The AAO Journal, 2019/09, 29(2):19-23, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

counterstrain [66]
muscle strain injuries [1]
rectus femoris [1]
osteopathic structural examination [5]
tender points [16]
case report [736]

Abstract:

Counterstrain (CS) is an osteopathic manipulative technique that utilizes indirect and passive positions of strained tissues to address musculoskeletal dysfunctions. As such, CS has potential as a treatment option for muscle strain injuries, such as rectus femoris origin (RFO) injuries. This case highlights an instance where the CS technique was used as an effective and inexpensive diagnostic tool to confirm the involvement of the reflected head of the rectus femoris muscle (RHRF) in an RFO injury. The presentation of symptoms in this case, like many other hip pain cases, was nonspecific, making it difficult to diagnose without the use of advanced imaging techniques, which are often time consuming and costly for patients. The use of CS was able to support a diagnosis of a reflected head of the RFO injury. After an osteopathic structural examination, it was noted that the patient had multiple bilateral tender points of the anterior thoracic region and hip: anterior thoracic-10 (AT10), proximal psoas (PP, formerly abdominal lumbar 2), iliacus, and reflected head of the rectus femoris (RHRF).1 In his 1981 text, Jones referred to an anterior medial trochanter tender point that is similar to the RHRF point; however, the location was described to be more lateral, rather than inferior, to the anterior inferior iliac spine than the RHRF point.2 Once all tender points were identified, treatment using the CS technique was administered weekly over the period of a month, and the patient noted markedly reduced tenderness of the tender points treated and was able to reincorporate soccer and other athletic activities back into his life.