Common Questions Answered

What is Fascial Counterstrain?

A specialized form of manual therapy that is designed to release spasm in all tissues of the body. Every organ, nerve, artery, muscle, ligament, tendon, vein and lymphatic vessel in the body can actively spasm and produce pain in a neutral, protective response to injury.

Where does this technique come from?  

FCS is a progression and expansion from the original, innovative work by osteopath Dr. Lawrence Jones. He realized the position of spontaneous release was in the direction of ease. Where his traditional strain counterstrain technique had approximately 200 mostly positional techniques, FCS is pushing over 1000 individual techniques, for which I now rely heavily on an app to help me in everyday treatment. 

Who do I treat?

I work with a lot of individuals, of all ages and backgrounds, whose past experience with physical therapy was often unpleasant or unsuccessful for what people describe as chronic, or hard-to-treat pain. I have my theories about what makes pain hard to treat, but if traditional forms of physical therapy have failed, then it’s likely that the pain one is experiencing is derived from something more involved than just musculoskeletal dysfunction. FCS has markedly expanded the specificity and scope of treatment for its ability to identify and correct dysfunction in all regions and systems of the body, not just that MS system. 

Think about all the typical injuries for which one might seek physical therapy: a torn hamstring or groin, low back pain, ankle pain, neck pain, post operative pain, etc. In addition to these, I see individuals who found traditional PT to be too intense and painful, athletes who are always training and often, to the maximum extent; individuals with PTSD and long-term stress, post operative cases, individuals with an extensive past h/o trauma that makes seemingly straightforward issues difficult to treat; past and active military personnel. 

What does it do?

FCS utilizes diagnostic tender points to identify painful, reflexively protected and contracted tissues. These guarded reflexive contractions of tissue occur in the body’s deep fascial layers in response to a number of different mechanical or chemical stimuli. These may include trauma, surgery, postural strain, repetitive movements, infectious or viral conditions, autoimmune disorders, even lifestyle choices. 

FCS removes these painful contractions when the practitioner uses specific tissue glides and/or positional treatments to slacken or decompress the involved structures. When the structure’s circulation is normalized, muscular guarding is deactivated, vascular drainage is promoted, and the correct neural input is restored, FCS maximizes the body’s natural ability to heal itself.

How does it work?

Diagnostic tenderpoints and areas of increased pain and/or hypersensitivity are indicative of either local or systemic dysfunction. When a FCS treatment is applied, it is used to slacken and decompress tissue. Recent evidence shows this is actually the most effective way to treat fascia. Gone are the days of foam rolling and sitting on a tennis ball to “break up” adhesions or knotted up tissue, which we now know actually increases inflammation at the site. 

By shortening this tissue instead, the ability for painful chemical irritants that make up inflammation may be released from the tissue. On a local level, this means the activity of the pain receptors can be mitigated so the patient feels a once painful tender point is no longer there. On a global, systemic level, this means the signals those receptors were once sending back to the central nervous system/the brain can be down regulated or completely eliminated altogether. 

Think about that for a minute, because this has pretty big implications when you consider that we are composed of a huge neural network that branches out into thousands of different tracts but also congregates into one central cord and brain. This is why people often have pain in different areas of the body, sometimes seemingly completely unrelated. This is also why FCS can be incredibly helpful for people whose pain just doesn’t follow the typical pattern we come to appreciate in relatively straight-forward cases. FCS can get to the root of the problem, which can often manifest itself in completely different parts, or systems, of the body. We’re complicated! 

What do treatments look like?

Again, this varies depending on each person’s needs and personal situation; however, a typical body work or FCS treatment involves important diagnostic techniques to determine the root cause of dysfunction. I do a postural assessment while the patient is giving his/her past history. I do a detailed physical assessment, which involves motion testing to determine the areas of greatest restriction in the tissue. Because our bodies are composed of a number of different systems that could be playing some kind of part in one’s pain, I use both a cranial scan and touch inhibition to hone in on the real source of the dysfunction. 

Describe the concept of the cranial scan?

In order to successfully describe it, I’ll give you an analogy. We all own, and wear, hooded sweatshirts. When you wear the hood over your head and put your hands in the front pockets, you inevitably feel the pressure of the hood on your head that comes from the weight of your hands in the front pocket pulling down on the material. If the material of the sweatshirt is analogous to the fascial components of our tissues, then the pull and strain that a dysfunctional area of the body has on the fascia is broadcast like a roadmap on your head. It is the specialized skill of the FCS practitioner to know what tender and tight areas on the head mean for whatever dysfunctional system and issue is going on in the body. Yet once the root of the painful issue is uncovered, then I can use FCS to affect change on the structure so the body can better heal itself. 

