The Jones Institute

Learning to Trust the FCS Cranial Scan

Thu, 28 May 2026 19:08:00 GMT

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Counterstrain in Practice · Issue #5

For many practitioners, the FCS cranial scan is one of the most challenging skills to develop. It’s also one of the most important.

The cranial scan is a diagnostic tool used to identify patterns of dysfunction and guide treatment decisions within the Fascial Counterstrain model. Like the techniques themselves, scanning requires practitioners to have a firm grasp on anatomy and develop precise palpation skills.

We caught up with FCS-developer, Brian Tuckey, to get his take on learning the scan, overcoming obstacles, and bringing it into practice.

Why the FCS Cranial Scan Takes Time to Master

One of the biggest challenges is not just the technical skill itself, but that practitioners often expect mastery too early.

And while this may feel discouraging at first, it’s a sentiment that resonates deeply with high-level Counterstrainers.

Mark Vennerholm, a teaching assistant for The Jones Institute, described his early coursework as “drinking from a fire hose.” It wasn’t until several courses into the curriculum that things started to connect clinically. Instead of trying to absorb every new technique, he shifted his focus toward diagnostics—particularly the cranial scan and tender point matching.

“Once I really focused on the skill of finding positive scans in class,” he shared, “adding new techniques didn’t seem like such a daunting task.”

The FCS Cranial Scan as a Diagnostic Framework

For most practitioners, the learning curve is even steeper because while some modalities utilize a variation of cranial therapy, the FCS cranial scan represents an entirely new diagnostic framework.

Mary Beth Johnson, a clinician certified in both traditional Strain Counterstrain and Fascial Counterstrain, admitted she initially resisted the scan altogether.

“Learning the cranial scan was incredibly difficult for me. I fought it right and left,” she said. “But I forced myself to scan every patient I worked with even if I didn’t follow it up with a Counterstrain treatment. I also practiced the scans on my own head in order to solidify the anatomy. I did this every night before I fell asleep.”

Progress not perfection

That progression is exactly what Brian hopes students understand.

His advice for gaining proficiency? “Carefully study and review cranial bone anatomy, and practice the key C-scan principles taught in F1 including location, depth, speed, and direction. Hands-on experience with real cases is also critical; this may mean treating patients after hours or practicing with friends and family. You can confirm that you’re scanning correctly when the tender points you identify match the scan findings and connect via inhibitory testing.”

Brian also discourages students from measuring their progress against certain cases too early in the process.

“It’s common to struggle with patients who exhibit central sensitization, where everything feels restricted and tender points seem to recur or don’t fully release,” he said. “These cases require advanced diagnostics and skills, so avoid judging your progress based on your most complex and dysfunctional patients. Instead, refer them to more experienced practitioners once you plateau and continue building your proficiency with less complex cases.”

No matter where clinicians are in the curriculum, the advice from experienced practitioners is remarkably consistent: keep scanning. Practice on classmates and family members. Recheck landmarks. Ask instructors for feedback. Use the manuals. Stay patient with the process.

It usually takes three to four courses for the FCS cranial scan to click. Students can trust that when it does, the entire Fascial Counterstrain model will suddenly feel expansive and far more accessible.

Counterstrain in Practice is a monthly series exploring real-world experiences across the Counterstrain learning journey.

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Counterstrain Success Stories: Patterns, Not Magic

Fri, 24 Apr 2026 23:29:00 GMT

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Counterstrain in Practice · Issue #4

Counterstrain practitioners have no shortage of patient success stories—from relieving chronic pain to resolving complex, multi-system issues like autoimmune conditions or lifelong digestive dysfunction.

And while those outcomes are powerful, they’re not the most interesting part. The real “magic” happens when clinicians begin to recognize the patterns behind them and begin to shift their clinical reasoning.

The Jones Institute’s teaching team weighed in some of these trends they see again and again in practice, often earlier than expected.

Symptoms aren’t always local

Israel Sanchez, LMT, CSC1, recalled a young athlete who came in with ankle pain after a martial arts tournament.

The patient’s mother thought it could be a sprain, yet there was no swelling, discoloration, or restriction—nothing local to explain it.

Instead, the evaluation led elsewhere to spinal epidural veins, then visceral structures.

