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Association Between Lumbar Counterstrain Tender Poins, Symptoms, and Lumbar Vertebral Somatic Dysfunctions in Osteopathic Medical Studentslumbar

Journal: The AAO Journal Date: 2014/11, 24(3):Pages: 12, type of study: clinical trial

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

strain and counterstrain [24]
lumbar tender points [1]
somatic dysfunction [147]
clinical trial [612]
poster presentation [4]

Abstract:

Context: Counterstrain is the fourth most common osteopathic manipulative treatment modality, and it is a key component of the teaching curriculum for undergraduate osteopathic medical education. In osteopathic manipulative medicine (OMM), effective counterstrain treatment depends on the proper diagnosis of tender points (TPs), which are small (<1 cm), nodular, edematous, tender-to-palpation nodules located in fascia, muscle, and ligaments. Objective: This study aims to assess a specific group of tender points taught in the osteopathic medical curriculum—the anterior and posterior lumbar tender points. Specifically, we wish to analyze the frequency of occurrence of these points in a cohort of osteopathic medical students, the association of these TPs to co-existing symptoms as described in the literature, and their association to segmental somatic dysfunctions at the respective, corresponding vertebral level. Methods: Data were collected at the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM). Osteopathic medical students used a worksheet in a laboratory setting to identify whether their laboratory partners have (1) lumbar TPs, (2) posterior lumbar transverse processes, and (3) associated symptoms (abdominal, urinary, low back pain, and lower extremity symptoms). Results: Of the 572 osteopathic medical students who participated, 48.4% (277) reported associated symptoms. Worksheets of respondents (n=394) checked by NYIT-COM OMM faculty were analyzed. Female respondents were at 2.35 and 1.91 greater odds for having an anterior lumbar 3 (AL3) and 4 (AL4) TP, respectively, and at 1.74 and 1.61 greater odds for having a posterior lumbar 1 (PL1) and 5 (PL5) TP, respectively, on either the spinous or transverse processes. Respondents reporting low back pain were 1.75 to 2.88 times more likely to have a TP at posterior lumbar levels 3 through 5 (PL3, PL4, PL5). Each posterior lumbar transverse process TP was found to be significantly related to a unilateral posterior transverse process at the corresponding vertebral level (p<.001). Conclusions: This preliminary study suggests that the association of lumbar TPs to underlying symptoms and of structural relationships to corresponding vertebrae may not be as reliable for diagnostic purposes as stated in osteopathic medical texts.3,5 This study also has educational implications. It provides a further framework both for effectively incorporating simulated patient encounters and for identifying high-yield TPs to be included in osteopathic laboratory sessions.


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