[Transcript] – The Little-Known Physical Therapy Method That Can Stop Injuries In Their Tracks, Fix Fascia & Amplify Your Recovery & Performance: Counterstrain With Tim Hodges.

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From podcast: https://bengreenfieldlife.com/podcast/timothy-hodges-podcast/

[00:00:00] Introduction

[00:00:42] Podcast Sponsors

[00:04:59] Podcast and Guest Intro

[00:07:14] What is Counterstrain, and how was it developed?

[00:10:42] Definition of tender points

[00:14:12] Difference between fascial Counterstain and trigger points

[00:17:11] What is a cranial scan and identifying the areas needing treatment

[00:20:36] How lymphatic drainage occurs

[00:24:14] Lymphatic drainage massage in conjunction with Counterstrain.

[00:25:50] Surprising applications of Counterstrain

[00:28:26] Podcast Sponsors

[00:31:10] HRV data during treatment from a quantification standpoint

[00:35:56] Logistics on what it's like to receive treatment

[00:41:57] Could this be used to enhance the performance of healthy individuals?

[00:50:15] How to connect with Tim

[00:54:02] End of Podcast

Ben:  My name is Ben Greenfield. And, on this episode of the Ben Greenfield Life podcast.

Tim:  So, we're looking at removing the source of the inflammatory buildup in the body by physically decompressing it. And then, what happens is the tender point just goes away because you've evacuated enough of the garbage that that central area of convergence in the cord is no longer inflamed.

Ben:  Faith, family, fitness, health, performance, nutrition longevity, ancestral living, biohacking, and a whole lot more. Welcome to the show.

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Alright, folks. So, you may have heard me interview the authors of a book called “Lifeforce,” which was all about longevity and anti-aging and regenerative medicine. Their names were Tony Robbins and Peter Diamandis, and they're pretty well-known guys and they've got their fingers pretty deep in this whole world of what works and what doesn't when it comes to keeping your body put together, fighting injuries and strains and sprains, everything from stem cells to more fringe anti-aging tactics. And, when I interviewed them, Tony in particular kept talking about this manual therapy technique that had provided him specifically a great deal of relief from pain and dysfunction. I had already read about it in the book, and then when he brought up on the podcast and kept talking about it, I'm like, “Geez, I got to look into this stuff.” So, it's called Counterstrain, Counterstrain. It's almost a physical therapy or manual therapy. And, I reached out to Counterstrain because I was interested in it and I wanted to see what it actually felt like, what the experience was like. And, one of the leaders in the Counterstrain movements actually flew out to my house and did a treatment on me. We actually video recorded it by the way. If you want to see it, I'm going to put the video where the shownotes are for this show at BenGreenfieldLife.com/Counterstrain, Counterstrain.

So, anyways, it was nothing I'd ever experienced. Tim was basically just mapping my body through points in my head and I didn't know what was going on half the time. He's doing pretty good job explaining it, but the whole time I was thinking, “Geez, I want to take a deep dive in this on a podcast.” So, that's what we are about to do. And, if you deal with pain, dysfunction, movement limitations, et cetera, then this is definitely something you're going to want to stay tuned into. And, as a matter of fact, I have another Counterstrain practitioner scheduled to come to my house and treat me in a couple of weeks based on that initial work with Tim.

So, anyways, who's Tim? His last name is Hodges. He's worked in physical rehab since 1996. He helps to develop this whole Counterstrain technique as well as trained practitioners in it. He started his private practice called Counterstrain Portland back in 2003, and so he's been doing this for quite some time and it is based out of the Portland, Oregon area. So, Tim, thanks for coming on, man.

Tim:  Hey, my pleasure, Ben. Thank you for having me.

Ben:  Yeah. And, there's obviously a ton of places we could start including all the weird things you were doing to my head and the rest of my body when you came visited my home a couple of months ago. But, I think I would love to step back and hear a little bit more about how you would actually describe what Counterstrain is and how it came to be developed.

Tim:  Yeah, that's probably the most commonly asked question that we get because most people have not heard of it. It is a relatively new technique, I guess, in the grand scheme of things all medically, all medical conditions or medical treatments. If you look at the history of that field, Counterstrain is basically an infant. It's been around roughly about 75 years. And, the original form of Counterstrain known as strain and Counterstrain or sometimes referred to as the Jones Technique.

Ben:  Okay.

Tim:  That dates back to 1955. And, that was really the frustration of a practitioner trying to figure out what to do with a client who had resisted all of his best efforts. And, Jones on this one momentous occasion, it just offered to position this guy in a way that allowed him to sleep because the guy wasn't able to sleep. And so, he spent about 20 minutes doing so and the guy actually had the most relief that he had had in six or eight months just from lying in this position for about 20 minutes. And, Jones was stunned. Yeah, he was like, “I don't understand what happened. I thought we were trying to figure out a place to put you so that you could get a night sleep because the guy was basically waking up every 10, 15 minutes, and not having restful sleep. 

And, the guy stood up at the end of the session and looked at Jones eye to eye, previously had been bent over, pulled off to one side not able to fully stand upright, and was completely altered. And so, Jones now had the sleepless nights and was pacing back and forth trying to figure out what in the world happened. And, that was the beginning. So, he began to search for just comfortable positions for patients that were in really bad acute states. That led to the realization that very specific tender point locations on the body would actually indicate what position needed to be performed. So, I think you remember at our session like I had poke around on your head and I look for various tender points in the body and then immediately, yeah, immediately go into a treatment that was specifically designed for that location.

