title: Frequency of counterstrain tender points in osteopathic medical students.
abstract: BACKGROUND
  Counterstrain is 1 osteopathic manipulative treatment technique taught to osteopathic medical students, but teaching all 300 counterstrain tender points is not feasible at most colleges of osteopathic medicine (COMs) because of time limitations.
  
  
  OBJECTIVE
  To identify high-yield tender points in osteopathic medical students for teaching and to assess for correlations between tender points and demographic information, weight, and history of pain or trauma.
  
  
  METHODS
  First- and second-year osteopathic medical students at 5 COMs were surveyed regarding the presence and absence of tender points found on themselves by fellow students. Demographic information, weight, and history of pain and trauma data were collected. The McNemar test was used to compare the frequency of positive tender points between the right and left sides. Multiple logistic regression models were fit to the data to determine if participant characteristics were related to having 1 or more positive tender points in a tender point group. Wilcoxon signed rank tests were used to compare the percentage of positive anterior vs posterior tender points. Multiple logistic regression models were used to test for differences between COMs after accounting for differences in participant characteristics.
  
  
  RESULTS
  Frequency of 78 tender point groups was obtained. Forty tender point groups (51%) were positive for the presence of 1 or more tender points by 50% or more of the participants. Positive tender points were more common on the right side for 23 groups (all P<.001). Female participants were more likely to have tender points for 22 groups (all P<.001). The 20- to 25-year-olds had more tender points for 6 groups (all P≤.03). Tender points were more common in participants with a history of pain for 29 groups (all P<.001) and with a history of trauma for 4 groups (all P≤.05). Anterior tender points were more common for cervical, thoracic, rib, and lumbar body regions (P<.001). Differences were found between COMs for all tender point groups (P≤.02).
  
  
  CONCLUSIONS
  Nearly half of the tender point groups surveyed were reported positive by 50% or more of participants, and high-yield tender points were found in each body region. Ultimately, these results may guide counterstrain curricula for COMs.
authors.affiliation: Department of Osteopathic Manipulative Medicine, A.T. Still University-Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, MO 63501-1443, USA. ksnider@atsu.edu
authors.forename: Karen T
authors.initials: KT
authors.lastname: Snider
authors.forename: John C
authors.initials: JC
authors.lastname: Glover
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rennie
authors.forename: Heather P
authors.initials: HP
authors.lastname: Ferrill
authors.forename: William F
authors.initials: WF
authors.lastname: Morris
authors.forename: Jane C
authors.initials: JC
authors.lastname: Johnson
mesh_terms: D000328:Adult; D003479:Curriculum; D005260:Female; D006801:Humans; D008297:Male; D026301:Manipulation, Osteopathic / Q000193:education*; D009140:Musculoskeletal Diseases / Q000628:therapy*; D010021:Osteopathic Medicine / Q000193:education*; D055360:Osteopathic Physicians / Q000193:education*; D012189:Retrospective Studies; D013337:Students, Medical; D014481:United States; D055815:Young Adult