28- Strain-Counterstrain Technique ..?!! _______ طريقة د.جونز للعلاج اليدوي كجزء من علم الاستيوباثي

Jones Strain and Counterstrain

Strain Counterstrain is an Osteopathic manual medicine technique. It emphasizes correction of abnormal neuromuscular reflexes rather than simply addressing painful, postural or structural problems. Counterstrain recognizes that these structural, postural and painful problems are a result of the abnormal reflexes. Until these abnormal neuromuscular reflexes are addressed significant healing is difficult

So, what in the world is strain and counterstrain anyway? Counterstrain is a form of manual manipulative therapy that uses an indirect means of passively positioning a painful or restricted joint or muscle to relieve pain and mechanical dysfunction.

That is an over simplified definition, but it captures the essence of the technique. Technically speaking, counterstrain is “A passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction. In addition, it is a mild overstretching applied in a direction opposite to the false and continuing message of strain from which the body is suffering.

This is one of the most gentle and powerful manual techniques that are currently employed in the field of rehabilitation. The reliability and effectiveness of this manual technique are rapidly becoming legendary, because they work so well!

Not only do the techniques work, they are applicable to a large range of musculoskeletal dysfunctions.

What is tenderpoints mean!!

Tenderpoints are manifestations of somatic dysfunction much as are the other TART changes. TART changes are seen as tissue Texture changes, Asymmetry, altered Range of motion, and Tenderness. The tenderpoint is a discrete pea sized area of tenderness that is uniquely a part of a somatic dysfunction. Each tenderpoint is a manifestation of a specific abnormal reflex that allows the practitioner to fashion a specific treatment for each patient.

How it works – The basics of physiology
Muscle origin and insertion

All muscles have a starting point on a bone (origin) and an ending point on a bone (insertion). Muscles are attached to the bone by a tendon. Think of a chicken drumstick. When you pull the meat away from the bone, it is adhered at the end by a clear or whitish tough cord. This is the tendon. A therapist can move a muscle into a lengthened position (stretch) or shortened position by knowing the origin and insertion of that particular muscle. By moving the bones, muscles can be put into a fully lengthened position, a shortened position or anywhere in between.

Sensory Input and Motor Output

All muscles communicate to the spinal cord and brain (central nervous system) via sensory nerves and receptors located in the tendon. These receptors called golgi tendon organs and muscle spindle fibers, relay information about the length of the muscles and how fast and in what direction the muscle is moving the bones and joints. They also communicate what state of contraction the muscle is in at rest (muscle tone). This is a part of our sensory feedback system which the nervous system uses to decide how to instruct the muscle what to do next (motor output). Our sensory system is highly sophisticated and sensitive. It provides our nervous system with the information to make rapid decisions to plot a course of action based on the desired activity of the brain while also avoiding injury.

Muscle Tone

Our central nervous system supplies a certain amount of constant output to each of our muscles. This is called the muscles’ tone. Without any input the muscle is flaccid (abnormal state) as seen in a stroke. With too much output a muscle is spastic and can make lengthening movement of a muscle nearly impossible. In between flaccid and spastic is a resting state for normal that varies with the individual.

Muscle tone continuum
l_______l______l_______l_________l______l________l________l
FLACCID RELAXED NORMAL TENSE SPASM SPASTIC(ABNORMAL) (ABNORMAL)

Muscle spasm – A vicious cycle.

A protective mechanism of the body based on these principles is called a muscle spasm. When the body perceives danger to a joint, the nervous system instructs the muscle to contract strongly to prevent movement that may cause damage. The muscle can stay in this state for a few minutes or a few days. It can become chronic and then this mechanism rarely serves to help or protect the body any longer and can become detrimental.





A vicious cycle is developed with pain, muscle guarding and muscle spasm.
A muscle in spasm is constantly sending signals to the nervous system, much like listening to music that is too loud. The nervous system reacts by sending strong signals right back. This is how a muscle can get into a vicious circle with the nervous system.


How it works – the technique




Dr. Jones developed a whole system based on understanding the tenderpoint. It is a unique finding with Strain/Counterstrain that the tenderpoint is found in the shortened muscle group, not in the muscle groups that most commonly present with pain. The treatment is achieved by placing a mild over stretching on the painful muscle thereby shortening the truly dysfunctional muscle group allowing for a reset of this abnormal reflex to a normal level.

-The therapist identifies the muscle in spasm.
-The muscle can be in visible or palpable spasm or can be identified by “tender points”. The therapist positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissues surrounding muscles and organs. More about this will be explained in future articles.)
-The therapist monitors tissue change and waits for optimum improvement to occur.