So, that's the origin of it. And, I think he probably continued on that path for the better part of his career figuring things out. And, he passed in 1996 after doing Counterstrain for almost 40 years or so. But, that's where it came from. He was an osteopath. Those of you have not heard of osteopaths, they're physicians, but they are a little bit different. They're a functional medicine doc that's a very popular thing to say.

Ben:  And, very good at manipulation too, by the way. My physician growing up, my family physician for some of my life was an osteopath and I remember he'd always take care of me in the same way that an allopath did, but then he'd do a lot of hands-on manipulation type of stuff, almost a blend between and I'll probably bastardize the whole profession by saying this, like a blend between a chiropractic doc and a traditionally trained physician.

Tim:  No, that's exactly, I think they actually share origins a lot of chiropractors can trace their origins back to the osteopathic community. So, they started in a very similar time in history, 1890s. And so, they do share a lot of their manipulative techniques with each other.

Ben:  Yeah, yeah.

Okay, so first of all, first question for you, these tender points. So, you were going around my head, you're going to my body, and you were actually touching on each of these different points. How would you define what a tender point actually is?

Tim:  Tender points and a lot of us are probably familiar with trigger points, that's a more commonly associated painful entity when it comes to bodywork, or if you're an athlete and you're constantly getting these really tender or taught bands of tissue worked out by a massage therapist or athletic trainers. And, the research into what actually goes on in the body in those locations indicates that there is a stuck inflammatory particulate and it doesn't really get out of the area due to physical entrapment or tension. A tender point, it's a little bit different and that it doesn't always have to be related to a mild facial structure. Most mild facial trigger points are related to the myofascial system. A tender point, on the other hand, can come from literally anything. It could be from a visceral structure like your colon or the pleura within your lungs.

Ben:  Okay.

Tim:  It could be peritoneum of the intestines. It could be vascular, could come from a vein or an artery. It could come from the outer sheath of a nerve, bone. The bone actually is covered with a pretty tough connective tissue called periosteum cartilaginous tissues, et cetera. All of these things have within them nerves that can sense when there's a problem. And then, when you follow that nerve back into the spinal cord, these will converge on a sensory tract, so you get multiple sources of input to a singular location. And then, you get what's called retrograde inflammation. So, this thing is being bombarded with inflammatory information due to pain. That pain signal will begin to saturate the spinal cord such that you get this trickling out or referred sensation due to central sensitization if you follow that.

Ben:  Yeah, yeah. That makes sense.

Tim:  So then, yeah, that actually creates a location very specifically in the body that becomes very, very tender. It just manifests because of the neurological convergence in the cord. So, it's not the problem, and I think that's the difference between what you're experiencing is I'm finding those locations. But then, once we go down to the tender point, I don't do anything to it. I position the body such that it just goes away. So, we're looking at removing the source of the inflammatory buildup in the body by physically decompressing it. And then, what happens is the tender point just goes away because you've evacuated enough of the garbage that that central area of convergence in the cord is no longer inflamed. And, that's how the process works.

Ben:  Okay. It kind of reminds me a little bit, but it is different. Perhaps you can explain the difference of this form of therapy that I used to receive a lot when I do Ironman active release therapy or active release technique. I forget what the T stands for. But, I would go down and raise Ironman Hawaii. And, yeah, there'd be a giant tent full of ART practitioners. They find a tender spot and they pin it and then move the joint through a range of motion while that spot was pinched or had pressure applied to it by the ART therapist. And, my understanding was part of that did involve deep facial pain, a lot of these nociceptors that if triggered will keep the tissue that surrounds the area and like an overprotected or a very guarded state that's limiting range of motion and increasing pain or increasing stiffness.

Now, what's the difference between something like fascial Counterstrain, you're working with these tender points and something like ART where they're working on tender points or what I think they might call trigger points?

Tim:  So, I think, again, it's concept and how do you look at the problem and the body. I would look at the tender point as evidence of a thing, but I would not blame the tender point for the problem. So, I look at it as a messenger from the central nervous system that said, “Hey, the blood supply in my spinal cord is stuck at T8, can you help me out?” And so, I say, “Oh, yeah, no problem. I'll go ahead and position you so that the vascular tissues at the T8 level and the spinal cord will relax.” Whereas, maybe an ART practitioner may look at the focal area of pain as the problem, and so they will do some direct method to it. So, they're going to contact. And, by the way, there's the tender point but then there's also this secondary effect, which is the myofascial element. And, I think this is probably where people get a little more drawn into the conversation about how exactly is this manifesting because every one of these structures that has a sensory neuron on it, which is literally everything in the body. So, whether it's a vessel or nerve or muscle, it doesn't really matter. They have these sensory mechanisms that can feel when this thing is potentially at the point of being stressed to a failure point.

And so, they will produce not only this inflammatory response, but a second order reflex will cause the myofascial structures in that area to go into a protective tone. So, it elevates beyond what you're consciously able to control the amount of fascial system to go into this protective mode. So, that second-level problem would restrict range of motion, would perhaps show up as a weak spot. It could change your posture. It could cause nerve compression and be a pain generator. So, the difference between a direct method attacking some structure in the body and an indirect method is again concept. I look at the amount of myofascial element again as a protective second order. So, I don't look at it as the primary driver. Now, in some cases, it can be, but we can differentiate between them.

So, basically, when you're looking at individual systems, they can all produce a very similar effect in the body. So, it wouldn't matter if it was a lung or rib or cartilage or sympathetic nerves in the lung, you might get a depressed shoulder or a forward protracted position in the body. And so, I need to know which system is primary. And, when I get the primary one, I get a very quick restoration and position posture, freedom of movement, strength, blood flow, whatever, it all will synergistically release if I get the primary thing. If I'm constantly on the surface of it looking at the myofascial presentation, I am getting to something see that the carryover is quite as good as I want it to be because I'm looking again at the second order, not the primary, but the second order of presentation into the myofascial system.

