Nociceptive considerations in treating with counterstrain

Abstract

The proprioceptive mechanistic model of somatic dysfunction proposed by Korr is accepted as the neurophysiologic basis of counterstrain by the developer of that manipulative technique. We suggest that the physician should also take into account the physical damage, if any, that the original trauma produced. We propose that with tissue injury, nociceptive reflexes could produce patterns of motion restriction opposite that predicted by a solely proprioceptive model. A nociceptive component is suggested as an explanation for the origin and maintenance of somatic dysfunction and its response to the counterstrain technique. In actuality, both proprioceptive and nociceptive responses may occur in dysfunctional states. Other physiologic responses also may be involved. These views are consistent with clinical experience.

Full text

Nociceptive
considerations
in
treating
with
counterstrain
MARK BAILEY,
PhD
LORANE DICK,
DO
The
proprioceptive
mechanis-
tic
model
of
somatic
dysfunction
proposed
by
Korr
is
accepted
as
the
neurophysiolo-
gic
basis
of
counterstrain
by
the
developer
of
that
manipulative
technique.
We
sug-
gest
that
the
physician
should
also
take
into
account
the
physical
damage,
if
any,
that
the
original
trauma
produced.
We
pro-
pose
that
with
tissue
injury,
nociceptive
reflexes
could
produce
patterns
of
motion
restriction
opposite
that
predicted
by
a
solely
proprioceptive
model.
A
nociceptive
component
is
suggested
as
an
explanation
for
the
origin
and
maintenance
of
somatic
dysfunction
and
its
response
to
the
coun-
terstrain
technique.
In
actuality,
both
pro-
prioceptive
and
nociceptive
responses
may
occur
in
dysfunctional
states.
Other
physiologic
responses
also
may
be
in-
volved.
These
views
are
consistent
with
clinical
experience.
(Key
words:
Counterstrain,
osteo-
pathic
manipulative
treatment,
nocicep-
tive
reflexes,
somatic
dysfunction.)
Counterstrain
is
a
passive
,
positional-re-
lease
manipulative
technique, developed by
Lawrence
Jones.l
·
2
Counterstrain
techniques
place
somatic
systemic
elements
into
the
posi-
tion
of
greatest
perceived ease,
or
comfort, by
passively
approximating
the
attached
surfaces
of those elements. Osteopathic physicians have
demonstrated
time
and
again
that
counter-
strain
is
a clinically
valid
and
useful
entity.
However,
the
theoretical
physiologic mecha-
Dr
Bailey,
currently
a senior
student
at
the
College of
Osteopathic Medicine of
the
Pacific, Pomona,
Calif
, will
be
starting
a neurology residency
at
the
University of
Alabama
at
Birmingham.
Dr
Dick,
past
chairman
of
the
Department
of
Osteopathic Principles
and
Practice, Col-
lege
of
Osteopathic Medicine of the Pacific, is currently
in
private
practice
in
San
Dima
s,
Calif.
Reprint
requests to
Mark
Bailey, PhD, 2128 South-
wood Rd,
Jackson
, MS 39211.
334
•
JAOA
•
Vol
92 •
No
3 • March 1992
nism
by which
counterstrain
techniques ame-
liorate
somatic dysfunction
has
not
been ex-
plained
conclusively. (Somatic dysfunction is
defined
3
as
"Impaired
or
altered
function of
re-
lated
components of
the
somatic [body frame-
work] system: skeletal, arthrodial,
and
myofas-
cial
structures,
and
related
vascular,
lym-
phatic,
and
neural
elements."
Korr
4•5
has
de-
scribed a proprioceptive
mechanism
of somatic
dysfunction
that
Jones
2
accepts
as
underlying
counterstrain.
This
explanation
is compatible
with
personal clinical impressions of changes
observed
during
counterstrain
treatment
.
However,
it
seems
unlikely
that
propriocep-
tive
reflexes
represent
the
sole
element
in-
volved
in
how
counterstrain
works, a position
with
which
Korr
agrees (conversation, May
1989). Advances
in
physiologic knowledge of
the
proprioceptive functions
have
not
changed
Korr's concepts. These advances,
in
fact,
have
clarified
the
theoretical
basis for somatic dys-
function
and
explanations
for response to
ma-
nipulative
treatments
.
In
this paper, we (
1)
sug-
gest
an
updated
theoretical
basis for somatic
dysfunction involving nociceptive
stimuli,
and
(2)
examine
the
responses to counterstrain
treat-
ment.
Our
proposed theoretical role of nocicep-
tive
mechanisms
in
initiating
or
maintaining
somatic dysfunction (or both)
and
proposed ba-
sis for effects of
counterstrain
treatment
ex-
tend
the
concepts related to proprioceptive func-
tions. •
Basic
reflexes
First,
let
us
apply
Korr
's proprioceptive model
to a simple hinge-type joint,
the
elbow.
To
fa-
cilitate
the
discussion,
let
us
concern ourselves
with
only two
antagonistic
muscles
that
act
across
the
elbow joint:
the
lateral
head
of
the
triceps
brachii
muscle,
an
extensor of
the
fore-
arm
,
and
the
brachialis
muscle
, a
forearm
flexor
(Figure 1).
Now
let
us
assume
that
while
the
elbow is semiflexed, a weight is placed
in
(continued on page 337)
Brief
report
• Bailey
and
Dick

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and/or
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atrial
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/
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an
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producing
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.
verapamil
(o
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digital
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.
Deve
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use
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30%
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.
Concomitant
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