“I asked mom if the boy had digestive issues and she mentioned he had endured chronic constipation since childbirth. The rest of the session was spent clearing visceral dysfunctions. His ankle pain went away though I never touched the ankle.”

Examples like this—where what appears to be a straightforward orthopedic issue points to another system entirely—are not uncommon.

The question shifts from “What’s wrong here?” to “What’s driving this?”

Small inputs can create outsized change

A newborn, just two weeks old, had been crying constantly. The baby wasn’t just fussing, she was in distress . She was barely sleeping, and feeding was extremely difficult. The entire family was exhausted.

Willy Cherry, PT, CSC1, stepped in to assess.

“Upon scanning the lymphatics of the head, congestion in the region of SUBM-LV was visible. A very gentle glide was an immediate off switch.”

The baby calmed instantly.

“Her eyes were glued on mine as she gave me an indescribably grateful smile,” he said. “I don’t think anyone has ever looked at me with that level of connection. I was glad to be able to remove a stumbling block to development—not to mention a huge stressor for the family.”

These moments challenge something fundamental: the idea that bigger problems require bigger, more aggressive interventions. Sometimes, the opposite is true.

As Willy says, “I kind of wish all our cases were so simple.”

Systems thinking changes everything

Treating the body as an interconnected system influences not just patient outcomes, but the specific way clinicians approach complex cases.

Jolene Daulton’s case involved a 57-year-old physical therapist with an MRI-confirmed C5-6 disc herniation, severe C6-7 stenosis, and EMG-confirmed acute C7 nerve damage. The patient had already tried steroids, epidural injections, Gabapentin, traditional PT, chiropractic care, and traction, with minimal relief.

With 7-out-of-10 pain and surgery just days away, Jolene’s patient sought Fascial Counterstrain treatment as a last resort.

“After just one extensive treatment, she walked out pain-free,” said Jolene, PT, MDNC, CSC1. “Her grip strength improved immediately from 45 to 72 pounds. She called her surgeon and cancelled the cervical fusion that day.”

While not every case presents as dramatically, the underlying pattern is consistent: when multiple systems are considered—vascular, visceral, neurological—new options often emerge.

And as if the story couldn’t get better, on the very day she had been scheduled for surgery—when her sons would have been at the hospital with her—her ex-husband suffered a massive heart attack. Because she was not in surgery, her son was able to get him to the hospital immediately. Physicians later said minutes made the difference.

Counterstrain success stories never get old, but the real heart of them lies in the process of getting there—in the patterns that emerge. For clinicians, that repetition is where clinical confidence begins to take hold.

Counterstrain in Practice is a monthly series exploring real-world experiences across the Counterstrain learning journey.

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Inside the Clinical Application of Counterstrain

Fri, 20 Mar 2026 22:48:00 GMT

The post Inside the Clinical Application of Counterstrain appeared first on The Jones Institute .

Counterstrain in Practice · Issue #3

Applying new techniques in the clinic can feel overwhelming, not just for those new to Counterstrain, but also for experienced clinicians continuing to build on their skills.

The lab offers clarity: concepts feel organized, techniques come together, and confidence builds. But translating that experience into real-time patient care—recalling assessments, navigating treatment order, and adapting on the fly—can feel far less straightforward.

The clinical application of Counterstrain looks different for every clinician and often evolves over time. These early experiences show how that shift first took shape in practice.

Integration as a marathon, not a sprint

In a recent social media post , Andrew Adams shared how he began integrating Counterstrain into the muscle energy and joint mobility work he was already using in the clinic. Rather than abandoning those techniques, he found that even a brief application of Fascial Counterstrain beforehand made his existing work more effective, improving outcomes with less resistance.

For Izzy Sanchez, the clinical application of Counterstrain was a lightning strike: fast, powerful, and impossible to ignore.

His post-surgical client had been stuck in a slouched posture despite repeated direct treatment to the surrounding musculature. After a brief, three-minute application of newly learned SCS techniques, Izzy’s patient could fully straighten his spine and lie flat for the first time in years.

While that single result was a turning point in Izzy’s practice, he considered Counterstrain a tool among others in his toolkit. “I’d be lying if I said I planned a methodical transition to Counterstrain” he said. “I still relied heavily on my direct work.”