Do you follow that? Does that make sense to you?

Ben:  Yeah, that makes sense.

And, the thing in terms of identifying the areas that need to be treated just absolutely intrigued me because you did and you already alluded to it a couple of times when you were explaining what Counterstrain is. You did what's called the cranial scan and you had this whole guidebook with hundreds and hundreds of different points that you're supposed to touch on the body or different tender spots. But, you started with this cranial scan, can you tell me about that, how that originated and what exactly it does and was looking for?

Tim:  Probably the easiest way to just out of the gate address the concept that literally everything is connected in the body. And, there's no separate parts of the body, so if I pull on someone's foot, they will likely be able to full line of tension all the way up into their head or neck. They can feel something being pulled upon. So, having everything connected and having a nerve to literally every structure within the body, it's not difficult to understand how various regions might based upon the type of tissue that we find there be somewhat of a homunculus or a map where various tissues or regions of the body might manifest as tension if they were to become tight. 

So, if you had a hamstring that tighten up and it was related to the nervous system, there might be something in the brain or in the nervous system in the central nervous system like the spinal cord, brainstem, or in the cerebral cortex that would manifest that as well like a physical tension. So, we look at the cranial scan as a very quick way to ascertain what systems in the body potentially are problematic.

Now, why exactly they line up the way they do? I think that's one of those, it's a God question. It's like we were made that way, and so that's just how it is. I don't know that we're going to know exactly what the underlying mechanisms are, but the mechanical one makes the most sense. And then, perhaps the cerebral cortex, the dura being a second level of connection where you see there's a dural tension, and maybe that dural tension is connected to some part of the cortex as well. So, we feel a physical rigidity in the cranial skull. So, a lot of people think of the cranium as being a pretty solid structure, and it is. Of course, there are many joints within it, but it is fairly stable. But, there are tissue texture changes that we identify as dysfunction, and this can be anywhere in the body. They just happen to also manifest in the head just a very high concentration. Again, thinking central nervous system, the dura, there's a concept of neural crest, which is basically something that can become centrally sensitized and create a large pattern in the body. So, there are many embryological connections to why this region can't function as a diagnostic process for us.

So, it again goes back to what part of the head is stuck, and we have mapped this out based on bone and ligamentous and spinal cord, lymphatics, visceral tissues, myofascial, nerves, whether they're sympathetic nerves or they're somatic nerves or the dural membranes of the brain, including the vascular tissues of the brain, et cetera. So, it is fast for us to be able to figure out where your problem is, and then I can very quickly connect this as you might remember to a motion restriction in the body, which we picked up something in your neck, I think, in the first few minutes and had you move and then we did various contact locations on the head, which would cause a momentary cancellation of the way the body protects itself, so it just relaxes it momentarily. It's not a treatment, but it is to show.

Ben:  Okay. That makes sense. That makes sense.

So, the tender points that you're finding in the head that you're then treating are basically causing this reflex reaction somewhere else. Like in my case, in my neck that then would cause that area to relax, get out of that persistently guarded or overprotected state and potentially return to normal function, which actually makes perfect sense. But, the other thing, I think that you had mentioned to me was that if there's localized tissue inflammation, localized tissue edema that there's some type of a metabolite drainage or this resetting of inflammation that occurs from Counterstrain, which to me seemed really interesting, you could be working on my head in one spot and draining inflammation almost in a lymphatic drainage type of way in another spot. And then, I went to look at some of the research on it, and it turns out I guessed that Brian Tuckey,who helped to develop Counterstrain, he actually had an article that was about impaired lymphatic drainage and what was called interstitial inflammatory stasis in musculoskeletal and pain syndromes.

So, can you get into what's going on from an edema inflammation or in terms of how some type of drainage would actually be occurring because I don't even understand the mechanism of action?

Tim:  I think we've had multiple theories over the last 50 years, but this is the newest one, and I actually think it makes the most sense because ultimately, what we do if you go back at least 20 years, we thought it was reflective, it was purely a neurological response. If that were the case, why did we have to hold it for a period of time? That never made sense. I'm like, “If it's a reflex and I calm it, why am I now holding this for a period of time? So, we now hold these treatments depending on where they are, what system. On average, I'd say 30, maybe 45 seconds. Back in the day, Dr. Jones will hold them 90 seconds. And, what you're really waiting there for that period of time is for physical decompression of the area that has been stuck in this protective state so that when it does relax, the internal — we call them intrinsic lymphatics, they're very tiny, very small vessels. And now, because of the newest research indicating that the interstitium is actually its own system within the body, it's actually been recognized as a separate anatomical system from other tissues, it is filled with tiny little vessels called interstitial vessels. And, these two things become physically compressed during a protective state such that they don't drain. And so, they contribute somewhat to this stasis of fluid.

Ben:  Oh, so it's like they're compressed when they're in that guarded state. And then, when you remove them from the guarded state, you almost get an expansion that causes the lymphatic drainage.

