title: Effect of counterstrain on stretch reflexes, hoffmann reflexes, and clinical outcomes in subjects with plantar fasciitis.
abstract: BACKGROUND
  Previous research indicates that osteopathic manipulative treatment based on counterstrain produces a decrease in the stretch reflex of the calf muscles in subjects with Achilles tendinitis.
  
  
  OBJECTIVE
  To study the effects of counterstrain on stretch reflex activity and clinical outcomes in subjects with plantar fasciitis.
  
  
  METHODS
  In a single-blind, randomized controlled trial of crossover design, the effects of counterstrain were compared with those of placebo in adult subjects (N=20) with plantar fasciitis. The subjects were led to believe that both the counterstrain and placebo were therapeutic modalities whose effects were being compared. Ten subjects (50%) were assigned to receive 3 weeks of counterstrain treatment during phase 1 of the trial, while the other 10 subjects were given placebo capsules. After a 2- to 4-week washout period, phase 2 of the trial began with the interventions reversed. Clinical outcomes were assessed with daily questionnaires. Stretch reflex and H-reflex (Hoffmann reflex) in the calf muscles were assessed twice during each laboratory visit, before and after treatment in the counterstrain phase.
  
  
  RESULTS
  No significant changes in the electrically recorded reflexes of the calf muscles were observed in response to treatment. However, changes in the mechanical characteristics of the twitches resulting from the electrical responses were observed. Peak force and time to reach peak force both increased (P< or =.05) in the posttreatment measurements, with the increase being significantly more pronounced in the counterstrain phase (P< .05). A comparison of pretreatment and posttreatment symptom severity demonstrated significant relief of symptoms that was most pronounced immediately following treatment and lasted for 48 hours.
  
  
  CONCLUSIONS
  Clinical improvement occurs in subjects with plantar fasciitis in response to counterstrain treatment. The clinical response is accompanied by mechanical, but not electrical, changes in the reflex responses of the calf muscles. The causative relation between the mechanical changes and the clinical responses remains to be explored.
authors.affiliation: Interdisciplinary Institute for Neuromuscular Research, Department of Biomedical Sciences, Irvine Hall, Ohio University College of Osteopathic Medicine, Athens, OH 45701-2979, USA.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Wynne
authors.forename: Janet M
authors.initials: JM
authors.lastname: Burns
authors.forename: David C
authors.initials: DC
authors.lastname: Eland
authors.forename: Robert R
authors.initials: RR
authors.lastname: Conatser
authors.forename: John N
authors.initials: JN
authors.lastname: Howell
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D036981:Fasciitis, Plantar / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006181:H-Reflex / Q000502:physiology*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D012026:Reflex, Stretch / Q000502:physiology*; D016037:Single-Blind Method