But as training progressed and clinical demands increased, so did his reliance on Counterstrain. “The more I trained, the less direct work I needed. It took me about eleven months since my first class to fully transition to Counterstrain.” Today, Izzy’s work is “99.9% Counterstrain based,” with only minimal direct visceral manipulation remaining, adapted through the same principles.

Key strategies for the clinical application of Counterstrain

Lymphatic-Venous instructor, Greg Zadow, emphasizes that integration is most successful when it’s intentional. Instead of trying to apply everything at once, he suggests starting with a patient with whom there is already a strong therapeutic relationship. “Being upfront with this type of patient seems to be received positively,” especially when introducing new techniques as a way to better address their specific complaints.

From there, it’s all about narrowing the scope. “I suggest initially focusing on one particular area of the body that perhaps many of your existing patients have in common.” By concentrating on a single region—reviewing tender points, scans, and treatments regularly—clinicians can build familiarity and confidence more quickly. “Pretty soon you will have the knee down pat and then you can add your next most common area.”

Across each of these experiences, a consistent theme emerges.

Integrating Counterstrain into practice doesn’t mean clinicians must abandon what came before. Rather, they can build on their existing approach, allowing the new paradigm to take hold as they start to see consistent results.

As the curricula continue to evolve, so does the pathway for integration, making the clinical application of Counterstrain more accessible and efficient than ever before.

And for many clinicians, it begins the same way: by trying something new and letting the results speak for themselves.

Counterstrain in Practice is a monthly series exploring real-world experiences across the Counterstrain learning journey.

The post Inside the Clinical Application of Counterstrain appeared first on The Jones Institute .

How to Explain Counterstrain

Fri, 20 Feb 2026 03:16:00 GMT

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Counterstrain in Practice · Issue # 2

When a new patient asks, “So what exactly is Counterstrain?” they’re not always looking for a technical definition.

They want to know if they can trust you.

Most people have never heard of interstitial inflammatory stasis. They don’t need a lecture on cytokines. They need to understand what you’re doing and why it might finally move the needle.

We asked our instructors and TAs how they explain Counterstrain to someone who’s never heard of it—whether that’s a brand-new patient or someone they’ve been treating who could benefit from a different approach. The answers were different, but they all came back to the same thing. Meet your patient where they are with language they can actually hear .

Simplicity is key

For many clinicians, the best explanation is straightforward.

MSK-C instructor Kyle Kusunose explains it like this: “Counterstrain identifies areas where inflammation has become trapped in the body’s tissues and systems. Through a specific diagnostic process, we find those restrictions and use a gentle, indirect technique to help that stagnation drain out of the tissue and recirculate.”

He also gives a simple analogy that patients can easily understand.

“When a suitcase zipper gets stuck, you can keep yanking on it. Or you can back up, adjust what’s caught, move some clothes out of the way, then zip it up smoothly.”

Translating the research on Fascial Counterstrain

Underneath that simple explanation is real research. In 2021, Brian Tuckey and colleagues explored impaired lymphatic drainage and interstitial inflammatory stasis in chronic musculoskeletal and idiopathic pain syndromes .

It gives context to what we’re seeing in practice—like pain that lingers beyond expected recovery timelines, or symptoms that don’t line up neatly with imaging.

But patients don’t need to hear the terminology.

They need something like, “There’s an area where fluid isn’t draining well. When that clears, your system can calm down.”

It’s clear and concrete. And if a patient wants to go deeper, the research is there to support it.

On reframing inexperience (and owning it)

There’s another layer to this.

If Counterstrain is new to you, say that. You don’t have to present it as something you’ve done for twenty years.

“I’ve been studying a different way of looking at inflammation and pain. I’ve seen the results firsthand, and I really think it could help.”

That kind of honesty builds trust faster than pretending you’ve always done it this way. It also helps ease the pressure of needing to get it perfect while you’re still learning.

Patients respect clinicians who keep learning. Bringing new tools to the table—even when you’re still refining them—can often reinforce your credibility.

Earning your patients’ buy-in

Some patients want research. Some want a simple analogy. Most just want reassurance that treatment will actually work . Your job is to recognize what they need to hear.

