1. Muscle Energy and Strain- Counterstrain Techniques You can do this! Andrea Gordon, MD Feb 9, 2010

2. 4 Tenets of Osteopathic Medicine 1) The body is a unit of mind/body/spirit 2) The body has a self-correcting, self- healing mechanism 3) Structure and function are inter-related 4) Rational treatment is based on the 3 ideas above

3. MD’s using OMT Respect the body’s adaptations Note when they have become maladaptations Look for ways we can safely bring back a better balance. Example: Patient with 4 inch leg-length discrepancy Look at the root cause of the pain – it may not be the site of the complaint. Think functionally. Example: Tiler with chest pain

4. Muscle-energy technique Based on principle of muscle relaxation after isometeric contraction Uses the patient’s own force, not yours Some can be done by the patient alone – Great for neck/HA problems – Can help where direct stretching is too intense

5. Neck stretch with Muscle energy Have patient move neck through ROM Note where range is restricted Gently bring head to the motion barrier Hold the head in this position and ask patient to push against your resistance for a 3-5 seconds – Neither the head nor your hand moves – Only requires about 1/3 of their strength – “Not a wrestling match”

6. Neck stretch with Muscle energy Have patient relax (stop pushing) and take a breath Move neck further until you feel the new point of resistance Can repeat 2-4 times Can do this in any direction – just proceed carefully and stop if too painful.

7. Neck stretch with Muscle energy Can teach patients to do this on their own

8. Practice! Try it yourself Now try with a partner Try in multiple directions

9. Muscle energy for hamstring stretching Have patient lie supine with one leg straight up, thigh perpendicular, knee bent. Straighten leg until feel resistance. Have patient bend knee as you counter their force for a count of 3. Have patient relax, go to the next point of resistance. Can use your shoulder to make it easier.

10. Muscle energy Often useful for: – Internal or external rotation of legs – Stretching psoas, which can help relieve back pain

11. Strain-Counterstrain technique Developed by Dr. Lawrence Jones, DO Found that tender points can be relieved by a position of comfort After this position is maintained for 90 seconds, the patient is passively returned to neutral Use tender point to monitor effectiveness

12. Theory Paired muscles – stretch receptors should be firing equally at rest. If one gets overstretched the other gets overshortened. Overstretched muscle fires more intensely while overshortened muscle fires less. When trying to get back to normal length, shortened muscle may start over-firing – acting as if it is being overstretched. Counterstrain serves as a “reset”