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Introduction
Introduction
Background :
Muscle Energy Techniques
&
Strain/Counterstrain
A Case Study
Recent
research
Conclusion
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The
ultimate aim of this sub-web is to encourage families to help those
who have lost muscular control regain some muscle use when other
therapies have failed to help. Professionals are often
unwilling to take on difficult cases which require many sessions,
and where the outcome is uncertain. They may, however, be
willing to train family/friends in the therapeutic techniques.
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This
sub-web briefly introduces the application of counterpressure
within a range of osteopathic treatments for both relieving painful
spasms and for toning muscles. Osteopaths initially believed
that the relief is effected through involuntary neuromuscular
responses. Nerve impulses force muscles straining against
the therapeutic counterpressure
to relax
briefly when the counterpressure is released. This provides
the opportunity for stretching and easing contracted muscles.
While the benefits of counterpressure have been measured and
acknowledged, there is some controversy over how this happens.
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Intuitive and improvised use of mild counterpressure, has induced
limited but almost immediate control of muscles by a) my
stroke-affected 93 year old father and b) a younger friend MM who
seemed to be coming out of a coma following an accident which caused
extensive brain damage. These two case studies make me think
that the therapeutic effect is caused by mental effort,
rather than the patient's physical effort, against the
counterpressure. In this page, I introduce the immediate and
amazing response in MM, witnessed by three of us. Since it was
more involved, the case study on my father will be presented later
after reflecting on why the therapy worked for him.
If
counterpressure-based therapy can be used to help stroke patients and
others to regain muscular control and to communicate their wishes, it
would be a great help. This would be especially important if a
patient needs to confirm or revoke an Advance Decision rejecting
life-sustaining treatment under the UK Mental Capacity Act 2005 (see my
sub-web on
End of Life).
I tried
improvisations of techniques which use counterpressure as a way of
relating to my father at a time when it was difficult to express my
feelings and have much conversation with him. His co-operation and
full participation could be enlisted since he was still able to
communicate. Counterpressure transformed my father's mental outlook
during the last three months. It gave him an objective and
something to work towards, instead of just lying there hour upon hour
waiting for his end. So, I hope that this sub-web will help both the
afflicted and relatives physically, emotionally and spiritually.
The method may be tried by even those who do not have the resources to
buy the services of a professional therapist. There were no
therapists I could call on when I first tried out the method on my
father in a developing country.
Background
Gravity-induced counterpressure has been used with dumbbells and weights
for toning up muscles in body building. Counterpressure has also
been instinctively self-applied to relieve spasms and tone wasted
muscles. Muscular pain and immobility (generally caused by muscle
shortening or spasm) are the body's way of protecting body parts from
further damage through movement. However, muscles can remain in
spasm or become flaccid when such conditions no longer serve a useful
function.
Muscle Energy Techniques
Muscle Energy Techniques,
which use gentle counterpressure in various ways, were
investigated and formalised by Fred Mitchell Snr in the 1940s and
1950s and published in 1979 (see
Fryer, 2000).
EBSCO Publishing (2007) explain that treatment
involves bending a joint just up to the point where muscular
resistance to movement begins (“the barrier”), and then holding it
there while the patient gently resists. The pressure is maintained
for a few seconds and then released. After a brief pause to allow
the affected muscles to relax, the practitioner then moves the joint
a little farther into the barrier, which will usually have shifted
slightly toward improved mobility during the interval
(from:
http://healthlibrary.epnet.com/GetContent.aspx?token=8482e079-8512-47c2-960c-a403c77a5e4c&chunkiid=37409,
which is no longer online).
Fryer
(MET: Efficacy and Research, in
Chaitow, 2006,
Chap 4 109-132) provides evidence that MET and associated techniques
are effective in improving the elasticity (extensibility) of muscles
and the associated range of movement in patients.
Fryer (2000)
provided a review of research on why and how the therapy works.
Strain/Counterstrain
Also
in the 1950s
Lawrence
H Jones (1981), an osteopath, discovered by chance that tense
muscles can be induced to relax when patients stay still in
positions of minimum pain relief for some time; see
Roth, online. Some of
these positions of relief may seem very unnatural and contorted but
they are said to work. Jones' method is known by
various names - Positional Release
Therapy;
Strain/CounterStrain Therapy
and Fold & Hold Therapy. Jones also found that muscular
bind and pain were associated with a) tender points in the locality
of the pain and
b) trigger points, located elsewhere
which induce referred pain. The trigger points found by Jones
and others are said to correspond to acupuncture/acupressure points
(Roth,
online).
