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By Dr Sarah Varmalis, Senior Osteopath Ehlers-Danlos Syndrome (EDS) is a group of genetic conditions that affect the body’s connective tissue. Connective tissue is what gives structure and support to things like ligaments, skin, blood vessels, and even internal organs. It’s essentially the “scaffolding” that holds everything together. In people with EDS, this connective tissue is more elastic and less supportive than usual. This often shows up as joints that move more than they should (sometimes called hypermobility), skin that may be more stretchy or fragile, and a tendency toward injuries like sprains, dislocations, or ongoing aches and pains. But EDS isn’t just about being “flexible.” Because connective tissue exists throughout the entire body, it can affect multiple systems. This means people may experience a wide range of symptoms; from joint pain and fatigue, to digestive issues, dizziness, or difficulty regulating energy levels. It can look very different from one person to another, which is part of why it’s often misunderstood or missed early on.  Learning More and Getting Diagnosed For those wanting to better understand Ehlers-Danlos Syndrome, ‘The Ehlers-Danlos Society’ is one of the most trusted resources available. They provide up-to-date information on the different types of EDS, as well as guidance around diagnosis and management. The current diagnostic criteria (particularly for hypermobile EDS (hEDS)) can be found here: https://www.ehlers-danlos.com/heds-diagnostic-checklist/ Diagnosis is not always straightforward. It typically involves a combination of medical history, physical assessment (including joint hypermobility), and ruling out other conditions. For many people, the process can take years. EDS also rarely exists in isolation. Because connective tissue is found throughout the body, it’s common to see overlap with other conditions and symptoms, including:
 An Osteopathic Approach to Ehler-Danlos Living with a condition like Ehlers-Danlos Syndrome (EDS) or ongoing chronic pain can feel confusing, frustrating, and at times, overwhelming. Many people go years trying different treatments, often being told that everything looks “normal” despite still feeling far from it. From an osteopathic perspective, the focus shifts away from chasing symptoms and toward understanding how the whole body is functioning and more importantly, where it’s struggling to adapt. What’s Actually Going On? Ehlers-Danlos Syndrome is a connective tissue condition. In simple terms, the “glue” that holds the body together; ligaments, fascia, blood vessels, even organs have a different structure. This often leads to increased flexibility, but that flexibility comes at a cost: reduced stability. Over time, the body works harder to compensate. Muscles overwork, joints become irritated, and the nervous system becomes more sensitive. This is where chronic pain can start to take hold. But here’s the key thing; pain in these conditions isn’t just about joints being “loose.” It’s about how multiple systems in the body are interacting and, in many cases, becoming overloaded. Why Traditional Approaches Don’t Always Work A lot of treatments focus purely on strengthening or stabilising joints. While that can absolutely be helpful, it often doesn’t address the full picture. In people with EDS or persistent pain, there are often underlying drivers such as:
A Different Way of Looking at the Body Osteopathy takes a whole-body approach. Rather than asking “where does it hurt?”, the question becomes “why is the body under strain in the first place?” Two techniques that are particularly useful in these cases are:
Counterstrain: Calming the Nervous System Counterstrain is a technique that focuses on tender points in the body, small areas that reflect dysfunction in muscles, nerves, blood vessels, or organs. Rather than stretching or pushing into pain, the body is placed into positions of ease. These positions are held briefly, allowing the nervous system to “reset” its perception of that area. In patients with EDS or chronic pain, this can be incredibly powerful. Why? Because the nervous system is often running in a heightened, protective state. Counterstrain helps reduce that sensitivity, allowing muscles to relax and improving how the body coordinates movement. A key part of this process is the cranial scan. By gently assessing points along the skull, practitioners can identify which systems in the body are under strain—whether that’s vascular, neurological, or visceral. It becomes a roadmap for treatment, rather than guessing where to start. The Barral Approach: Supporting the Organs When people think about pain, they rarely think about organs but they should. The Barral approach (often called visceral manipulation) looks at how organs move and interact with surrounding structures. Each organ has its own natural rhythm and mobility. When that movement is restricted, it can create tension patterns throughout the body. For example:
In EDS and chronic pain conditions, these subtle restrictions can play a much bigger role than expected. By gently improving how these structures move, the body often finds it easier to settle, stabilise, and function more efficiently. Why Gentle Treatment Matters One of the biggest misconceptions is that stronger or more forceful treatment leads to better results. In reality, for people with EDS or heightened pain sensitivity, the opposite is often true. The body responds best to:
Both Counterstrain and the Barral approach respect this. They work under the body’s tolerance, rather than pushing past it. What Patients Often Notice While every person is different, common changes patients report include:
Importantly, progress is usually gradual and layered—because the body is unwinding patterns that have often been there for years. The Bigger Picture Managing Ehlers-Danlos and chronic pain isn’t about finding a single “fix.” It’s about helping the body become more adaptable, more efficient, and less reactive over time. Osteopathy, particularly when using approaches like Counterstrain and Barral, offers a way to support that process gently and intelligently. It’s not about forcing the body into place—it’s about giving it the space and input it needs to find a better way of functioning. By Dr Sarah Varmalis, Senior Osteopath When most people think of osteopathy, they imagine joints being gently mobilised, muscle tension being soothed, and maybe some back pain relief. But osteopathy is so much more than just musculoskeletal care. It’s a hands-on, whole-body approach that can also support and restore balance to our internal organ systems. Yes, that means your liver, kidneys, stomach, lungs, intestines, and even your reproductive organs.  The Body’s Inner Landscape: Visceral Connections The Barral Institute has been a leading voice in teaching and researching how manual therapy can influence the health and mobility of the internal organs, a field known as visceral manipulation. According to their work, every organ in the body needs to move freely to function properly. Think of it like this: your diaphragm moves up and down 20,000 times a day with each breath. If your organs are restricted, that repetitive motion creates strain and compensation patterns throughout the body. Over time, these restrictions, caused by things like surgery, infections, trauma, inflammation or even emotional stress, can reduce an organ’s mobility. And when one part of the system isn’t moving well, it throws off the balance of everything else. That’s where osteopathy comes in. How Osteopathy Helps Organ Systems Osteopaths trained in visceral techniques gently assess the motility (natural rhythm) and mobility (movement in relation to surrounding structures) of the organs. Using light, specific techniques, often with barely any pressure, we aim to restore the subtle motion between organs and their surrounding fascia, ligaments, and muscles. This can have a profound effect not only on the function of the affected organ, but on your overall sense of health and wellbeing. Improvements can show up as:
Counterstrain and the Autonomic Nervous System Another powerful system we use is Counterstrain, especially the fascial and visceral branches of this method developed by Brian Tuckey. While traditional Counterstrain focuses on tender points in muscles, newer developments explore how fascia and nerves influence visceral dysfunction. One fascinating area is the autonomic nervous system - the network of nerves that keeps your organs functioning behind the scenes. Inflammation or tension in certain tissues can create reflexes that keep the body stuck in a heightened stress response. This contributes to chronic issues like IBS, anxiety, hormone imbalances or fatigue. Using gentle positioning and sustained pressure on precise reflex points (often found through cranial scanning techniques), osteopaths can unwind restrictions in:
What a Session Might Look Like In practice, a treatment for organ support might start with a cranial scan or palpation of the abdomen. You won’t necessarily feel a big adjustment like in some other therapies. Sometimes the techniques are so subtle you wonder if anything’s happening... until you realise you’re breathing easier, your abdomen is softer, or a pain you didn’t even mention has faded. Many patients report feeling deeply relaxed after treatment, with improved digestion, reduced bloating, or a general sense that their body is functioning better — because it is. Who Can Benefit? Visceral and neural-fascial osteopathic approaches can be helpful for people experiencing:
In Summary Osteopathy isn’t just about backs and necks. With the right training and a gentle, informed touch, we can assess and treat restrictions in organ systems, nerves and fascia, supporting your body’s ability to function, digest, detox and thrive. If you’ve tried everything else and still feel like something’s not quite right, your organs might be asking for some osteopathic attention. By Duke Autret, Myotherapist Mapping the ‘Inflammatory’ Terrain of a New Clinical Frontier In the age of chronic inflammation, persistent pain, long-haul syndromes, diffuse mystery symptoms and systemically ‘invisible’ illness conventional diagnostic models are breaking down. Patients present with seemingly random multisystem complaints like digestive, neurological, musculoskeletal, psychological etc, and are met with more symptomatic labels and pharmaceutical management, so modern healthcare finds itself increasingly challenged. Blood tests, MRIs, and CT scans often fail to detect the low-grade and ‘sub-clinical’ dysfunctions that millions live with daily. Yet beneath the threshold of detection lies a potent and persistent and only recently observable reality: inflammation trapped in the fascial system (the soft tissue scaffolding that organizes and communicates across the entire body). So what if the issue isn’t just at the level of tissue, or even the organ, but instead at the level of terrain? And what kind of terrain is fascia? Welcome to the clinical frontier of Fascial Counterstrain (FCS), a method that brings technical precision to a biological paradigm that has long been ignored.  Fascia: From Framework to Feedback System Traditionally thought of as inert packing material, fascia is now understood as an intelligent, contractile, and highly innervated organ. Fascia isn’t just structural, it’s sensory. It wraps every nerve, vessel, organ, and muscle and is loaded with nociceptors (pain sensors) and proprioceptors (motion, balance, posture sensors). It contains contractile cells (myofibroblasts) as well, and when inflamed, it becomes the central interface between body, brain, and environment. Whether the inflammatory driver is viral (e.g., post-COVID), chemical (PFAS, microplastics, spike proteins), metabolic (diet, blood sugar), or postural (strain), or injury (trauma), the body reacts with cytokine release. This sets off a cascade