The shortened position of a muscle is a non-threatening position for a muscle in spasm. The communication from the muscle to the nervous system at this time is one of relaxation. The nervous system no longer receives the excessive feedback from the muscle and instructs the muscle tone to change from spasm to a resting tone. Relief and restoration of motion is often immediate. By disarming muscle spasm in major muscle groups the body is able to return to pain free function and pain free movement can be restored and built upon with exercise.

This technique lays the groundwork for rehabilitation of any painful condition. This technique is best used for:
-Spasm in any area of the body
-Post surgery in any area of the body
-Restoring more upright posture (tightened muscles can pull you into poor posture)
-Chronic pain

Can a muscle be in spasm (hypertonic) without a person knowing it?

Yes! People experience decreased mobility, tightness, or nothing at all if another muscle is compensating for it.

Advanced strain-counterstrain techniques have been pioneered by Sharon Weiselfish, PT, and PH.D. to release the muscle contained in the arteries, veins, lymph vessels and lining of some internal organs. These techniques relax the skeletal muscles of the immediate area surrounding the structure and sometimes can improve in a limited way the function of the structure released.

27- Osteopathy علم الاستيوباثي...ماهو وتفاصيلة..

About Osteopathy

is a system of medical practice based on the principle that health depends on the maintenance of proper relationships among the various structures of the body.Osteopathic medicine holds that true health involves complete physical, mental, and social well-being, rather than merely the absence of disease. In this system, the body has a capacity for health that the physician helps the individual attain. The osteopathic physician, therefore, treats the whole patient, considering such factors as nutrition and mental health in addition to physical symptoms of illness.According to osteopathic theory, defects in the musculoskeletal system—the muscles, bones, and joints—influence the natural function of internal organs. To correct structural abnormalities, osteopathic therapy, or manipulative treatment with the hands or related mechanical means, is used. The osteopathic physician uses this treatment when appropriate, either alone or in combination with other accepted therapeutic methods such as drugs, surgery, and radiologic treatments, depending on the medical symptoms of the individual patient.The fundamental principles of osteopathic medicine were formulated in 1874 by American physician Andrew Taylor Still, who established the first osteopathic medical school at Kirksville, Missouri, in 1892. Today more than 24 accredited osteopathic medical schools and more than 200 osteopathic hospitals operate in the United States. More than 38,000 osteopathic physicians treat some 35 million Americans annually. A doctor of osteopathy (D.O.), like a doctor of medicine (M.D.), is fully trained and licensed to practice all branches of medicine and surgery. Osteopathic physicians are licensed in all states and participate in all federally funded health programs. Posted by (Dr.\Hesham Khalil PT, DO (tw)statement 2007



Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. In most countries osteopathy is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions (Osteopathic Manipulative Medicine, or OMM in the United States) in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Many osteopaths see their role as facilitating the body's own recuperative powers by treating musculoskeletal or somatic dysfunction. According to the American Osteopathic Association, the difference between an osteopath and an osteopathic physician is often confused.In the United States, Doctors of Osteopathic Medicine (D.O.s) are fully licensed medical physicians and surgeons, practicing in all clinical specialties along with their M.D. colleagues . Just like M.D.s, D.O.s practice the full scope of medicine, but with an emphasis on the role of the neuromusculoskeletal system. D.O.s practicing in primary care, pediatrics, family, or internal medicine, are trained to have a more empathetic approach to patient care which has awarded them some level of distinction from M.D.s Outside the United States. The practice rights of U.S.-trained Doctors of Osteopathic medicine varies.


What do osteopaths treat?

Osteopaths treat a variety of common conditions including changes to posture in pregnancy; babies with colic or sleeplessness, repetitive strain injury, postural problems caused by driving or work strain, the pain of arthritis and sports injuries.

Osteopathic principles
These are the eight major principles of osteopathy and are widely accepted throughout the osteopathic community:

1-The body is a unit.
2-Structure and function are reciprocally inter-related.
3-The body possesses self-regulatory mechanisms.
4-The body has the inherent capacity to defend and repair itself.
5-When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue.
6-The movement of body fluids is essential to the maintenance of health.
7-The nerves play a crucial part in controlling the fluids of the body.
8-There are somatic components to disease that are not only manifestations of disease, but also are factors that contribute to maintenance of the disease state.
These principles are not held by osteopathic physicians to be empirical laws, nor contradictions to medical principles; they are thought to be the underpinnings of the osteopathic philosophy on health and disease.

