Fascial Counterstrain (FCS) is an indirect system of manual therapy targeted at reducing the tension in the complex fascial network of the body. FCS is a technique developed by Brian Tuckey, PT, OCS, JSCCI which he expanded greatly from an older osteopathic technique called Strain Counterstrain (SCS), which was originally developed by Dr. Lawrence Jones, DO, FAAO.
My experience with FCS
I have been using FCS since 2019. There is a great deal of material to learn and master in FCS, and I have only learned part of it. Because of how complex the body is, and the nature of the technique, it will likely take me years to learn the whole system, and even longer to master it. That having been said, what I have seen since starting to use it has been impressive. People who were not getting good results with direct methods of manual therapy, are now improving. Some people have had improvements in areas I didn't realize could be treated with manual therapy. Sometimes changes are dramatic even within the first visit. Though it pains me, I still can't provide significant help to everyone that comes to me for FCS, but I can confidently say that more of my patients get better with FCS than they did before, and more of my patients experience greater improvements that they did before. I still use direct methods on occasion, but FCS has changed the way I think about manual therapy and broadened my thinking on what it can accomplish.
What is fascia?
Fascia is a type of connective tissue found throughout the whole human body. Fascia connects to bones, blood vessels, lymphatics, organs, nerves, muscles, and ligaments. In recent years it has been discovered that fascia is both highly innervated (meaning that it has a lot of sensory nerve endings) and has the ability to contract in response to possible threats. Because of the complex network that fascia is, when it contracts, it can affect a variety of body areas. This may ultimately lead to difficult to treat pain syndromes, and sometimes difficult to diagnose symptoms related to various organs.
What is indirect manual therapy?
Most forms of manual therapy rely on direct treatment. If a joint is restricted, typically the joint is “manipulated” or “mobilized” or “adjusted”, all of which essentially are trying to push past the restriction to restore normal motion. If a muscle is tight, it would be stretched, massaged, needled, scraped, cupped, or otherwise cajoled into relaxing. This type of approach can be effective, and I still use it. In contrast, however, indirect treatments would move the restricted joint in the direction it can move, rather than into the motion barrier, or move the tight muscle into a position of ease, rather than into tension. It could be said to be the opposite of stretching. This is a very gentle type of technique; but which is surprisingly effective.
How does FCS work?
The short answer: by holding a contracted tissue in a position of ease for a period of time, it allows the nerves that are causing the contraction to reset, turning off the contraction, and restoring normal tone to the treated area. For the explanation of the scientific hypothesis of how FCS works, I refer you to an article written by Brian Tuckey, PT, the founder of FCS.
What can I expect during treatment?
A visit that includes FCS would start with a conversation about your complaints, followed by an orthopedic physical exam, and joint motion testing. Evaluation and treatment are done fully clothed. If FCS is appropriate, a “cranial scan” would then be performed. Because of the complex network of fascia in the body, when an area becomes restricted, a predictable area of tension will also occur on the cranium. Since the cranium is much smaller than the body, it is much more time efficient to test the cranium for tension as a starting point.
Once an area of tension is identified on the cranium, the region represented is then scanned for tender points. These tender points will be at least four times more tender than surrounding tissue and will have characteristic tissue texture changes. Tender points are diagnostic for mechanical dysfunction, and each tender point represents a specific anatomical structure. The indicated structure, not the tender point, is then treated. Some of these tender points can be very painful, and can be located all over the body, including the front of the chest, pelvic, and gluteal regions. Care is taken in these regions. If you do not want a specific area examined or treated, you can make it known, and your request will be respected.
During the process of the treatment the tender point will be monitored for changes over time. After the treatment, the tenderness of the area should be reduced by at least 50%. If not, treatment will be re-attempted. The exact treatment depends on the specific structure indicated by the tender point.
The number of sessions required will vary dramatically and cannot be fully predicted. The individual will be re-evaluated based on symptoms and exam to determine when treatment is complete. Following the session, it is possible to experience transient lightheadedness upon first rising from the treatment table, temporary soreness of the treated areas later that day or the following day, and the return of old pains. The return of old pains is considered a good sign, as it suggests that newer areas of tension, which were covering up old pains, have been removed, allowing for treatment of the older pain. Treatments will typically be once weekly to start with, but frequency can vary depending on need and scheduling concerns.