Tim:  That is precisely what happens. And so, there's a little more that happens in addition to that. But, that's the mechanics of it. Because if you look at all of the tissues in the body, doesn't really matter what they are, they have this layer of drainage. Everything has to. And, the action of lymphatics being not really a passive system but it's an active system, if you impair its ability to remove fluid, you will automatically become swollen or inflamed. That's a pain generator. Alright, it doesn't matter where it is, it's going to lock up that area and until you can get the fluid out, and I would say reduce the pro-inflammatory state in the tissue, it will stay that. And, to digs itself a bit of a hole and that the inflammatory cytokines that are released by cells that are feeling strain or stress are the same ones that shut off the active lymphatic pump. So, unless you can mechanically open these things to get some fluid to move out, this thing just stays chronic.

Ben:  Yeah, yeah. That's really interesting.

So, do you think that you would still want to do something like lymphatic drainage massage or some type of massage therapy that would more directly target that area in conjunction with Counterstrain if you were really trying to decrease some type of systemic inflammatory condition?

Tim:  Most manual therapies work based upon the concept that fluid movement is beneficial. And, I think massage therapy certainly helps certain chiropractic techniques obviously would target that as well from it, maybe a slightly different mechanism. But, there's a synergistic effect to multiple types of manual therapies, and I think that the underlying mechanism as to why something stays persistent to the best of our knowledge, it is how Brian has presented this. So, I think that yes, there's this decompression first has to happen and then sustained decompression such that the area drains. The only way that we know that it really clears out at least from our standpoint and can verify it is by checking to see if the tender point has been extinguished. Because remember, that is not a local manifestation as much as it is a central nervous system manifestation.

Ben:  And, that's where you go back up to the head and check, right?

Tim:  Well, no, you could check the local tender point. The scan that we use in the diagnostic state, when we're up at the head, we're looking to see is that region clear. But, it still tells me to go down and look to see if I've gotten all of the really bad tender points in the area. So, I might do one or two things, go back up and the head says, “You still haven't gotten it.” So, I got to go back down to recheck. When I get it gone, then our main diagnostic at the head no longer shows that the area is sensitive, and that would be an extinguished area so then we move on to the next thing.

Ben:  Okay, got it.

Now, it seems to me that it's not that surprising that this seems to do a good job alleviating some musculoskeletal conditions like aches and strains and a little joint pains and things like that. But, there's some other things that seem to be affected by musculoskeletal conditions like that, perhaps even some surprising things like say headaches or cardiovascular issues or emotional struggles like depression, things like that. I'm curious if you've come across some surprising applications of Counterstrain that actually really leapt out to you as conditions that you wouldn't expect to respond to something like this that actually did.

Tim:   Well, I would say that during the development of Counterstrain for the nervous system, we ran into things that I would say that we thought it was possible, conceptually prior to actually coming across the actual treatments that were the most effective. But, treating in the sympathetic and the parasympathetic nervous system can have a profound impact on PTSD, anxiety, depression in addition to things like you mentioned, cardiovascular problems. And, what you're looking at there is the central nervous systems affect through these peripheral neurons that are specific to the autonomic nervous system. 

And, what do they do? They function to regulate typically blood flow into organs, drainage out of organs. Some of the sympathetics can ramp up the activity of the cardiovascular system. Some of the sympathetic, the lower down ones into the GI can slow down the GI process. Parasympathetic obviously would speed up the GI process. So, you look at things like digestive disorders, constipation, irritable bowel disease, and in the heart and lung and tachycardia, difficulty breathing, maybe issues with O2 saturation levels and you're looking now at the functioning processes of the organs being regulated by the nervous system. And, being able to release specific nerve pathways that are sympathetic and origin means you can calm this aberrant tone in the nervous system and then you get a calmer organ system. Or, you get a calmer state within the body. 

A lot of these things obviously project back up into the brain. And so, if you have the persistent level of irritation coming from peripheral neurons that are sympathetic, then you constantly drive various parts of the brain that cortex into a state of anxiety. So, the person can experience an emotional state that they have no reason what they're feeling that they don't feel like it's coming from their brain. And, in this case, it's not, it's coming from their body. So, yeah, we do see application to things.

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That's fascinating. But, by the way, that makes me think about this upcoming treatment I have with, I think, Andrea from Spokane has come up to treat me in a couple of evenings. And, I was thinking about wearing like a real-time HRV monitor to see what was happening to the nervous system in terms of sympathetic and parasympathetic strain during a treatment like this. And, it sounds like there is a pretty big impact on the nervous system. Have you ever actually had anyone quantify that? 

And, when I say quantification, I guess I'm just kind of curious if you guys have ever quantified anything from what happens to HRV during a treatment or if you've looked into from a lymphatic drainage standpoint like presence of cytokines like measuring blood and biomarkers per your post-treatment or anything like that from a quantification standpoint.

Tim:  I think there's some ongoing studies happening right now. One by my friend, Dr. Holly Christy. She's a naturopath in Washington State. And, she took it upon herself to form a nonprofit, I think it's called the Bridge Back Organization or bridgeback.org. And, they target specifically PTSD, so they're reaching out to a lot of the first responders, military, and they've been doing some research now I think for the last three years, three or four years, and they have found at this point, I don't know that it's published yet, and so, hopefully, I'm not stating this in a pre-published state, but they have found that the Counterstrain method to treating PTSD so far has outpaced all other current methods. And, this is early preliminary findings in their research. So, that is being done. As far as heart rate variability, I have purely anecdotal from the athletes that I treat because they all wear some type of device, whether it's a Whoop and the Oura Ring is another one, I think, that can pick up on all these little variations within the cardiovascular system. They all report the same thing that their heart rate variability improved. So, it would make sense if you're removing a strain from a system that's pretty tightly controlled, the cardiovascular system is arguably extremely important. And so, fine-tuning how this thing runs and keeping a tab on every aspect of it, that's the job of the sympathetic nervous system and the intrinsic neural system within the heart itself.