Techniques of Osteopathic Manual Medicine
(Osteopathic Manipulative Medicine)

In the United States, physical or manual treatment carried out by D.O.s is referred to as Osteopathic Manual Medicine or Osteopathic Manipulative Medicine (both abbreviated OMM). In other countries, manual treatment by osteopathic physicians is simply referred to as osteopathic treatment.
The goal of OMM is the resolution of somatic dysfunction to reestablish the self-regulatory mechanisms of the body. There are various techniques applied to the musculoskeletal system as OMM. These are normally employed together with dietary, postural, and occupational advice, as well as counseling to help patients recover from illness and injury, and to minimize pain and disease. Most osteopathic physicians view manual therapies as a complement to physiotherapy, and use more invasive therapies (pharmaceuticals and surgery) where necessary.

Scope of manual therapies
There is now a well-established body of scientific literature that makes a strong case for the use of manual therapies in the treatment of many neuromusculoskeletal pain syndromes, such as low back pain and tension headache, alongside exercise and other rehabilitative techniques. In recent years, mainstream medicine has begun to accept the use of manual therapies to treat spinal pain of mechanical origin.
More controversial is the use of manual therapies in the treatment of seemingly organic conditions, such as asthma, middle ear infections in children, menstrual pain, and pulmonary infection. While research is beginning to shed some light in this area, exploration of the relationship between the NMS system and organic disease and the scope of manual therapies are in their infancy. Nevertheless, the sum of research and clinical experience to date suggests that osteopathic treatment can be a safe and cost-effective means of managing (or co-managing) certain diseases.

Cranial osteopathy

It has been suggested that this section be split into a new article entitled Cranial osteopathy.
( Craniosacral therapy )
Cranial osteopathy, although well-established, is a contested issue within the profession; it is not known what proportion of osteopathic physicians are practitioners. Cranial osteopathic physicians are trained to feel a very subtle, rhythmic shape change that is present throughout the head and body. This is known as the involuntary mechanism or the cranial rhythm.

The movement is said to be very subtle, and it takes practitioners with a very finely developed sense of touch (palpation) to feel it. This rhythm was first described in the early 1900s by Dr. William G. Sutherland.[6] The theory underlying cranial osteopathy is rejected by many physicians because it was previously understood that cranial bones fuse by the end of adolescence.
However, histological studies have demonstrated the presence of Sharpey's fibres between the adjacent bones forming the sutural margins, and it is known that these specialized fibers form only at areas where tissue movement is allowed. It is, of course, accepted by most modern osteopathic physicians working within the cranial field, that the spheno-basilar symphysis (a large joint in the skull base) does indeed ossify (turn to bone) and the original principles of cranial osteopathy have thus evolved alongside increasing knowledge.

Cranial osteopathic teaching refers to movement remaining within the thin bone of the sutures, and that flexibility within living bone occurs, in contrast to dried specimen bones. The brain does pulsate, but some research suggests this is related to the cardiovascular system. The same study looked at inter-operator reliability of palpating the 'cranial rhythm' and found there to be little agreement, although modern understandings in the cranial field describe a number of simultaneous rhythms with differing rates, relating to different aspects of function.

How this mechanism is related to health/disease has not been scientifically established. Some osteopathic physicians believe that healing dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow. Many without direct experience of the benefits of treatment dismiss cranial osteopathy as merely theoretical. However, patients of cranial osteopathic physicians have reported emotional releases, lightness and buoyancy, and visualizations.

This technique is increasingly being recognised as especially suitable for newborn babies and young children, with particularly good results in the treatment of colic and crying. It is claimed that as their bones have not fully fused and hardened, they are more susceptible to the treatment.
All in all, this practice appears to be popular with patients with an increasing demand for experienced practitioners.
Craniosacral therapy is based on the same principles but the practitioners have not attended medical school and are therefore not osteopathic medical physicians. Chiropractor & osteopathic physician, M.B. Dejarnette further developed craniopathic techniques inside of a complete Chiropractic system known as Sacro-Occipital Technique or simply "S.O.T."

Visceral osteopathy
Proponents of visceral osteopathy state that the visceral systems (the internal organs: digestive tract, respiratory system, etc.) rely on the interconnected synchronicity between the motion of all the organs and structures of the body, that at optimal health this harmonious relationship remains stable despite the body's endless varieties of motion. The theory is that both somato-visceral and viscero-somatic connections exist, and manipulation of the somatic system can affect the visceral system (and vice-versa).
Visceral osteopathy is said to relieve imbalances and restrictions in the interconnections between the motion of all the organs and structures of the body--namely, nerves, blood vessels, and fascial compartments. During the 1940s, osteopaths like H.V. Hoover and M.D. Young built on the pioneering work of Andrew Taylor Still to create this method of detailed assessment and highly specific manipulation. The efficacy and basis of this treatment remains controversial even within the osteopathic profession. Visceral manipulation was further promoted within osteopathic treatment by Jean-Pierre Barral in his recent series of books on the subject.

