Book Review  |   May 2008
Clinical Application of Counterstrain
Author Affiliations
  • Michael L. Kuchera, DO
    Philadelphia (Pa) College of Osteopathic Medicine
    Professor of Osteopathic Manipulative Medicine Director of the Human Performance & Biomechanics Laboratory Clinical Director of the Center for Chronic Disorders of Aging
Article Information
Book Review   |   May 2008
Clinical Application of Counterstrain
The Journal of the American Osteopathic Association, May 2008, Vol. 108, 267-268. doi:
The Journal of the American Osteopathic Association, May 2008, Vol. 108, 267-268. doi:
Lawrence H. Jones, DO, the originator of the Strain-Counterstrain technique of osteopathic manipulative treatment (OMT), said, “If you listen to the body, it will tell you all you need to know!”1 
With the publication of Clinical Application of Counterstrain, author Harmon L. Myers, DO, amplifies Dr Jones' message, focusing on a practical approach to counterstrain designed to improve a patient's body function through precise and time-effective positioning of the key myofascial structures. 
Besides having clear and useful text, this book boasts detailed anatomic diagrams and large, colorful photographs of treatment positions. These images are particularly effective in allowing busy osteopathic physicians to easily grasp and implement Dr Myers' many clinical pearls. The end result is a book that truly promotes the development of osteopathic physicians' palpatory and therapeutic manual skills, elsewhere defined as the “thinking, seeing, feeling, [and] knowing fingers.”2 
It is no mystery that this text should be so clinically appealing. Dr Myers brings more than 50 years of clinical experience—approximately half of that emphasizing counterstrain—to this impressive, yet uncomplicated, resource. Each of the book's nine chapters on different body regions is grounded in reality. Actual case histories are used to illustrate the counterstrain approach and linkages made between common patient symptoms and dysfunctional tender points associated with these symptoms. Moreover, Dr Myers' message about integrating counterstrain into therapeutic intervention is clear, consistent, and pristinely practical. 
Practicality extends to the book's physical elements as well. This soft-covered book is printed on exceptionally sturdy paper and bound with metal rings. Because of these features, the book can remain open to the selected page when placed on the treatment table. 
I have taught manual medicine to physicians and physicians-in-training all over the world—to DOs and MDs alike. The sensible approach to instruction used in Dr Myers' text demonstrates how counterstrain can best be taught to clinicians. Rather than being a simple OMT “cookbook” with “recipes” for an exhaustive series of somatic dysfunction points, the nine chapters “served up” by Dr Myers are “complete meals.” 
The first chapter, for example, deals with the use of counterstrain to treat patients with headache, neck pain, or temporomandibular dysfunction. In this chapter, Dr Myers focuses on the three major headache culprits—the trapezius, levator scapulae, and sternocleidomastoid muscles. In addition, the trapezius, sternocleidomastoid, and other muscles are examined in this chapter for referring pain and dysfunction into the temporomandibular joint region. 
Other chapters in Clinical Application of Counterstrain highlight muscles, dysfunctions, and treatment techniques in the following body regions: shoulder (anterior and posterior); thoracic area and ribs (anterior and posterior); forearm, wrist, and hand; lumbar spine, pelvis, and hips (anterior); lumbar spine and sacrum (posterior); knee; and lower leg, ankle, and foot. Throughout this book, osteopathic physicians and other healthcare practitioners will find material that will contribute to a profound respect for the clinical impact and diagnostic and therapeutic importance of musculoskeletal dysfunction. 
In each chapter, Dr Myers articulately discusses—and photographs clearly demonstrate—his care for patients with common, recalcitrant symptoms. Although his treatment procedures use counterstrain positioning, Dr Myers notes that he makes diagnoses of “what to treat” by using the myofascial pain patterns popularized by Janet G. Travell, MD, and David G. Simons, MD, in their two-volume set, Myofascial Pain and Dysfunction: The Trigger Point Manual.3 Functional illustrations, by Barbara D. Cummings, are beautifully reprinted from that text,3 providing Dr Myers' work with a same-page juxtaposition of diagnosis and treatment. 
The clinician shines through in Clinical Application of Counterstrain, which consistently espouses the osteopathic philosophy of treating the whole patient. Each of the nine case histories presented incorporates this theme, featuring useful information about the patient and the pattern of tender points found. Although the cases and techniques discussed by Dr Myers emphasize pain and dysfunction of the neuromusculoskeletal system, the author also writes about the clinical efficacy of managing myofascial and segmental dysfunctions when caring for patients with digestive or cardiac problems, dry cough, irritable bowel syndrome, respiratory distress, or restless leg syndrome. 
Dr Myers is board certified by the American Osteopathic Association for family practice and for neuromusculoskeletal medicine and osteopathic manipulative medicine. For more than a decade, he has taught clinicians and treated patients in the integrative medicine clinic at the University of Arizona in Tucson. Dr Myers' exceptional skill in patient care and teaching and his integrated application of the osteopathic approach to medicine won trust and praise from that clinic's founder—Andrew Weil, MD, noted author of Spontaneous Healing.4 Dr Weil wrote the forward for Clinical Application of Counterstrain. In 2004, the American Academy of Osteopathy recognized Dr Myers with its highest honor—the Andrew Taylor Still Medallion of Honor. 
I highly recommend this book to all healthcare practitioners. For clinicians without OMT skills (or for those whose skills have atrophied), this text provides the ultimate practical introduction or reintroduction to counterstrain. For those of us who teach OMT skills to others and who use OMT in patient treatment, this text marries the best of myofascial-pain diagnosis with the best of counterstrain treatment from a master who is experienced with each. 
Grasp the essence of this book and you will have gained proficiency for the clinically effective gift that Dr Jones, who was a friend and colleague of Dr Myers, left as a legacy to healthcare practitioners. Absorb Dr Myers' practical clinical insights, and you will have gained something even more valuable—a new approach to better listen to and influence the story that your patient's body is telling you. 
Clinical Application of Counterstrain suggests that Dr Myers' teaching approach shares a basic philosophical underpinning with General George S. Patton, Jr, who famously said, “Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.”5 
 By Harmon L. Myers, DO. 186 pp, $109.95. ISBN: 978-0-9633658-1-1. Tucson, Ariz: Osteopathic Press; 2006.
Jones LH. Cited by: Osteopathic manual medicine technique: strain/counterstrain technique development posting. Osteopathic Manipulative Treatment Web log. December 12, 2006. Available at: Accessed May 16, 2008.
Sutherland WG. Contributions of Thought. El Paso, Tex: Sutherland Cranial Teaching Foundation; 1967:v .
Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol 2. Philadelphia, Pa: Williams & Wilkins; 1992.
Weil A. Spontaneous Healing: How to Discover and Enhance Your Body's Natural Ability to Maintain and Heal Itself. New York, NY: Knopf Inc; 1995.
QuoteDB Web site. Quotes from George S. Patton. Available at: Accessed April 7, 2008.