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FCS Developer Expands Physiological Rationale for Indirect Tissue Manipulation

August 24, 2021
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  • Counterstrain Rationale
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The following is an excerpt from “Impaired Lymphatic Drainage and Interstitial Inflammatory Stasis in Chronic Musculoskeletal and Idiopathic Pain Syndromes: Exploring a Novel Mechanism” by Fascial Counterstrain-developer Brian Tuckey, PT, OCS, JSCCI, along with John Srbely, Grant Rigney, Meena Vythilingam, and Jay Shah.

Abstract

A normal functioning lymphatic pump mechanism and unimpaired venous drainage are required for the body to remove inflammatory mediators from the extracellular compartment. Impaired vascular perfusion and/or lymphatic drainage may result in the accumulation of inflammatory substances in the interstitium, creating continuous nociceptor activation and related pathophysiological states including central sensitization and neuroinflammation. We hypothesize that following trauma and/or immune responses, inflammatory mediators may become entrapped in the recently discovered interstitial, pre-lymphatic pathways and/or initial lymphatic vessels. The ensuing interstitial inflammatory stasis is a pathophysiological state, created by specific pro-inflammatory cytokine secretion including tumor necrosis factor alpha, interleukin 6, and interleukin 1b. These cytokines can disable the local lymphatic pump mechanism, impair vascular perfusion via sympathetic activation and, following transforming growth factor beta 1 expression, may lead to additional stasis through direct fascial compression of pre-lymphatic pathways. These mechanisms, when combined with other known pathophysiological processes, enable us to describe a persistent feed-forward loop capable of creating and maintaining chronic pain syndromes. The potential for concomitant visceral and/or vascular dysfunction, initiated and maintained by the same feed-forward inflammatory mechanism, is also described.

Introduction

Chronic pain is the leading cause of disability with up to 49% of the population experiencing pain <3 months duration. The estimated cost of chronic pain and associated opioid use disorder in the USA is currently between $560 and 635 billion annually. Chronic pain is positively correlated with age and, given the rapidly aging demographic, the burden of chronic pain will continue to impose significant challenges to our healthcare system.

Myofascial pain syndrome (MPS) is among the most common, yet least understood forms of chronic musculoskeletal pain, and is a frequent cause of primary care physician and pain clinic visitation. Few people live without experiencing muscle pain following injury, overuse, strain, or trauma. Although pain associated with MPS frequently resolves in a few weeks, in some cases it can persist long after the inciting event and/or spread to distant, uninjured tissues. Although MPS is typically characterized by the expression of pain localized to myofascial tissues, it is also associated with a broad and growing profile of non-musculoskeletal symptoms including fatigue, sleep disturbance, and visceral pain syndromes. These associations suggest a shared pathophysiology between MPS and several common idiopathic conditions (e.g., visceral pain syndromes). The pathophysiological mechanisms underlying this association, however, are not fully understood and remain largely undescribed.

It is well-established that persistent, peripheral nociceptive sources can initiate, maintain, and perpetuate chronic pain states. This occurs, in part, through central mechanisms including retrograde inflammation produced by dorsal root reflexes, and/or areas of secondary hyperalgesia produced by glial cell neuroinflammation. However, in idiopathic peripherally generated chronic pain, our understanding of the pathological processes that generate and maintain ongoing nociceptive input is limited. Examples include whiplash associated disorders which present with pain, proprioceptive and autonomic-linked symptoms despite a lack of correlative pathological evidence on computer tomography and/or magnetic resonance imaging. Additionally, existing pain hypotheses are limited in their ability to address many of the pathophysiological findings common to both chronic pain and idiopathic visceral/vascular syndromes. This includes elevated levels of plasma and interstitial pro-inflammatory cytokines in myofascial and visceral pain syndromes, and evidence of sympathetic nerve activation (SNA) in MPS, visceral disease, and vascular disorders. Microvascular disturbances and impaired lymphatic function have also been identified in both MPS and visceral disease, supporting the concept of a shared pathophysiology.

