ISSUE 118 – AUTUMN 201632 INTERNATIONAL THERAPIST www.fht.org.uk

SPORT | Lower back pain

John Gibbons discusses how strain counter-strain can help clients

with lower back pain

probably in all of my published books and numerous articles.

Let’s go back to the era of the 1950s and 1960s, a time I am sure that was very different from 2016. However, aside from the rock and roll and hippy movement, there was an osteopath called Dr Lawrence Jones, who came across a technique that would change the way he treated his patients, and that particular technique is known today as ‘strain counter-strain’ (SCS). Developed in 1955 purely by chance, he initially referred to it as ‘positional release technique’.

So, how did this chance happening come about? As far as I am aware, a patient kept presenting to Dr Jones with ongoing back pain; no matter what Jones did in terms of treatment and trying to improve the symptoms of his patient he couldn’t truly help this particular gentleman. One day Dr Jones was busy with another patient and he suggested to his patient that he put him in a comfortable position while he treated someone else, stating he would come back and take another look afterwards. Obviously, this took many minutes while he tried to find the most comfortable position for his patient, but eventually his patient felt some relief and so he proceeded to treat someone else in the adjoining room. Twenty to 30 minutes or so had passed by the time Dr Jones came back into the room and ‘untangled’ his patient from his position of ease, before helping him stand up. Jones and the patient could not believe the difference – not only was the patient able to straighten up fully, more importantly the pain had completely disappeared.

Dr Jones suggested his patient come back in a few days, so that he could try to make sense of what had happened. However, the patient didn’t turn up for his appointment and Dr Jones eventually contacted him to ask why. The patient in question merely informed him that his pain had gone and he could stand up, and he didn’t want Dr Jones to touch him, just in case the pain returned.

Dr Jones was personally intrigued and he wanted to find out how and why his patient had experienced a reduction in their symptoms simply by finding a position of ease. He then spent many years of his life researching this and all that information is published in his book, Strain Counter-Strain.

THE ROOT OF THE PROBLEMLet’s return to the case study. Remember Doris was pruning the roses so that meant she was in a position of spinal flexion and possibly side bent and rotated to one side. The muscles responsible for maintaining this position will mainly be the erector spinae. I am sure some of you may be thinking that it has to be the abdominals. However, thinking

Iwas in my clinic one day when a mature woman (who I will call Doris) called

and said she was in a lot of pain. She was suffering with her lower back but there was no history of back pain and she informed me with a distressed voice that she hadn’t done anything in particular apart from spending a few hours in her garden because the weather had started to improve and she loves gardening.

Doris said: ‘I was only pruning my roses, along with a little bit of weeding, and then when I tried to stand up to make myself a cup of tea, I found that I couldn’t straighten up properly and suddenly felt pain in my lower back’. Doris felt she had developed a stooped posture and was unable to completely straighten her spine without experiencing excruciating pain and the only comfortable position she could find was to lay on her back with her knees bent.

Many years ago, while I was still studying for my degree in osteopathy, my tutor discussed with the class a similar case history to the one I am writing about in this article. He had encountered an

older gentleman who was doing some gardening for a few hours and was unable to stand up straight without first causing himself pain to the area of the lumbar spine. The tutor mentioned that he was able to reduce the patient’s pain as well as being able to help him straighten up completely within a couple of minutes, without the need for a series of treatments over a few days or even weeks.

The tutor also mentioned to the class that he was able to reduce his patients’ pain to the lumbar spine and improve their stooped posture by more than 70% within a couple of minutes during the first consultation session. He also claimed he did all of this without actually assessing or treating the lower back area. The entire class, and me in particular, was intrigued to know how this was even possible, especially without touching the area affected by pain. The tutor recited to the class those famous words by Dr Ida Rolf, ‘where the pain is, the problem is not’ and those few words have stayed in my mind ever since. I too quote Dr Rolf’s words many times over, when training, and

Strain of thought

33 ISSUE 118 – AUTUMN 2016 INTERNATIONAL THERAPISTwww.fht.org.uk

Lower back pain | SPORT

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about this logically, the erector muscles will be working in an eccentric manner to lower her upper torso downwards as well as controlling this position, and the muscles of the abdominal wall (in particular the iliopsoas) will now be in a state of relative relaxation. Doris had spent a considerable amount of time in this

tried to stand up, her iliopsoas muscle attempted to lengthen to allow natural spinal motion. However, because her hip flexors (iliopsoas) had been ‘reset’ to an unnaturally ‘shorter’ length, the muscle spindles responded by sending signals to the spinal cord, preventing them lengthening and this in turn sent a neurological signal back to the iliopsoas telling the muscle to contract.