Muscle energy techniques using counterpressure have incorporated
Jones' findings of optimal positions and tender/trigger points.
While there are hands-on courses on these therapies (see for example,
Jones Institute) there seems to
be a paucity of therapists skilled in this method in many parts of the
UK.
Chaitow's book (2006), is pitched at
therapists but includes a CD-ROM.
Discussion
forums on physical therapy cite other useful texts and explain
terminology. The original text by
Chaitow (1993)
was written for the general public. This text is worth persevering
with, despite excessive use of acronyms and technical terms (which I had
to keep looking up initially given my lack of training in anatomy and
poor recall).
A case study
This
therapy helped my stroke-afflicted 93-year old father a) regain use of
his paralysed left arms and hand, and also b) relax his left leg muscles
which were contracted so much that they looked and felt like bone. Stroke victims, especially
the aged, need the touch and support of someone else - hopefully someone
knowledgeable and confident, but above all someone loving and
compassionate. Although my father was only three months from
death, his response to painless counterpressure was like a miracle and
he was so proud of his achievement in being able to touch his nose
again.
In 2007, I
tried this therapy again on a friend, MM. MM was deemed to be
vegetative and since his medical team could do no more for him, he
was discharged from hospital to a nursing home.
Much of his progress (see
Case study - MM) is due to
his wife's love and daily application of various therapies. After 4 months,
MM has shown us on occasions that he is trying to help himself. We
believe that MM is minimally conscious.
If you
decide to explore counterpressure please note this caution.
If your attempt seems to
cause pain, you must stop.
You may not be applying counterpressure appropriately. Remember
that pain is a natural defence mechanism to immobilise organs and joints
damaged by arthritis, accident, tumours and other conditions.
An osteopath, trained in use of counterpressure, will be able to advice
and help.
Recent research
A recent BBC program, 'One
Life: The Waking Pill' (BBC
October 2007) reported that some
patients in a vegetative state could be temporarily revived by taking
Zolpidem (see also,
Daily Mail, OCtober 2007). One of the founding principles of
homeopathy is the Principle of Similars - i.e. that a patient's
disease can be cured by a substance that is capable of producing the
patient's symptoms in a healthy person. Homeopathic remedies
should not be ingested but should enter the blood stream through mucous
membranes, such as in the mouth. I was unable to ascertain from
the BBC program as to whether Zolpidem works equally well when given
directly to the stomach in peg feeding.
Researchers are still trying to differentiate between the
neural correlates of the vegetative and minimally conscious states (Scientific
American, April 2007;
Trends in
Cognitive Sciences). A team of British researchers announced they
had imaged the brain of one of their "vegetative" patients and
discovered that she was in fact conscious and aware. Rapid
advances in neuroimaging, have already led to
neuroprosthetics, such as the cochlear implant. Researchers at
Brown University have already tested
BrainGate, a brain-to-movement system which uses implants to enable
someone paralysed in all four limbs to control movement by thought alone
(Daily
Mail 2006). Research on motor neuron extensions at
The
Salk Institute is seeking to help restore movement in people
following spinal cord injury, or those with motor neuron diseases such
as Lou Gehrig’s disease, spinal muscle atrophy, and post-polio
syndrome. So, the future is promising for those in coma.
The case
of
Terry Wallis (reported in the New Scientist in 2006) who spoke after
19 years is particularly interesting. It provides evidence of
neural plasticity; i.e. the capacity of a damaged brain to recover
functions by re-wiring itself. Could it be that counterpressure-based
therapy stimulates brain cells to repair and 'rewire' themselves?
Conclusion
The method I
have tried is just an improvisation of Mitchells' basic ideas. It
is somewhat simplistic and my optimism is based on very limited evidence
- just two case studies. Personally, I believe that the initial focus in
self help should be on finding something which works. One
can then choose or reject the explanatory theories according to one's
world views.
Disclaimer
©
Mahes Visvalingam, 18 Jun 2007
Last updated on
22/06/10
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