Considering the limitations in current understanding, we hypothesize that elevated pro-inflammatory cytokine levels, through specific pathophysiological mechanisms, adversely impact vascular hemodynamics and lymphatic function in the extracellular compartment. Impaired venous and lymphatic drainage can create a state of inflammatory interstitial stasis (IIS), which results in ongoing nociceptive bombardment of the dorsal horn (central sensitization). Recent anatomical discovery and advances in pre-clinical and clinical research, enable us to further elucidate the potential pathophysiological factors involved in this process. This includes contraction of fascial myofibroblasts following local TGF-b1 expression which we hypothesize can cause pre-lymphatic/lymphatic vessel contraction and/or fibrosis. And the effect of specific pro-inflammatory cytokines including tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6) and interleukin (IL-1b) in cessation of the normal lymphatic pump mechanism, the development of chronic pain states and the creation of long-term microvascular disturbance following stimulation of segmentally linked somato/visceral-sympathetic reflexes.

Click here to continue reading the full article. To view upcoming Fascial Counterstrain courses led by Brian Tuckey and other instructors, visit our Student Portal.

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      Shannon Arndt, MSPT, JSCC, is a distinguished physical therapist and owner of Soundview Center for Well-being, Lone Lake Physical Therapy, and Sage Counterstrain. She holds an MSPT from the University of Rhode Island, where she graduated at the top of her class, and is a Board Certified Specialist in Strain and Counterstrain. Shannon’s expertise extends to her work with The Bridge Back Project, where she uses counterstrain techniques to support veterans and first responders in their recovery from PTSD. Passionate about patient education, she thrives on uncovering the complex interconnections of physical impairments and empowering individuals to manage their health autonomously.

      Dr. Kim Braun, PT, DPT, brings over 30 years of experience to her practice as a doctor of physical therapy, with a focus on comprehensive pain and dysfunction treatment. She earned her initial PT degree from the University of Iowa and later completed her Doctor of Physical Therapy at St. Scholastica College. Passionate about infant care, Dr. Braun specializes in treating and preventing torticollis and plagiocephaly. Her dedication to patient-centered care is rooted in integrity, efficacy, compassion, and advocacy, utilizing a holistic approach for rehabilitation, prevention, and wellness. Dr. Braun has pursued extensive post-graduate study in the Fascial Counterstrain technique through the Jones Institute and with Brian Tuckey, PT, OCS, JSCCI, and is excited to leverage Counterstrain when other interventions have proven insufficient.

      Michael Wangsness, PT, DPT, ATC, CSC I, holds a Bachelor of Science in Athletic Training from Nova Southeastern University (2007) and earned his Doctorate in Physical Therapy from the University of Minnesota (2010). He began incorporating Fascial Counterstrain (FCS) into his practice in 2011 and has advanced to teaching roles, serving as a Teaching Assistant since 2016 and a Lab Instructor since 2020. In 2022, Michael was among the first to receive his CSC I certification. Passionate about FCS, he has been privileged to train extensively under Brian Tuckey. Michael currently practices at an outpatient clinic for M Health Fairview in Woodbury, MN. Outside of work, he enjoys golfing, coaching hockey, and spending time with his wife, Heather, and their three children: Olivia, Gavin, and Amelia.

      Greg Zadow has been a self-employed physical therapist since 1998. He earned a Bachelor of Applied Science in physiotherapy from the University of South Australia and Doctor of Physical Therapy from the Rocky Mountain University of Health Professionals. Greg is the owner and clinic director of Green Ridge Physical Therapy and Wellness, his Oregon-based private practice. In 2011, he became certified in the Strain Counterstrain (SCS) technique and continued on to complete a mastery program with Counterstrain Academy and become a Jones Strain Counterstrain Certified Instructor (JSCCI) of Fascial Counterstrain (FCS). Greg has been using Counterstrain ever since his first introduction to the technique in 1991 and now holds over 20 years of continuing education experience in the field of manual therapy.

      Kyle graduated from San Diego State University in 2010 with a bachelor’s degree in kinesiology and earned a Doctor of Physical Therapy from the University of Miami in 2014.​ Kyle immediately started his private practice and became certified with The Jones Institute after witnessing the powerful effects of Counterstrain on his patients. Kyle currently lends his expertise to the Doctor of Physical Therapy programs at both San Diego State University and the University of Miami. Since joining The Jones Institute as a lab instructor in 2015, Kyle has taken on additional roles in managing the company’s domestic headquarters, developing the curriculum for a new anatomy program, and teaching Anatomy Dissection as the lead instructor.

