Use of Osteopathic Counterstrain for Postoperative Incisional Pain Following Minimally Invasive Surgery: A Case Report
- 1General Surgery, Central Surgical Associates, Jackson, USA
- 2General Surgery, Edward Via College of Osteopathic Medicine, Monroe, USA
- 3Surgery, Willis-Knighton, Shreveport, USA
Abstract
Postoperative pain is commonly managed using multimodal analgesic strategies. Osteopathic manipulative treatment has been investigated as an adjunct to conventional postoperative care, although evidence regarding individual osteopathic techniques remains limited. We present the case of a 68-year-old woman who developed focal pain at trocar sites following robotic-assisted paraesophageal hernia repair with gastropexy. On postoperative day one, osteopathic evaluation identified localized tenderness corresponding to bilateral anterior thoracic 9 (AT9) counterstrain tender points. The patient reported an incisional pain score of 3/10, while tenderness at the identified points was assigned a baseline value of 10/10 for assessment during treatment. Following initial positioning into the counterstrain position of ease, the patient reported complete resolution of tenderness, with the tenderness score decreasing to 0/10 and remaining 0/10 throughout the 90-second treatment interval and following return to neutral. She subsequently reported no further abdominal pain during the remainder of her hospitalization and was discharged on postoperative day 3 following an upper gastrointestinal contrast study demonstrating no evidence of contrast leakage near the hiatal hernia repair. This case describes the application of osteopathic counterstrain for focal postoperative tenderness following minimally invasive surgery. Because this is a single-patient observation without a control condition, the observed temporal association cannot establish treatment efficacy, causality, or a specific relationship between the identified tender points and the surgical sites. Further controlled investigation is warranted to determine whether this response is reproducible and specific to counterstrain.
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BibTeX
@article{ponce2026osteopathic,
title = {{Use of Osteopathic Counterstrain for Postoperative Incisional Pain Following Minimally Invasive Surgery: A Case Report}},
author = {Alexander Ponce and Alexander D Gendreau and Sahana R Padumane and Spencer Hays and Mark H Smith},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117101},
url = {https://europepmc.org/article/PMC/PMC13716539},
note = {CC BY},
}
RIS
TY - JOUR
TI - Use of Osteopathic Counterstrain for Postoperative Incisional Pain Following Minimally Invasive Surgery: A Case Report
AU - Alexander Ponce
AU - Alexander D Gendreau
AU - Sahana R Padumane
AU - Spencer Hays
AU - Mark H Smith
PY - 2026
DA - 2026/09/28
JO - Cureus
DO - 10.7759/cureus.117101
UR - https://europepmc.org/article/PMC/PMC13716539
AB - Postoperative pain is commonly managed using multimodal analgesic strategies. Osteopathic manipulative treatment has been investigated as an adjunct to conventional postoperative care, although evidence regarding individual osteopathic techniques remains limited. We present the case of a 68-year-old woman who developed focal pain at trocar sites following robotic-assisted paraesophageal hernia repair with gastropexy. On postoperative day one, osteopathic evaluation identified localized tenderness corresponding to bilateral anterior thoracic 9 (AT9) counterstrain tender points. The patient reported an incisional pain score of 3/10, while tenderness at the identified points was assigned a baseline value of 10/10 for assessment during treatment. Following initial positioning into the counterstrain position of ease, the patient reported complete resolution of tenderness, with the tenderness score decreasing to 0/10 and remaining 0/10 throughout the 90-second treatment interval and following return to neutral. She subsequently reported no further abdominal pain during the remainder of her hospitalization and was discharged on postoperative day 3 following an upper gastrointestinal contrast study demonstrating no evidence of contrast leakage near the hiatal hernia repair. This case describes the application of osteopathic counterstrain for focal postoperative tenderness following minimally invasive surgery. Because this is a single-patient observation without a control condition, the observed temporal association cannot establish treatment efficacy, causality, or a specific relationship between the identified tender points and the surgical sites. Further controlled investigation is warranted to determine whether this response is reproducible and specific to counterstrain.
SN - 2168-8184
ER -