What can I expect?

A treatment that is purely unique to you. My approach involves first asking for a past history and sharing your current limitations. I do a physical exam, looking for areas of tissue tightness and restriction while seeking feedback for painful tender points I find. I’m also looking for asymmetry in resting postural alignment that may give me a clue as to the underlying fascial dysfunction. 

Treatments are completely painless and of low intensity, which makes it a good option for even the most painful or involved cases. My sessions are held in a quiet office space, much like you’d expect in a manual or massage therapy room. I typically start with one hour sessions, but depending on the patient’s goals, I have the flexibility to schedule longer sessions on a case-by-case basis. 

Only when patients begin to feel better, which is often after just 1-2 visits, do I introduce foundational exercises that help the patient learn and feel correct postural awareness to help maintain the benefits of the FCS treatment. 

How many treatments are necessary?

It always depends on each individual’s situation. Some people feel better after 1-2 visits and are good to go. Others have near complete cessation of pain after 4-5 visits. Still others, especially those with a long history of chronic pain or trauma, require more visits to peel away the layers of armor their bodies have laid down in an effort to function as normally as possible in day-to-day life. 

When someone comes to me after an acute injury or surgical procedure, I will follow the doctor’s orders and post operative protocol. Often, these cases require more of the standard 12-18 visits, depending on the surgery. In these cases, I use FCS in the very acute stages of healing to address increased edema and promote better circulation to healing tissue, as well as work to maintain what ROM we are allowed to work through, depending on the protocol and the goals. 

Describe the concept of the cranial scan?

In order to successfully describe it, I’ll give you an analogy. We all own, and wear, hooded sweatshirts. When you wear the hood over your head and put your hands in the front pockets, you inevitably feel the pressure of the hood on your head that comes from the weight of your hands in the front pocket pulling down on the material. If the material of the sweatshirt is analogous to the fascial components of our tissues, then the pull and strain that a dysfunctional area of the body has on the fascia is broadcast like a roadmap on your head. It is the specialized skill of the FCS practitioner to know what tender and tight areas on the head mean for whatever dysfunctional system and issue is going on in the body. Yet once the root of the painful issue is uncovered, then I can use FCS to affect change on the structure so the body can better heal itself. 

What are the limitations?

By itself, it’s not a panacea. FCS treats the underlying aspects of the disease process, but it does NOT cure the disease itself. As the practitioner, my goal is to affect change in the dysfunctional structure or system so the capacity of the body to heal itself is restored. You can probably imagine how our lifestyle choices can work directly against these changes. I educate my patients that once I have helped them, they need to work hard to help themselves by eating clean, anti-inflammatory foods, staying hydrated, exercising daily to promote circulation, and definitely not smoking. 

Is FCS all you do?

Goodness, no. I describe FCS as a very important, effective tool in my tool box. Where once I used to rely heavily on muscle energy technique, modalities, exercise, and soft tissue massage, I now use FCS as my first method of treatment because it does such a good job of taking care of 95% of the problem. It also sets me up well to be far more effective with other treatment approaches, and my patients experience much more success from their postural exercises because they can feel what they’re doing without nearly the amount of pain. 

I enjoy using FCS to help people with issues they thought no one could treat, but I enjoy helping people appreciate the benefits of strength using small, corrective exercises they can implement in everyday life and activity. It’s tough to feel the benefits of those exercises, though, if I don’t first use FCS to correct the tissue dysfunction. 

Why practice as an out of network provider? 

I choose to prioritize the patient instead of accepting the requirements of insurance, which ultimately limit what I can do for each patient. This way, I’m not constrained to only provide certain treatments and modalities, I get to spend more one-on-one time with each patient, and we can design a treatment plan that satisfies the needs of the client and allows me to help each person better achieve his/her goals. 

Who can see you? 

Anyone can see me for my services. I charge a prompt-pay discount on the day of service, which is also my cash rate. If someone wants to try to seek reimbursement from their insurance because they know they have OON benefits, then I provide the patient with a superbill that can be submitted to insurance for reimbursement. 

I am enrolled with traditional Medicare (Plan B) only. By accepting assignment, though, it means I have to follow the rules and requirements set forth by my Medicare Administrative Contractor and which are described carefully in the CMS manual. I educate those individuals hoping to use their MC benefits of these stipulations. Once they have met their goals and no longer exhibit functional limitations that qualify them for coverage by MC, we discuss options related to following a home exercise program and/or using regular tune ups and body work to maintain one's well-being through pain management.