So, yes, we have had reports and I can't say that this has been researched because this is something that has been happening over the last several years in our clinics, but it's certainly something I would say is ripe for research and a lot of idiopathic conditions in this region often turn out to be dysfunction. So, I think it's very difficult to image, take a CT or MRI and figure out what's going on from this world because you're looking at such small amounts of inflammation along a very tiny autonomic nerve pathway. Not general inflammation like you got a disc in the core that's upsetting the central nervous system.  So, it's probably very difficult at this point to image.

Ben: Okay, that makes sense. What about taking measurements on cytokines or inflammatory markers, anything like that? Have you guys looked into that?

Tim:  So, the article that you quoted before, impaired lymphatic drainage, interstitial inflammatory stasis. I think one of the co-authors, Jay Shah did do a study where they took a very small fluid sampling from a tender point, and they assessed it, and it was basically full of pro-inflammatory cytokines. So, we know that the tissues that become hypoxic and irritated, any tissue really if it becomes irritated to a point of it releasing an inflammatory cytokine, the ones that they typically release the most are your interleukin 6, interleukin 1B, and tumor necrosing factor-alpha. So, those three show up over and over and over again. They're the ones that shut down the lymphatic pump. They're the ones that are released during tissue trauma. Hypoxia can cause the body to release these. And then, depending on where it is like let's say this is all occurring in the gut, you might see that the entire GI becomes inflamed. And now, you have systemic levels of inflammation due to lymphatic drainage. Of the gut back into venous circulation. So then, you see levels of CRP going up.

So, when we see those things that we're thinking, “Oh, there's a mesentery problem, there's a GI problem that is creating this almost an autoimmune state of inflammation, and it's being propagated throughout the body.”

Ben:  Yeah, yeah. It's interesting too because when you think about a lot of idiopathic conditions or unexplainable illnesses and think about how many of them can be rooted to inflammation, it seems to me that even something like for people listening in, if you could find a practitioner and just at least start off with some a cranial scan to see what's going on because, for me, this is not necessarily trying to fix a disease or a serious issue, but I'm just curious about how the body would respond to a few episodes of this as far as just little aches and pains or just small things in terms of overall energy levels or sleep or anything like that.

So, I'm actually in in very curiosity-driven mode right now when it comes to receiving my own series of treatments here coming up. And, that's actually what I wanted to talk to you a little bit about was the whole logistics of this like what it's like to receive a treatment.

So, let's say someone schedules with a Counterstrain practitioner — I'll link to a bunch of directories if you go to BenGreenfieldLife.com/Counterstrain. Let's say someone goes in or in my case actually convinces the practitioner and pays a little extra travel time for it to have someone come to their house. What's that first treatment actually look like? And, how long can someone expect in that first treatment? And then, what happens as far as follow-up treatments are concerned if those are actually necessary?

Tim:  We come from a varied background, so that's one thing to get out of the gate here is we're massage therapists, athletic trainers, PTs, OTs, some osteopaths, some medical doctors, nurse practitioners, chiropractors. So, we have a pretty wide swath of allied health. And so, accessing an individual practitioner can look a little different. So, in my practice, it's cash and so people typically just call and schedule appointment. In other places, if you're seeing a physical therapist, there may be a physician involved and you might have to get a referral. 

So, it can go from you have a 30-minute session with somebody in some states to like we'll often see people for an hour or two hours. And, if they travel in from out of state, sometimes we'll increase it to a three-hour session. And then, the whole process basically begins with the same question and answer that you would experience at most PTs. We're trying to figure out like, is there a history here? What is the primary problem? And then, when we get into our diagnostic phase, we may look for an area that is in our mind and demonstrated through movements to be the area of greatest restriction or what we would identify as a key lesion. So, where is the body locked up the most? We're very motion-focused. So, I want to make sure that I'm not doing something in an area that works fine. I want to find what's stuck and alleviate it.

So, that's where I think the complexity of applying this, it's hard to get that across in a podcast, but we're looking literally at about 5,000 different locations on the body and probably somewhere in the neighborhood of a thousand, thousand to one hundred individual diagnostic locations. There's some overlap obviously like the thoracic spine, for instance, you have 12 ribs. So, there's a lot of things there that are done similarly. So, it wouldn't be an individual technique to say I did a rib treatment at T4 and a rib treatment at T5, they're the same thing. 

But, yeah, lots of different locations and we're looking at what's stuck and then identifying through our cranial scan diagnostics and then, of course, through individual system tender point identification, which ones are the primary ones. And then, we go right to work. And, we'll repeat that process multiple times. I think if you remember the session that we did back in May, I'd had to get up, move around, and see how things felt. And, until we alleviated four or five different systems, it was like, “Ah, it's still stuck, still stuck,” and then we got the fifth one out and you're like, “Yeah, it seems like that's free now.” Then, we move on to the next thing. So, it's a little bit of a exploration and you're a participant because you're giving constant feedback. A lot of people want to know how painful is it. And, really the technique is not painful but it will often locate specific locations. And, I would say most people want to know that we found something.

So, even though we can probably feel where something is painful, we often will push on the thing and verify that, yes, that is a pretty painful spot that we're going to treat. And, this whole process repeats over and over again throughout the entire session and we may find single system problems which are rare. What most common is three or four issues, you get a little problem with the arterial supply to something, the nerves are a little bit upset, the venous lymphatic system doesn't drain well, and maybe there's a myofascial chain that's tight. And then, you alleviate all of those in that area, and people like, “Wow, so that pattern of movement now feels very free.” 

