Bazzi Michael O., Sergent Shane R.
Michigan State University College of OM
Neck pain is a frequent complaint among the general population and may be attributed to improper posture, inadequate sleep positioning, an acute injury, among other causes. It has been reported that about half of all individuals will suffer from neck pain at some point in their life. While numerous treatment options exist for neck pain, only a handful of patients seek osteopathic manipulative treatment (OMT). OMT remains one of the staples of the osteopathic medical school curriculum and is widely used among practicing osteopathic physicians today for the treatment of neck pain and other musculoskeletal pain. As one of the more gentle techniques within the scope of OMT, strain-counterstrain (SCS), also known as positional release therapy, is an effective and safe alternative treatment option for patients experiencing cervical pain. Despite little research being conducted on this technique, SCS has been utilized clinically by osteopathic physicians for over a half-century.The technique has shown promise in patients who have failed to achieve relief of symptoms from other treatment methods. Among the approximately 25 OMT techniques that exist, SCS was reported as the fourth most commonly used by a survey of osteopathic providers. Aside from cervical pain, SCS can be used to treat several medical conditions, especially those involving the musculoskeletal system. Founded in 1955 by Lawrence H. Jones, D.O., the strain-counterstrain (SCS) model has been primarily utilized by osteopathic physicians as a procedure performed to aid in the diagnosis and indirect treatment of a patient's somatic dysfunction. Diagnosis is achieved through a pain scale and tissue texture abnormalities found at associated myofascial tenderpoints (TPs). Examples of tissue texture abnormalities include asymmetry, restriction, changes in tone, or temperature. As an indirect technique, SCS attempts to move the affected region in the direction opposite of the restrictive barrier. Treatment is performed by positioning the patient to achieve spontaneous tissue release while the physician simultaneously monitors the TP. In essence, the TP should be relieved by placing the patient in a position-of-comfort, holding this position for 90 seconds, and slowly returning the patient to a neutral position. SCS, along with all OMT techniques, aims to reduce pain, enhance function, and improve a patient's quality of life. This review will discuss the use of SCS, particularly involving the cervical vertebrae. The basic steps required to perform strain-counterstrain (SCS) in any region of the body are as follows: 1. Find a TP. 2. Assess the tenderness using a pain scale. 3. Passively and gently place the patient in a position-of-comfort that results in the greatest reduction of tenderness at the TP. Approximate the position first, then fine-tune through small arcs of movement. Aim to achieve at least 70% tenderness reduction, with the goal of 100%. 4. Maintain the position for 90 seconds while continuing to monitor the patient's TP. 5. Passively return the patient to a neutral position. 6. Re-test for tenderness at the TP.
颈部疼痛是普通人群中常见的主诉，可能归因于姿势不当、睡眠姿势不佳、急性损伤等多种原因。据报道，约半数人在一生中的某个阶段会遭受颈部疼痛。虽然针对颈部疼痛有多种治疗选择，但只有少数患者寻求整骨手法治疗（OMT）。OMT仍然是整骨医学院课程的主要内容之一，如今在执业整骨医生中广泛用于治疗颈部疼痛和其他肌肉骨骼疼痛。作为OMT范围内较为温和的技术之一，应变 - 反应变法（SCS），也称为定位释放疗法，是颈部疼痛患者一种有效且安全的替代治疗选择。尽管对该技术的研究较少，但整骨医生已在临床上使用SCS超过半个世纪。该技术在那些未能从其他治疗方法中缓解症状的患者中显示出前景。在现存的约25种OMT技术中，一项针对整骨治疗提供者的调查显示SCS是第四常用的技术。除了颈部疼痛，SCS还可用于治疗多种病症，尤其是涉及肌肉骨骼系统的病症。应变 - 反应变法（SCS）模型由劳伦斯·H·琼斯博士于1955年创立，主要被整骨医生用作辅助诊断和间接治疗患者躯体功能障碍的一种程序。通过疼痛量表以及在相关肌筋膜压痛点（TPs）发现的组织质地异常来实现诊断。组织质地异常的例子包括不对称、受限、张力或温度变化。作为一种间接技术，SCS试图将受影响区域朝着与限制屏障相反的方向移动。治疗时将患者摆至能使TP处压痛自发减轻的舒适体位，同时医生持续监测TP。实质上，应通过将患者置于舒适体位、保持该体位90秒并缓慢将患者恢复至中立位来缓解TP处压痛。SCS与所有OMT技术一样，旨在减轻疼痛、增强功能并改善患者生活质量。本综述将讨论SCS的应用，特别是涉及颈椎的应用。在身体任何部位进行应变 - 反应变法（SCS）所需的基本步骤如下：1. 找到一个TP。2. 使用疼痛量表评估压痛。3. 被动且轻柔地将患者置于能使TP处压痛最大程度减轻的舒适体位。先大致确定位置，然后通过小弧度运动进行微调。目标是使压痛减轻至少70%，理想目标是100%。4. 保持该体位90秒，同时继续监测患者的TP。5. 被动将患者恢复至中立位。6. 重新测试TP处的压痛。