      Eryn Milian earned a Bachelor of Science in chemistry and environmental science from William Smith College along with a Doctor of Physical Therapy and PhD from the University of Miami. Her doctoral work focused on anatomical sciences and measurable outcomes which inform her current clinical expertise in orthopedics and sport physical therapy. Since joining the University of Miami’s faculty in 2013, Eryn has expanded her role as assistant professor to become a course master for neuroanatomy and instructor for both pelvic anatomy and the university’s orthopedic, sport, and neuroscience residency programs. Her research interests lie primarily in knee injuries and the development of reliable and valid measures of assessing ACL risk in adolescent athletes via musculoskeletal ultrasound.

      Tim Hodges has worked in the field of physical rehabilitation since 1996. Since joining The Jones Institute in 2004, he’s assisted Brian Tuckey, PT, OCS, JSCCI, in the development of several Fascial Counterstrain techniques and taught numerous Fascial Counterstrain courses as a certified instructor. Tim continues to apply his knowledge and expertise through Counterstrain Academy—a mastery program designed for licensed Counterstrainers throughout the country. In addition to developing the program’s curriculum and overseeing its mentorships, Tim is currently practicing at Counterstrain Portland, his Oregon-based private practice.

      Larry Ham graduated from the University of Southern California in 1978 with a Master of Science in physical therapy. He took his first Counterstrain course in 1986 after Lawrence Jones, D.O., treated him and successfully eliminated all back and sciatica pain. He’s now certified to teach Strain and Fascial Counterstrain courses for the spine and extremities and the viscera, respectively. In addition to teaching Counterstrain in the U.S. and Australia, Larry has served on the sidelines of over one thousand sporting events as a Certified Athletic Trainer. Though nearing retirement, Larry still practices in Spokane, Washington, and enjoys spending his free time with his wife, sons, and grandchildren. You can catch him scuba diving with sharks, remodeling his home, or hydrofoiling on the lake.

      Robert Dowd holds a Bachelor of Science in medicine with a certificate in physical therapy, Master of Healthcare Administration, and Doctor of Physical Therapy. Robert is now a Jones Strain Counterstrain Certified Instructor (JSCCI) who’s dedicated to presenting Counterstrain the way Lawrence Jones, D.O., advised his students to do at his final course offering. Robert applies the philosophy of Counterstrain to all clinical settings from the outpatient orthopedic clinic, acute care hospital, and ICU to the nursing home and hospice industry. When he’s not practicing in the Black Hills of South Dakota, Robert can be found writing, fishing, hunting, or riding his motorcycle.

      Holly Christy earned a Bachelor of Science from the University of Washington, Master of Acupuncture from Northwest Institute of Acupuncture and Oriental Medicine, and Doctor of Naturopathic Medicine from Bastyr University where she currently teaches as an adjunct clinical faculty member. Holly started her practice in 2000 and became a lead instructor for Counterstrain Academy in 2014 after a mastery-level internship with Tim Hodges, LMT, JSCCI. In 2019, she became a Jones Strain Counterstrain Certified Instructor (JSCCI) of Fascial Counterstrain (FCS) for the nervous system. Though Counterstrain is her primary modality, Holly also offers primary care, acupuncture, prolotherapy, custom orthotics, and intravenous nutrient therapy.

      Brian Tuckey, a magna cum laude graduate of the University of Maryland School of Physical Therapy, became board certified in orthopedics in 1995. Under the tutelage of Lawrence Jones, D.O., Brian became one of only four physical therapists in the world to be certified in the Strain Counterstrain (SCS) technique. He was also the first practitioner to recognize Counterstrain’s impact on the fascial system which led to his development of Fascial Counterstrain (FCS) with over 800 anatomically-specific techniques in addition to the FCS Cranial Scan—a proprietary assessment that identifies dysfunction in all systems and regions of the body. When he’s not teaching, Brian is treating complex patients at Tuckey and Associates Physical Therapy in Frederick, Maryland.

      Randall Kusunose founded The Jones Institute in 1988 with Lawrence Jones, D.O., the original developer of Counterstrain. He was the first therapist to be board certified in orthopedics by the American Board of Physical Therapy Specialties in California. Randall has trained all Jones Strain Counterstrain Certified Instructors (JSCCI) in the U.S., France, Italy, and Australia, and developed over 60 Jones Strain Counterstrain techniques along with the Facilitated Counterstrain curriculum. When he’s not practicing, you can find Randall skiing, scuba diving, and relaxing on the sand in the beautiful beach town of Encinitas, California.