So, that's how the process works, follow up. Unless it's a pretty simple thing, we're going to recommend a follow-up because you treat a bunch of things, you send the body away, the body does it to work. I'd say that the vast majority of what the body is going to do with the problem is done after manipulation, not during. So, that could be a good 24 to 48 hours of just laying low, not straining the system allowing the body to fully drain the area and go to work in terms of repairing things. And then, follow up, we typically will see people once a week. If it's a local person and they've got a chronic condition, once a week, once every two weeks is not uncommon. If it's more acute, we might want to see somebody a couple times a week and just keep the sessions shorter to get them over the hill faster.

Ben:  Yeah, yeah. It seemed as though really like when it came to these tender spots, it was like fine one, hunt it down, work on it, boom, that one's done, move on to the next one, move on to the next one. But, I also get the impression that some tender points might not respond right away to the first treatment and you got to hit them again in subsequent treatments.

Tim:  I would say that that happens when there are things that you didn't tease out in detail during the diagnostic process. So, if I've run into a situation where it's not going away, which this happens, happens to all of us, I instantly just stop what I'm doing, back out, and I re-examine because my expectation is that they will go away relatively quickly. You shouldn't be there for 10 minutes trying to get something to go away. That's just the body saying you may have missed the correct diagnosis, go back and look because when you alleviate the mechanical problem and it causes that area to open up and dilate and it pulls inflammation out, I should at least feel tissue texture change like something softened. 

And then, over the course of 15 or 20 seconds, the tenderness should be gone like just gone. So, if you run into stubborn ones, it's like, okay, this one's here but it may not be the one that is actually generating the pattern. So, I need to go find that. So, that's a diagnostic thing and you just go a little bit higher up the chain. Maybe you miss something in the brain, maybe there's something in the spinal cord itself, and that's usually what that situation means.

Ben:  Okay, okay, got it. That makes sense.

Now, what about somebody who doesn't have any significant injuries or aches or medical conditions even though I don't know if that person actually exists? But, let's take this theoretical perfect person. Let's say like an athlete and they just want to say run faster, lift a heavier weight, perform better, do you think there's any cross over here in terms of performance implications for somebody who's just like, “I'm going to do this as an ergogenic aid for performance?”

Tim:  There's multiple ways to answer this question. So, yes, I would say yes there are applications there. And then, there's wellness applications as well. So, I wouldn't say you have to have a specific complaint to come in and have somebody do this work. And, why do I say that? Your body has this insane ability to compensate for all kinds of things. I think you and I were just joking that we were kind of shocked that we survived our teenage years given the physical activity that we put our bodies through. And yet, here we are in our 40s and we're still okay, we're still here. So, do we still carry those histories with us? Well, absolutely. And, beyond that normal process of healing, what does your body hold on to? 

I would say that in many cases, the body resolves these situations. It does a good job of healing. And, it's the ones that stick around where you're like, “I'm going to need to assist that one because it didn't drain out when it was done scarring down.” And so, that's where our stuff comes in. But, people can have a lot of these that are sub-threshold. And, that really has to do with like where is their pain threshold really at? That's a varied gauge of what somebody will tolerate for 10 years, somebody else couldn't do for 10 minutes. So, that's very individual. And, someone can come in saying they feel pretty fine and I can do two hours of work on them and they get up and they're like, “I had no idea that I could feel better than I did.” So, it's people that have literally nothing wrong. That's their perception obviously because they're living in their body, but there's probably some sub-threshold things that just aren't hitting their consciousness. And so, they're not even aware that they're there. It's like spotting movement pattern disorders and be like, “Oh, that's a little tight right there,” but the person says, “Well, I don't really feel anything.”

So, yes, there's definitely performance enhancement, there's a wellness aspect to this, and there are sub-threshold dysfunctions that I would say you just want to keep them away. It's like you don't drive your car for five years not doing an oil change and just wait till it breaks. You do preventative maintenance. So, I would say that this fits into that role. So, if you had no problem whatsoever, you felt great, you're very active or whatever and you just want to add something to your wellness routine four times a year. I say come in with the seasons and work with one of us for one or two hours, and let's just eradicate things that you probably build up over time. And, you just keep everything quiet. And so, things don't manifest that way. 

Plus, and this is specifically for you as an athlete and other athletes, you're always pushing the envelope, always. So, the likelihood that you tear something during athletic competition, if you had one of these latent dysfunctions is higher. You may not be aware of it, but the chance that you push beyond the extensibility of some tissue due to the fact that it doesn't move as well as it could if it was completely healthy just increases your risk of injury.

So, I think you probably saw in the book I worked directly with Diego Valeri who was a Portland Timbers for nine years. He came up from Argentina when he was 26, I think, left recently left last year at the age of 35. And, when I met him in 2015, his body was full of these things. He was very stiff, his rib cage didn't move very well, he said he could no longer jump because his ankles had been sprained so many times. He didn't have the flexibility to jump. His speed was definitely lower. His endurance was fine, but he's a professional athlete so I think they manage their expenditures quite well. They know how to get around and not burn themselves out. And, he was a master just seeing the field. So, he had a lot of other things that he could dwell upon, but his physical body was definitely not functioning to the best that it could. I think he told me he tested last in their functional movement assessment that they do every year, last in the entire team. So, that was in 2015.

