Strain-counterstrain (or simply counterstrain) is a passive functional (indirect) technique developed by Dr. L. H. Jones in 1955. It was originally developed after he observed relief of pain from what he would later term “tender points,” and improvement of function after a patient assumed a pain-free position. Tender points are small, edematous, hypersensitive areas of tenderness located in the myofascial tissue that are elicited upon palpation. They are typically located near muscular attachments to the bone, overlying tendons, and in the belly of major muscles. There are more than 200 identified tender points typically correlating to specific positioning of the body with some exceptions called maverick points. However, the mainstay of the strain-counterstrain system is placing a particular joint or region of the body in the most comfortable and least painful position; this typically correlates to anatomically shortening the muscle between two attachments.
- Pioneered by Dr. Lawerence H. Jones in 1955
- Tender points (Jones points) are small, edematous, painful areas elicited upon palpatory examination.
- Differ from trigger points because they typically do not radiate pain
- More than 200 identified points
- Often correlate to somatic dysfunctions
- Strain-counterstrain assumes the patient in a pain-free position to relieve the “strain”
- There are three cardinal features of the strain-counterstrain system.
- There are anterior, posterior, and lateral tender points.
The most painful tender point should always be treated first.
- Surrounding tender points may resolve spontaneously.
- The examiner should monitor for post-treatment emotional reactions.
Cervical tender points
Anterior cervical tender points
|Tender Points||Locations||Anatomical Correlation||Treatment|
|AC2|| || |
Posterior cervical tender points
|PC1 midline (inion)|| || |
|PC1 lateral (occiput)|| || |
|PC2 midline|| || |
|PC2 lateral (occiput)|
|PC3 midline|| |
|PC3–PC7 lateral|| |
|PC8 midline|| |
Rib tender points
Anterior rib tender points
Posterior rib tender points
|PR1|| || |
|PR2|| || |
Thoracic tender points
Anterior thoracic tender points
Posterior thoracic tender points
Lumbar tender points
Anterior lumbar tender points
AL1 → F STRA
AL2 → F SARA
AL¾ → F SARA
AL5 → F SARA
Pelvic tender points
Anterior pelvic tender points
|Iliacus|| || |
|Low ilium flare-out|
Posterior pelvic tender points
Upper pole L5 (UPL5)
Lower pole L5 (LPL5)
Lumbar transverse process
Lumbar spinous process
|High ilium flare-out (HIFO)|
|High ilium sacroiliac (HISO)|