Counterstrain (CS) is defined as “a system of diagnosis and treatment that considers the dysfunction to be a continuing, inappropriate strain reflex, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the reflex; this is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response” (1). Other terms commonly used today to describe the technique include Jones technique, strain-counterstrain, and spontaneous release by positioning. The term “positional release by therapy” is frequently used by physical therapists (2).

Counterstrain, originally termed “spontaneous release by positioning” (3), began as a treatment for a patient with low back pain. In 1955, Lawrence H. Jones was working as an osteopathic practitioner in Oregon. One day, Jones was treating an otherwise healthy 30-year-old man for recalcitrant low back pain. Jones had been unsuccessful in all his prior attempts at treatment, as had two chiropractors. The pain was severe enough to allow only short bouts of sleep at night, before it woke the patient. In an attempt to find a position in which the patient could obtain enough relief to allow sleep, Jones fine-tuned the patient’s position until the pain was almost completely relieved. When this position had been achieved, Jones left the examination room to attend to another patient. On returning, Jones allowed the patient to arise from the table. To their mutual surprise, the man was nearly pain free (4).

Jones worked on refining this accidentally found treatment technique for many years after his initial discovery, and his failure rate continued to decline. It was during this refinement period that Jones discovered other important aspects to treatment with the counterstrain method. Jones noted that the need for a passive and slow return from the treatment position was required to minimize the possibility of recurrence of the dysfunction.

The final important piece of the counterstrain puzzle was unlocked in much the same accidental fashion as the initial piece. Jones had been able to find the tender point in only approximately half of the patients he saw. A patient whom Jones had recently treated for back pain had struck himself in the groin with a gardening hoe and was suffering from severe pain. After concluding that no hernia had occurred, Jones began a second treatment for the patient’s back pain. During idle time waiting for the requisite treatment period to elapse, Jones began to once again probe the inguinal region. The pain was almost completely gone. This discovery led to a 3-year search of the anterior aspect of the body for tender points (5).

The idea of relieving dysfunction and enhancing body function by position is not a new concept. For over 5,000 years, many forms of yoga have included positioning as a method to place areas of the body under stress while other
parts are placed in a position of relaxation (6). One of the eightfold paths of yoga is known as the Asana, or postures and poses. It is during these Asana that the yogin attempts to give the body stability and strength. To achieve this effect, the yogin should be able to hold the body in a particular position for long periods of time without effort (7).

Jones’s counterstrain points also compare favorably with certain points in acupuncture. Local tender points in an area of dysfunction are considered spontaneous acupuncture points. These were termed Ah Shi points in Chinese medicine. These points were used in the treatment of painful conditions dating back to the Tang dynasty. Needling treated these points in the same manner as points along the acupuncture meridians of the body (8).

Although osteopathic physicians have used counterstrain for nearly 50 years, research to establish an exact physiologic basis for the counterstrain, as with all manual techniques, has been limited. It is by extrapolation that osteopathic physicians and researchers are able to understand how tender points occur and how counterstrain may work. Combining research results from the muscular system with results from the neurologic and circulatory systems, one can begin to understand an interrelationship that forms the basis of counterstrain.

To understand the probable mechanism of tender point generation, one can use an agonist/antagonist model of muscle action. Both muscles maintain a baseline firing rate when at rest in a neutral position. Activity can then induce lengthening in muscle A and contraction in muscle B. This increases the proprioceptive activity in muscle A, while a decrease occurs in muscle B’s activity. When these muscles are called on to return from this position of moderate strain, if the motion occurs too forcefully or rapidly, muscle B is stretched against this increased firing rate. This can induce a reactive hypertonicity in muscle B with sustained increased firing, and a tender point develops (9). This theory of proprioceptor activity in somatic dysfunction was first delineated by Irvin Korr in his article “Proprioceptors and Somatic Dysfunction” (10).

The underlying mechanism in treatment using counterstrain proposed by Jones was strengthened by Korr’s research. If the affected muscle could be placed in a position of maximum comfort, this would allow the muscle to shorten enough so it would no longer report the strain. As stated previously, this position would need to be held for 90 seconds to adequately affect the changes in the neural system processes as well as the myofascial tissues and the microcirculation. The initial reduction in discomfort may be explained by an instant change in the neural component, whereas the myofascial and circulatory changes would occur slowly over the remainder of the 90-second treatment.