ADDRESSING THE PROBLEMWe need to try to ‘reset’ the muscle spindles and as therapists, we can do that by passively taking the affected area into a position of ease by counter-straining the strain position. So rather than trying to stretch the area through muscle energy techniques (METs), which in my experience can sometimes make the situation worse, through specific palpation using our fingers, we guide the area into further relaxation until the pain has completely subsided. It is usual practice to hold this position of ease for approximately 90 seconds.

TECHNIQUE APPLICATION1 With the patient in a relaxed position, with their knees bent, locate and gently palpate the psoas muscle until you find an area of particular tenderness as shown by figure 1.1 and if possible ask the patient to rate the discomfort around an 8-10 on a pain scale (10 being very painful).2 With the contact hand still gently palpating the psoas muscle, gently lift the patient’s leg until the patient can feel the pain start to reduce. Fine-tune the motion of the patient’s leg until the pain has achieved a score of between 1-2 (pain scale) as shown by figure 1.2.3 The therapist now holds this position of ease while maintaining gentle pressure to the psoas muscle for approximately 90 seconds and after this time the therapist returns the affected limb back to the couch. The patient is then assisted off the couch and a reduction of pain and an improvement of straightening of the spine should be achieved by at least 70%.

flexed position, causing her erector muscles to be in a constant state of contraction with continual lengthening of the muscle spindles. When these spindles are continually stretched, they naturally respond by sending signals, via a sensory nerve, that informs the spinal cord of the relative position of the erector muscles. Because these muscles have been stretched for some time, the neurological response is to send a message to the same muscle via a motor nerve and this causes an

ongoing contraction of the erector spinae muscles. Think of the simple reflex arc.

I mentioned in the previous paragraph that the erector muscles are constantly in a state of contraction due to the natural flexion position of the spine while Doris is happily pruning her roses. However, while these muscles are contracting eccentrically

there is an automatic inhibitory signal that is being sent to the antagonistic muscles (opposite side) and this creates a state of inhibition, especially to the iliopsoas muscles. The problem of this inhibition to the main hip flexors is that this can result in the muscles bringing about a somewhat ‘resetting’ of the length of the muscle spindles that are formed within the iliopsoas, especially as

it has already been forced to adopt a naturally shortened position. Doris had been working hard in her garden but when trying to straighten up, the motion of simply standing induced a reversal curvature from a flexed lumbar spine to a neutral lordosis curvature (extension) – hence Doris found she was unable to straighten her spine without causing herself excruciating pain to her lower back.

Remember what I said earlier about the resetting of the muscle spindles – well that is exactly what has happened to the iliopsoas muscle and these muscles have now simply reset to an ‘unnaturally’ shortened resting length, due to the fact that the muscle spindles’ function is to control the tonicity of the muscle. As Doris

John Gibbons is a registered sports osteopath, sports therapist, author and lecturer for the Bodymaster Method®. He specialises in the assessment, treatment

and rehabilitation of sport-related injuries, specifically for the University of Oxford sports teams and delivers advanced therapy training to qualified professionals. He has published a number of books, including The Vital Glutes, A Practical Guide to Kinesiology Taping, and Functional Anatomy of the Pelvis and the Sacroiliac Joint.www.johngibbonsbodymaster.co.uk

Fig 1.1 Therapist locates the psoas muscle

Fig 1.2 Therapist fine-tunes the position until the pain reduces

psoas major iliacus

Fig 1.3 Fine tuning position for the psoas