By early 2017 about a year and a half later, he had leapfrogged the entire team and was now the best in terms of his functional movement capacity. And, that was after a year of working with us here at Counterstrain Portland removing again all these things that had basically made it difficult for his body to move like a normal one. He accumulated all of these dysfunctions. He also regained the ability to jump. And, I don't know if you noticed in 2017 but he got the league MVP, and I think he had 21 goals. Fully half of those were jumping headers. So, performance enhancement, yes, functional improvement, yes, longevity, yes, and then of course just looking at the wellness like how do you improve everything so that your body just feels better, performs better. I think all those things fit quite well. We do quite a bit of wellness work here as well.

Ben:  Yeah. And, that's obviously a pretty good testimonial from a performance standpoint. Back to Tony Robbins who introduced me to this protocol and they connected me with you guys, I recall back in the day he was into this form of somatic therapy for pain called network spinal analysis or NSA, which I haven't had done but apparently, they put light touch on certain parts of your spine to release tension and then they say then that frees up energy and increases flexibility in the spine and decreases back pain and heals the nervous system. It seems to me like this is pretty similar except you're working higher up in the central nervous system up in the head instead of the spine. Do I understand that correctly?

Tim:  I've known a few network providers. Obviously, I run into them at Tony's events. And, yeah, there's a lot of similar, there's a lot of overlap in manipulation. And so, the areas that they focus on are like spinal cord reflexive centers. Obviously, the spinal cord, 69 million nerves, highly sensitive structure, orchestrates everything, has all your preganglionic autonomic nerves to every organ in your body, every vascular structure. So, if you wanted to have a full body impact, you're basically left with head or spinal cord. And, those two things, it will absolutely touch every aspect of the body. 

As far as them not doing, I'm not sure if there's nothing that they do with the head or if it's just that they focus primarily on the spinal cord itself. But, I would assume that there's impact there as well because every time we do spinal cord work, for instance, you can feel things in the head changing as well. So, you can imagine something like a second-order motor neuron that actually originates in the motor cortex. And so, when you follow from the motor cortex down to the brain stem to the opposite side of the body, that's a one continuous neuron pathway until it lands on whatever nucleus that it's going to communicate with in the spinal cord. So, it's not like they're not having an impact on the brain, it's just I think they focus a little bit more in the spine. But, I think that they're, like I said, very similar in terms of the central aspect and the whole emotional element. It's like you can't remove certain things from the work that you do because we're a unified being, our souls, our spirits, and our body are one thing. They may live in different realms, but these are our uniform. I would say every person I've seen that has had like an emotional trauma when we begin to work, it's like you're not just impacting their physiology like there is an absolute emotional element to this or an energetic element to this. It's just not the intent of many practitioners like they don't intend to work directly with that. And so, sometimes that happens during a treatment and they're not exactly sure what exactly is going on, but the connection is extremely strong. They have tapped in far more I think to that energetic side like you said.

Ben:  Yeah, yeah. This just once again highlights the fact that there's more than one way to address some of these issues and I've experimented with a lot of stuff. Folks probably remembered my podcast with the Human Garage who does all sorts of fascia manipulation. I interviewed my massage therapist. I've had practitioners come over to my house. I had the another guy I'm blanking on his name, he did kind of like a mapping with the eyes and the vagus nerve and an eye movement resensitization type of protocol. And, a lot of this stuff's just kind of fun to play with and see what actually works for your body when you throw that noodle against the wall so to speak, and see if it sticks.

So, based on that Tim, could you explain if there's a practitioner listing in who wants to learn how to do this stuff on their patients where they would go and then also if there's someone listening who just wants to go and experience Counterstrain for themselves where they should go.

Tim:  Sure. So, I would assume you have people on your call here that are global like an international group.

Ben:  Yeah.

Tim:  So, in cases where you're in certain countries, it's going to be difficult to get access to training, but we do have trainings that occur in Indonesia, in Australia, and throughout Europe. We've got courses running primarily in France, but we've got practitioners in Italy and the UK and Germany. So, we're spreading but it's fairly new. Like I mentioned before, it hasn't been around that long. In fact, the form that we're really discussing here debuted in 2008. So, that's a little bit of the history as to why this is still in its infancy. 

But, the best ways to go is Counterstrain.com and there's a listing there of practitioners, but there's also training. So, you can click on the Training tab and it gives you an overview like what the training is like and where you would do it. And then, if it's in a foreign country, it's not the U.S. There are links there that take you directly to, the host partners that run courses in those countries. And, that's the best first step. If you're curious about what the amount of time is, it's going to vary from one person to the next. But, at the moment, there's about 12 courses that span every system in the body. And, each one of these lasts about three days. So, if you looked at it from a day standpoint, it's limited, but the amount of information that we often present is enough to keep you busy for three to six months. So, you could stretch that out over for three, four years.

And then, somebody who wants to experience it also on Counterstrain.com is a database of people that have taken their courses. I think there's around a thousand on there currently. We get people registering all the time for a profile. They just have to take at least four of our classes to get on there. So, there's likely another thousand out there that haven't achieved that and so they're not listed on there. But, it has grown tremendously since its inception. There were only 22 people in the first class, and that was in 2008, and this thing has grown and grown. So now, we're seeing a very healthy introduction of new people into our courses which we're very excited about. But, I know your clientele is likely a good portion of them I think are probably in this medical field just based on my own research looking into who you speak to.

Ben:  Yeah, yeah, a ton of practitioners listening. So, what I'll do is I'll link to all the resources as well as previous podcasts I've done, my chat with Tony and Peter about this. And, this will be cool for people to see like I mentioned, Tim when you're at the house, we had a videographer capture your entire initial treatment on me and you guys can see my reaction and perhaps read by my face how tender or non-tender the points were. And, you can see Tim actually mapping my head and doing the cranial scan. So, I will embed that video also if you go to BenGreenfieldLife.com/Counterstrain. It's BenGreenfieldLife.com/Counterstrain. And, as I go forward and get a few treatments done, I'll keep you guys posted about anything else that I experienced with this pretty cool form of manual therapy.

