Strain and counterstrain is a type of indirect osteopathic manipulative soft tissue technique developed by Lawrence Jones in 1955 to passively treat musculoskeletal pain, decreased range of motion, and somatic dysfunction (muscles, nerves, and lymphatic systems) in the hand and upper extremity by causing changes in the cellular function of the tissues being treated.

Strain Counterstrain is a manual therapy technique that involves applying gentle pressure to specific points on the hand, wrist, and forearm in order to reduce pain. This technique is based on the principle that certain muscles, tendons, and ligaments in the hand can become shortened or strained due to injury or overuse. By applying gentle pressure to these specific points, the hand therapist can release the tension and help to reduce pain. This technique is often used in combination with other manual therapy techniques such as joint mobilization or active release technique to optimize hand function.

Strain and counterstrain is an effective approach to improving acute soft tissue dysfunction in the hand and wrist. The patient’s hand is moved through non-painful directions until positions of relief, decreased muscular tension, or reported relief are found. The passive positioning of hand muscle tissue that is hypertonic (excessive tone or tension) towards positions of comfort assists in forcing immediate reduction of muscle tone to normal levels. This technique is extremely gentle and particularly beneficial for the delicate structures of the hand.

How is this technique used in hand therapy?

Strain Counterstrain is used to treat hand and upper extremity disorders causing pain including:

• Acute hand and wrist pain
• Chronic hand pain
• Muscle spasms in the hand and forearm
• Small joint pain in the fingers
• Osteoarthritis of the thumb and finger joints
• Carpal tunnel syndrome
• Cubital tunnel syndrome
• De Quervain’s tenosynovitis
• Trigger finger
• Sports injuries to the hand
• Elbow tendonitis
• Golfer’s elbow
• Tennis elbow
• Hand and wrist sprains
• Post-surgical hand pain and stiffness
• Guyon’s canal syndrome
• Dupuytren’s contracture
• Gamekeeper’s thumb
• Wrist tendonitis
• Finger joint stiffness
• Chronic edema in the hand
• Complex regional pain syndrome affecting the hand

How does it work for hand conditions?

The hand therapist seeks to identify the dysfunctional muscle groups in the hand and forearm by identifying tender points, areas of tense, tender and swollen muscles, and fascia. They will use their hands to apply gentle pressure to these specific points on the hand, wrist, and forearm, known as tender points. The therapist will maintain this pressure for a short period of time, typically between 30 seconds and 2 minutes. The pressure decompresses the restricted tissues in the hand. This technique is believed to work by helping to release muscle spasms and tension in the intrinsic and extrinsic hand muscles, which can lead to pain relief and improved hand function.

Why does it work for hand therapy?

Strain-counterstrain is designed to relieve pain and restore the function in the lymph system to treat local inflammation and circulation in the hand and wrist to help with nutrients and waste removal, decrease swelling and improve tender point pain caused by a lack of blood flow in the small vessels of the hand.

Improved drainage can release the fascia to relieve muscle and connective tissue tightness in the hand so that the muscles can move more freely, allowing for better fine motor control and dexterity in activities of daily living.

Is it safe for hand conditions?

Strain and counterstrain is a gentle technique that is considered to be safe for most people with hand and upper extremity conditions. There is minimal risk of further injury or pain when using this technique on the hand and wrist. The gentle nature of this technique makes it particularly suitable for acute injuries, post-surgical conditions, and sensitive hand structures. However, as with any manual therapy technique, it is always important to consult with a hand therapist before beginning treatment to ensure it’s appropriate for your specific hand condition.

When you or a loved one suffers from hand pain and dysfunction, contact CAO Sports Performance and Therapy to discover how strain and counterstrain manual therapy can improve your hand pain and quality of life. Our specialized hand therapists have offices in California, Leonardtown, and Waldorf, Maryland for your convenience.