Fascia and Inflammation When the body experiences trauma, infection, surgery, chronic stress, poor posture, or toxic exposures, inflammatory cytokines like IL-1B, IL-6, and TNF-alpha flood into the interstitial fluid, triggering the cascade:
Why Conventional Approaches Fall Short Pharmaceuticals travel in blood, not lymph. Most physical therapies target muscles, not neurovascular or visceral fascia. And traditional diagnostics don’t detect the subtle physiologic dysfunction in fascia or lymphatics. And moreover, this inflammatory stasis doesn’t just cause pain. It alters movement, impairs organ function, limits perfusion (blood flow and nutrient/waste exchange), and even contributes to neuro-degeneration and cognitive decline (think, brain fog, early dementia, post-viral syndromes). In fact, trapped inflammation in the brainstem can affect everything from digestion to heart rate to anxiety. This is the Inflammatory Paradigm; the recognition that many chronic conditions are driven by persistent, unresolved inflammation, not at the organ or blood level, but at the fascial and interstitial levels. Enter Fascial Counterstrain Fascial Counterstrain is not a “direct” technique in the traditional sense. It’s not about stretching or mashing tight tissues. It is a system of precisely targeted decompression designed to drain inflammation and restore fluid flow. By identifying tender points (the surface markers of deeper inflammatory reflexes) and applying exact vector-based positioning, practitioners can slacken specific fascial structures (e.g., the sheath of a nerve, the adventitia of an artery, or a ligament of the liver for example), reactivate lymphatic flow, and break the inflammatory loop. Results are often immediate and lasting. Patients can walk out with restored range of motion, less pain, and improved function, sometimes after decades of dysfunction. But the key is that deeper layers, not just the symptom, is what’s being treated. A Systems-Based Approach In FCS, dysfunction is not isolated. A tight psoas may be guarding a congested iliac artery. Piriformis syndrome might stem from an inflamed cecum. A TMJ dysfunction could be driven by trigeminal nerve irritation, brainstem inflammation or dysfunction of the mesentery! This approach requires systemic fluency, understanding not just muscles and bones, but vascular beds, autonomic reflexes, lymphatic flow, organ attachments, and the central nervous system. As such muscle guarding is oftentimes secondary. FCS is, therefore, true precision therapy, not because it uses advanced tech or pharmacogenomics, but because it targets the correct layer of dysfunction in the right sequence. Rather than mashing buttons on the game controller to try and make something happen, it’s playing the right sequence at the right time that makes it highly effective. Wellness vs Symptom Relief This goes beyond pain relief. FCS doesn’t just clear symptoms, it supports the whole system by improving perfusion, oxygenation, and neural conductivity, it supports tissue regeneration. But it also reveals something deeper, we are only as healthy as our terrain. If the body is perpetually inflamed, because of stress, sugar, poor sleep, endocrine disruptors, viral debris, or biomechanical strain, it will not heal, no matter how targeted our treatment. This is why frameworks like the “buckets of health” are also crucial to appreciate:
The Bigger Picture - Terrain, Not Just Technique Most patients (and clinicians) want discreet solutions. A method. A protocol. A “fix.” And FCS delivers that in many cases. But the truth is also that the context in which we live (environmentally, socially, nutritionally) is flooding the system faster than it can be drained. This means FCS must be understood not just as a technique, but as a diagnostic lens, a way of reading where the system is burdened, congested, or trapped. And from that lens, we must ask deeper questions:
Reclaiming Our Terrain Fascial Counterstrain isn’t a silver bullet. But it is a paradigm shift, a way of seeing the body not as a machine with broken parts, but as a fluid, intelligent system locked in struggles with its environment. A system designed to heal, if only we can help it along the way to free itself up. In a world filled with chronic inflammation, we don’t just need better medicine, we need a new map. And that map may just be drawn through fascia. If you're seeking an osteopath or myotherapist working in our clinic and you're ready to go beyond symptom chasing, if you’re seeking a clinical framework that bridges physiology, neurology, fascia, and fluid flow, then we invite you to reach out and ask us about who is your best fit to try out this exciting new modality for yourself! Precision with a Paradigm Fascial Counterstrain brings a rare offering, a technically precise treatment within a whole-body, systems-aware paradigm. By identifying tender points (surface markers of deeper fascial inflammation) and using indirect decompression techniques, FCS:
Coming Up Next: When Precision Fails Without a Paradigm In my next blog, we’ll zoom out further, to explore how modern medicine's obsession with precision can actually blind us to the larger systems that make us sick in the first place. Why do so many people seek discreet hacks instead of meaningful change? And how can clinicians bridge the gap between technical care and paradigmatic wellness? By Dr Sarah Varmalis, Senior Osteopath Counterstrain is a gentle, hands-on therapy that helps the body release tension, restore mobility, and calm an overactive nervous system. It works by identifying very specific points of irritation — often where fascia (connective tissue), nerves, blood vessels, or organs have become irritated or inflamed — and then positioning the body in a way that allows those tissues to “let go” of their protective reflexes. This isn’t a technique that forces anything to change — it invites the body to reset itself. Counterstrain is based on the idea that pain and restriction often come from the body trying to protect itself. When something gets overstretched or irritated, the body can clamp down around it. That’s helpful in the short term — it stops you from injuring yourself further — but over time, it can create layers of compensation and dysfunction. Counterstrain gently unwinds that.  A Short, Winding History of Counterstrain Like many good stories in osteopathy, this one starts with curiosity. Back in the 1950s, Dr. Lawrence Jones, an osteopathic physician in Oregon, was treating a man with chronic back pain. The patient couldn’t stand upright, and nothing seemed to help — not adjustments, not stretches, not rest. So Dr. Jones tried something different: he propped the man up with pillows in a way that felt totally comfortable — no pulling, no pain. He let the patient rest like that, and when the man stood up… he was about 80% better. Not just temporarily, either — the results lasted. Jones was fascinated. He started experimenting with this approach and noticed that if he held the body in these pain-free positions for about 30 to 90 seconds (sometimes shorter, sometimes longer), the body would often relax, reset, and the pain would diminish. He called the sensitive areas he worked on “tender points,” and over time, he mapped out over 200 of them. This method became known as Strain-Counterstrain (SCS). Fast forward a few decades, and one of the few physical therapists trained directly by Dr. Jones — Brian Tuckey — took the work even deeper. He noticed that a lot of dysfunction didn’t seem to be coming from muscles alone. Instead, it was showing up in the fascia around nerves, blood vessels, even organs. These deeper systems had their own reflexes and protective patterns. Tuckey refined the technique to target these more complex areas, and Fascial Counterstrain (FCS) was born. Today, there are thousands of known tender points — and we’re still finding more. How Does It Work? Your body is wired to protect itself. When something hurts — whether it's a twist, strain, inflammation, or infection — your nervous system often responds by tightening up around it. That’s a smart move at first, but if it sticks around too long, it can become part of the problem. Counterstrain works by gently placing the body into positions that turn off these protective reflexes. When we find the right tender point, we guide the body into a posture that’s as comfortable as possible — which might mean curling around it, twisting slightly, or supporting the area. We hold that position for 30 to 90 seconds (or a little longer, if needed), allowing the tissue to reset. This process can reduce pain, improve movement, and calm the nervous system — all without needing to stretch, crack, or force anything. Using the Cranial Scan to Guide Treatment One of the key tools I use in Counterstrain is the cranial scan — a gentle, hands-on assessment that helps pinpoint exactly where the body’s restrictions and tender points lie. By lightly palpating specific points along the skull with minimal force, I can feel for subtle restrictions or tension patterns in the tissues. For example, if I detect a restriction along the superior temporal line, that clue helps me identify which system or region in the body needs attention. This scan guides me in locating the precise tender points to treat, whether they’re related to muscles, fascia, nerves, or other connective tissues. It’s a bit like tuning in to the body’s signals, allowing the treatment to be targeted, effective, and incredibly gentle. What Does It Feel Like? Most people describe it as relaxing, relieving, or strangely satisfying. You’ll be guided into a very specific, comfortable position — often using soft bolsters or the practitioner’s hands for support. You don’t need to stay fully clothed during the session — wearing appropriate undergarments or soft clothing that allows direct skin access is usually recommended, depending on the area being treated. While the position is being held, you might feel warmth, pulsing, or even a wave of tiredness. That’s a good sign — your nervous system is shifting gears. After the release, the practitioner will slowly bring you out of the position and recheck the area. Often, people notice improved range of motion, less tenderness, or an immediate lightness in the body. What Kinds of Issues Does Counterstrain Help With? Because it works with the body’s reflexes and connective tissues, Counterstrain can help with a surprisingly wide range of issues — even some that don’t seem “muscular” at all. Here are just a few things it may help with:
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Mel Simon (Senior Clinical Myotherapist) and Dr Sarah Varmalis (Senior Osteo) are available 7 days a week at our Boronia clinic. Archives
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