So, Tim, thanks so much for coming on the show and sharing all this with us, man. I think it's fascinating. And again, I'm excited to experience a little bit more of it.

Tim:  Yeah. And, Ben thank you so much for being open to having me up at the house. That was a blast. I loved being able to interact with you and just very appreciative of the opportunity. So, thank you very much. Really appreciate it. 

Ben:  Awesome, awesome. Well, folks, I'm Ben Greenfield along with Tim Hodges from Counterstrain signing out from BenGreenfieldLife.com, have an amazing week.

More than ever these days, people like you and me need a fresh entertaining, well-informed, and often outside-the-box approach to discovering the health, and happiness, and hope that we all crave. So, I hope I've been able to do that for you on this episode today. And, if you liked it or if you love what I'm up to, then please leave me a review on your preferred podcast listening channel wherever that might be and just find the Ben Greenfield Life episode. Say something nice. Thanks so much. It means a lot. 



When I interviewed Tony Robbins and Peter Diamandis in the episode “Tony Robbins, Peter Diamandis & Ben Greenfield Reveal New Anti-Aging Biohacks & Breakthroughs in Precision Medicine You’ve Never Heard Of Before.“, we discussed a special form of injury and recovery physical therapy called “Counterstrain,” which was also featured in Tony's book Lifeforce and is a cutting-edge manual therapy technique that provides relief from pain and dysfunction.

I was so interested in this protocol that I had one of the leaders in the Counterstrain movement – Tim Hodges – fly to my house to do a treatment on me. It was like nothing I've ever experienced, so I hosted Tim on this podcast to delve into exactly what Counterstrain is, who it's for, and what it does exactly.

Tim Hodges has worked in the field of physical rehabilitation since 1996. He is involved in the ongoing development of the Counterstrain technique and the creation of training programs renowned for producing highly-skilled Counterstrain Practitioners. In 2003, Tim started his private practice, now called Counterstrain Portland. A Teaching Assistant since 2003 and Facial Counterstrain Instructor for the Jones Institute since 2014, he is one of a select few certified to teach the modern version of Counterstrain.

Tim has helped Brian Tuckey develop many of the Counterstrain techniques used today. He continues to apply his expertise in the field through private treatment at Counterstrain Portland, the mentoring of Healthcare Practitioners at the Counterstrain Academy, and by teaching large-scale continuing education seminars for health care providers. Tim created counterstrain.com, the Counterstrain brand, and along with Brian Tuckey, developed 3D Counterstrain.

During our discussion, you'll discover:

-What is Counterstrain, and how was it developed?…07:03

  • Originally known as “Strain Counterstrain” or the Jones Technique
  • Story about Jones’ sleepless client and how after treatment had the best sleep of his life
  • Specific tender point locations on the body indicate what position needs to be performed
  • A blend of osteopath and chiropractic medicine; shared origins

-Definition of tender points…10:35

  • Trigger points are related to the myofascial structure  
  • Tender points can come from a visceral structure, peritoneum, vascular or arterial, nerves, and bone
  • Retrograde inflammation; multiple inputs to a singular location 
  • Methods/ways of removal

Difference between fascial Counterstrain and trigger points…13:13

  • Identifying the problem by looking at the tender point as a messenger from the central nervous system 
  • Difference between an ART practitioner 
  • Sensory mechanism failure points
  • Posture change and weak spots

-What is a cranial scan and identifying the areas needing treatment…17:09

  • Everything in the body is connected
  • A cranial scan identifies the problematic parts of the body
  • Identify what part of the head is stuck
  • Map out the crania based on bone, ligaments and spinal cord, lymphatics, visceral tissues, myofascia, nerves
  • Identify sympathetic or somatic nerves, the dural membranes, including the vascular tissues of the brain, etc. 

-How lymphatic drainage occurs…20:49

-Lymphatic drainage massage in conjunction with Counterstrain…24:05

  • Massage therapy and certain chiropractic techniques help
  • There's a synergistic effect between multiple types of manual therapies
  • Decompression has to happen first
  • The scan checks the local tender point to see if that region has been cleared

-Surprising applications of Counterstrain…25:42

  • Effective at treating the sympathetic and the parasympathetic nervous system, has a profound impact on:
    • PTSD
    • Anxiety and depression
    • Cardiovascular problems
    • Central nervous system 
    • Regulate blood flow into the organs 
    • Digestive disorders, constipation, irritable bowel disease
    • The heart, like tachycardia
    • Lungs, difficulty breathing
  • A calmer organ system = a calmer state within the body
  • Strain Counterstrain: Current Concepts And Clinical Evidence

-HRV data during treatment from a quantification standpoint…31:03 

-Logistics on what it's like to receive treatment…35:56

  • Counterstrain Practitioners
  • People typically just call to schedule an appointment
  • Sessions vary from 30 minutes to 1-2 hours, could be three-hour sessions for out-of-state patients
  • Process involves:
    • Patient history
    • Identifying the primary problem
    • Diagnostic phase
  • Identify areas of greatest restriction
  • Looking at 5,000 different body locations and thousands of diagnostic locations

-Could this be used to enhance the performance of healthy individuals?…41:48

-How to connect with Tim…49:30

-And much more…

-Upcoming Events:

Resources from this episode:

– Tim Hodges:

Brian Tuckey

– Podcasts:

– Other Resources:

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