Tender Points and Counterstrain Mechanics - Draining Trapped Inflammation

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Article 6 of 6 of "That Was Not A Muscle" companion series

Imagine reporting to your healthcare provider that you have a tender spot that radiates pain, only to receive quizzical looks. Imagine being told that what you are feeling is not real or significant.

You wouldn’t be the only one. Many complaints get the eye-roll when they involve the presence of trigger points. Never mind that Dr. Janet G. Travell had already presented research on myofascial trigger points as early as 1942. Never mind that hundreds of clinicians and therapists continue using her 1983 textbooks to help thousands of pain cases.

Eventually, modern research showed that trigger points were a real phenomenon driven by trapped inflammation. This was evident in the research conducted by Dr. Jay P Shah and published in the January 2008 issue of Archives of Physical Medicine and Rehabilitation.

Dr. Shah used a micro dialysis needle to extract the clear fluid from an active trigger point on a symptomatic trapezius and compared it to the fluid in the asymptomatic side. He found that twenty-three different proinflammatory mediators were elevated on the affected side compared to the uninvolved side.

This paper was a breakthrough discovery that resonated with scientists investigating complex pain, which is evident by being cited over 580 times. It also corroborated the existence of trigger points, myofascial pain, and other systemic pains that until then were dismissed because conventional testing methods couldn’t point to any established markers.

But it also presented a conundrum: Trigger points meant trapped inflammation, but how does one remove that inflammation?

This where Fascial Counterstrain (FCS) shines, but before elaborating, it’s important that you’re acquainted with neural convergence. If you’re not, make sure to first review the article covering the topic.

Neural Convergence, Counterstrain, and Tender Points

The use of tender points is not unique to Counterstrain, and many modalities treat them, though they refer to them by their established trigger point moniker. The crucial distinction is that Fascial Counterstrain does not treat the tender points, but rather, their symptom-driving structures, which are the structures harboring the source inflammation.

As recently stated, what affects one neuron in a convergence affects all the neurons in that convergence. It turns out that all deep spinal neurons also converge in a segment of the skin, thus, any inflammation affecting that convergence will also inflame that segment of the skin. This small area of retrograde inflammation is the tender point, and since it’s the proxy of the target structure harboring the source inflammation, it can be used to monitor treatment.

By draining the source inflammation from our target structure, we’re stopping the inflammatory cycle and also draining the inflammation from the converging structures including the skin. We touch the tender point because the changes produced on it by the application of our treatment allow us to monitor progress.

FCS Mechanics and the Direction of Ease

We had mentioned that there’s nothing random or phantasmal about the direction of ease as it’s an expression of autonomic protective mechanisms. We can now appreciate how FCS turns all these autonomic interactions into a simple, elegant, gentle, and effective technique.

Recall that trapped inflammation triggers reflexive fascial contraction and muscle guarding reflexes. It also increases interstitial pressure which further prevents inflammation from accessing the lymphatic channels. It’s the combined physical expressions of those reflexes that lead us to the source inflammation and its proxy tender point. We do not treat the tender point because it’s only an expression of retrograde inflammation, but we use it to confirm the involved structure and to monitor treatment.

What we treat is the structure harboring the source inflammation by indirectly engaging its fascial structures, and then following its direction of ease. This direction of ease is determined by the physiological characteristics of the involved structure as well as the presence of scarring, fibrosis, or anatomical variations. The direction of ease also takes advantage of the elevated interstitial pressure and the mechanical tension from the anchoring filaments at the lymphatic channels to create a vacuum effect that extracts all the surplus elements back to circulation for elimination.

With the source inflammation removed, the dorsal root ganglion and interneuron are no longer under inflammatory bombardment and the protective reflexes are shut off. This allows our natural perfusion mechanisms to resume so that any leftover retrograde inflammation in converging structures can be drained without interference.

Provided that no other injurious or inflammatory insults are added, the anti-inflammatory mediators can handle any leftover neurogenic and retrograde inflammation on their own. That’s why we encourage patients to fully rest and relax for at least two days after a session.

Closing Thoughts

The skilled application of Fascial Counterstrain gives it a veneer of magic because it defies what we’ve come to accept as manual therapy. That’s why exploring its scientific principles without harmful oversimplification or supernatural terms is crucial. Removing all the esotery helps dubious patients and medical professionals explore its potential without concerns of getting dragged into some woo-woo rabbit hole.

The emergence of Fascial Counterstrain has been a journey of finding the research that explored what we experience on our treatment tables on a daily basis. Brian Tuckey has been the unstoppable driving force in this journey, both directly and indirectly.

Do you remember Dr. Shah’s study on trigger points? It was Brian Tuckey who inspired it. Dr. Shah was a patient of Brian, and he wanted to know what Brian was doing that was making such a remarkable difference with his pains. Two great minds converging to create history.

It’s also worth mentioning that Dr. Jones had confided in Brian that his concern was that his work would disappear with his passing. Brian then promised his mentor that he wouldn’t allow that to happen, and he has fulfilled that promise many times over.

Counterstrain continues evolving and changing lives. It keeps reigniting joy in those who thought their predicaments were hopeless, and also reigniting passion in therapists who were burning out from their failures until they found Counterstrain.

I hope this series was helpful to you. Whether you followed them to complement the information from my book, or not, they were created to clarify the principles governing our modality. But as I previously said, Counterstrain is a modality must be experienced to be understood.

We look forward to welcoming you to our practices, or greeting you as a colleague.

Until next time, I wish you a joyous and pain-free life.

Certified Counterstrain Therapist - CSC I

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The topics in this series are covered in-depth in the book That Was Not A Muscle, available now at your favorite online book retailer.

All photographs, illustrations, graphics, videos, and other media contained in or associated with this publication are the intellectual property of Izzy Sanchez, Integrated Healing and Strength Systems, Inc., and Mar en Hoguera Media, LLC, and are protected under United States and international copyright laws. Unauthorized reproduction, distribution, display, modification, publication, or use of these materials in any form is strictly prohibited. Any infringement of these rights may result in civil and/or criminal penalties, and violators may be subject to prosecution to the fullest extent permitted by law.

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