Osteopathic Manipulative Treatment: Counterstrain and Facilitated Positional Release (FPR) Procedure - Lumbar Vertebrae

The lumbar spine is involved in a myriad of duties, including weight-bearing, providing a sound structure that allows for locomotion, and upholding the spinal neural structures. With constant motion and close proximity to a network of nerves, the lumbar spine is a common source of low back pain. Low back pain is common in the adult population. Some estimates show that 84% of the adults in the United States will experience low back pain at some point in their life. A metanalysis has found that Osteopathic Manipulative Treatment (OMT) can significantly reduce lower back pain.  There are a variety of Osteopathic Manipulative Treatments (OMT) aimed at reducing lower back pain, two of which include counterstrain (CS) and facilitated positional release (FPR) techniques. Both of these techniques are considered to be indirect techniques, meaning they take the patient away from the restrictive barrier. The basis of the CS technique is identifying the inappropriately hypertonic, or shortened muscle belly, which causes an excessive amount of discomfort during activation or palpation. CS aims to relieve the muscle’s tension indirectly. To achieve this, the muscle is placed in a position of ease for a sustained period. FPR is a similar indirect technique that places the somatic dysfunction in a neutral position and adds an activating compressive or rotational force. While focusing treatment on the lumbar musculature, it is important to evaluate and treat the adjacent axial skeleton and spinal segments. A full osteopathic treatment should consist of evaluating the surrounding structures such as the thoracic spine, sacrum, and the pelvis for alleviating and preventing further lumbar somatic dysfunction and associated back pain. This educational paper aims to educate on these two osteopathic treatment modalities for lumbar somatic dysfunctions: counterstrain and facilitated positional release.