While neither cranial osteopathy nor visceral manipulation are the mainstay of most osteopathic medical practices, there is increasing interest in both of these areas from patients and practitioners alike. Training in cranial osteopathy in the UK has now reached validated MSc level, which aims to improve standards and contribute to the body of evidence with research-based studies carried out from within the profession.


Is osteopathy regulated?
The General Osteopathic Council (GOsC) is one of 13 organisations in the UK known as health and social care regulators. Each organisation oversees the health and social care professions by regulating individual professionals.
The Statutory Register of the General Osteopathic Council (GOsC) opened on 9 May 1998. The title "osteopath" became protected by law from 9 May 2000 when the transitional registration period ended. As a result it is a criminal offence, liable to prosecution, to describe oneself as an osteopath in the UK unless registered with the GOsC.
The GOsC regulates, promotes and develops the profession of osteopathy, maintaining a Statutory Register of those entitled to practise osteopathy. Only practitioners meeting the high standards of safety and competency are eligible to join this register. Proof of good health, good character and professional indemnity insurance cover is also a requirement.

What qualifications do osteopaths have?
Osteopaths undertake four to five-year honours degree programmes underpinned by thorough clinical training.

26- Walking, Recreational Exercise Do Not Increase Risk for Knee OA in Older Adults

January 31, 2007 — Walking and other 

recreational exercise do not

increase the risk for developing osteoarthritis (OA) in older adults without OA, according to the results of the Framingham Offspring Study reported in the January issue of Arthritis Care & Research.

"Regular exercise is recommended for middle-aged and older persons," write David T. Felson, MD, of the Boston University School of Medicine in Massachusetts, and colleagues. "The effect of regular exercise on the development of osteoarthritis (OA) in older persons, especially those who are overweight, is unclear."

This longitudinal study followed up 1279 community-dwelling adults who were older (mean age at baseline 53.2 years) and many of whom were overweight. Using a questionnaire about physical activity, subjects were asked about recreational activities, including walking or jogging for exercise, and working up a sweat, and they were asked to compare their activity levels with those of others. At baseline, subjects were also asked about knee pain and had weight-bearing anteroposterior (AP) and lateral knee radiographs.

Approximately 9 years later, subjects were reexamined for OA, and radiographs were evaluated for OA features in both tibiofemoral and patellofemoral compartments and scored for tibiofemoral joint space narrowing. Knees with OA at baseline were excluded for all analyses.

The main knee-specific endpoints were incident radiographic OA, symptomatic OA, and tibiofemoral joint space loss. After adjustment for age, sex, body mass index (BMI), knee injury history, and correlation between knees, the investigators evaluated the association of each recreational activity with OA development.

Recreational walking, jogging, frequency of working up a sweat, or high activity levels relative to peers were not associated with decreased or increased risk for OA or with joint space loss. Participants with BMI above the median (27.7 kg/m2 for men and 25.7 kg/m2 for women; mean BMI > 30 kg/m2 for both) had no increases in risk for OA with different types of activity.
Study limitations include lack of MRI imaging at baseline evaluation and insufficient number of joggers or runners to evaluate the effect of running on OA.

"Among middle-aged and elderly persons without knee OA, many of whom were overweight, recreational exercise neither protects against nor increases risk of knee OA," the authors write. "Although dynamic loading may have a trophic effect on cartilage, there is no measurable protective effect of recommended weight-bearing exercise on OA. Physical activity can be done safely without concerns that persons will develop knee OA as a consequence."

The National Heart, Lung, and Blood Institute of the National Institutes of Health's Framingham Heart Study and the Boston University School of Medicine supported this study.
In an accompanying editorial, Marian A. Minor, MD, of the University of Missouri in Columbia, called this "a useful and valid study that supports recommending regular moderate physical activity without undue fear that such activity may increase the risk for knee OA."

"Future research, whether designed to evaluate the effectiveness of interventions or to identify risk factors for development or progression, should characterize subjects in terms of variables relevant to knee OA," Dr. Minor writes. "We must identify and agree upon meaningful characterization of research subjects and move beyond general statements of risk and efficacy in the aggregate.

In addition to improving the usefulness of knee OA research, our ultimate aim must be to produce evidence that assists clinical decision-making and individualized recommendations regarding safety and effectiveness of interventions, including physical activity."

Posted by Mostafa gala & Mohamed rizk