Getting patients on board with something new starts with how you communicate it. Even if Counterstrain is new to you, speak clearly and confidently. Invite them into the process. Instead of prescribing, propose. “Here’s what I’m seeing. Here’s why I think this could help. Let’s try it and see how your body responds.”

That subtle shift changes the dynamic. When patients feel involved in the decision-making process, they’re steadier and more trusting, and that carries into the treatment itself.

Counterstrain in Practice is a monthly series exploring real-world experiences across the Counterstrain learning journey.

The post How to Explain Counterstrain appeared first on The Jones Institute .

Learning Counterstrain as a Beginner

Fri, 09 Jan 2026 00:41:00 GMT

The post Learning Counterstrain as a Beginner appeared first on The Jones Institute .

Counterstrain in Practice · Issue #1

Though every Counterstrain journey begins a little differently, there’s often a shared moment early on when something clicks . For many clinicians learning Counterstrain, that moment comes when a technique feels unexpectedly precise, a patient responds faster than expected, or the work begins to change how they think about treatment.

For the first edition of Counterstrain in Practice , we caught up with three Counterstrainers to reflect on what it was like to begin incorporating this work after their first course, and what surprised them most along the way.

Quick Wins and Early Challenges

Amy Stewart began using Counterstrain in 2014 while working as a home health therapist. Her early application of the technique was practical and immediate—especially with post-operative patients.

“I quickly noticed patients were recovering faster,” she said. “Swelling, pain, and range of motion improved in a much shorter period of time.”

As her confidence grew, so did the scope of her application. Counterstrain became part of nearly every treatment plan, addressing everything from chronic pain and weakness to gait difficulties. Her work was so successful, in fact, that Amy now runs her own practice in San Diego, CA .

Still, the early learning curve isn’t always easy. Dr. David Harvitz, owner of Renew Integrative Physical Therapy in Pensacola, FL, spoke candidly about his struggles.

“Incorporating Fascial Counterstrain in my practice after my first class was actually very difficult!” he said. “I had to go through sort of a midlife crisis, taking what I thought I knew and changing everything to an indirect, inflammatory-based model. This was very different from the direct mechanical model. I really struggled realizing that what I thought I knew was wrong.”

Seeing What’s Possible

Like David, many Counterstrainers begin their journey not by transforming their practice overnight, but by getting a glimpse into the future of manual therapy.

Dr. Holly Christy, founder of Element 7 Wellness in Poulsbo, WA , took her first Counterstrain course in 2010, at a time when the curriculum looked very different than it does today.

“There was only one Fascial Counterstrain course—a combined lymphatic and visceral course,” she shared. “Even then, I recognized how innovative and unprecedented this work was. I wanted to be part of it from the start.”

What stood out wasn’t just the technique itself, but its specificity.

“There is no physical medicine modality more powerful,” Holly said. “Fascial Counterstrain allows us to be incredibly targeted in our approach—like invisible surgery.”

More than a decade later, that sense of curiosity hasn’t faded. With 25 years in practice, Holly still encounters cases that challenge her. Using FCS to solve the puzzle is what keeps things interesting to her.

“I collaborate with my patients and involve them in their care,” she explained. “The ones who come prepared and have buy-in are the ones who do the best and recover the fastest.”

Is the Juice Worth the Squeeze?

Despite their early challenges, David and Amy agree: Counterstrain pays off in dividends.

“Mastering Counterstrain is complex,” she said. “But that challenge is also what sets us apart as clinicians. The effort is worth it because the improvements we help our patients achieve are truly life-changing.”

David added that although he was a very good manual therapist before Counterstrain, patients were wowed as they experienced faster and more complete results.

“The results just speak for themselves,” he said. “As I used Counterstrain, it was just more effective than what I was doing prior.”

Amy’s advice to those new to learning Counterstrain?

“Don’t give up. Success takes time—but it’s deeply rewarding.”

Counterstrain in Practice is a monthly series exploring real-world experiences across the Counterstrain learning journey.

For additional perspective on progressing beyond the introductory Foundations course, explore our YouTube discussion on why the lymphatic and venous systems play a critical role in learning and mastering Counterstrain.

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FCS Developer Expands Physiological Rationale for Indirect Tissue Manipulation

Tue, 24 Aug 2021 21:03:59 GMT

Abstract

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.

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 .