrain Procedure - Cervical Vertebrae ', In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 2022 Aug 1.

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