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Anatomical Validation of Jones Counterstrain Tenderpoint Nomenclature: A Feasibility Study

Journal: Journal of Osteopathic Medicine Date: 2009/01, 109(1):Pages: 43-44. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2009.109.1.40/html)

Keywords:

anatomy [101]
counterstrain [53]
observational study [218]
physiology [50]
tender points [15]

Abstract:

Background: Counterstrain is an OMT technique that relies on specific tenderpoints (TP) to detect and treat somatic dysfunction. The coordinates of each TP have been specifically described. The naming convention of the TP is inconsistent as it relates to specific muscles or cutaneous nerve level innervation or seemingly unrelated structures. To date, there have been no published attempts to physically explore the anatomy underlying these TP to determine if the name of each correlates with the underlying anatomy. The goal of this investigation was to determine if such an investigation is feasible and whether statistical analyses can be applied to an anatomical dissection. Methods: Using a single, average-built male cadaver, 22 thoracic, lumbar and pelvic TP coordinates were marked and steel pins (1/8″ diameter) were inserted at each point, penetrating to bone. A layer-by-layer dissection was performed and all structures within a 5-mm radius of each pin were considered pierced and identified. The sensitivity and specificity was then determined for the tenderpoint name (TN) using the dissected anatomy (DA) as the reference standard. Sensitivity was defined as the frequency of an anatomic TN describing exclusive DA (i.e., single muscle pierced). Specificity was defined as the frequency of a non-anatomic TN describing nonexclusive DA (i.e., multiple muscles pierced). Results: The dissection yielded a clear visualization of anatomical structures and their relationships to each TP marking pin. Overall, TN has 89% sensitivity and 38% specificity (PPV 50%). For muscular points, TN is 100% sensitive and 0% specific (PPV 38%) to the revealed muscles. For points named after cutaneous nerve innervation, TN is 100% sensitive and 0% specific to the revealed nerves (PPV 63%). For unclearly named points (HISI, HFO-SI, MPSI, UP5L, LP5L, LISI), TN is 0% sensitive and 100% specific (NPV 83%). Sensitivity and specificity of the suggested anatomy at these points was 100% and 40%, respectively (PPV 25%). Conclusion: Cadaver dissection to assess validity of counterstrain tenderpoint names is feasible. The application of statistical analysis to an anatomical dissection is also feasible. By applying sensitivity and specificity statistics to this single cadaver, it appears that TN and SA are not accurate systems of nomenclature for all lumbar and pelvic counterstrain points using anatomy as the reference standard. Further investigation may also aid in teaching of this technique.


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