14: Intro To Counterstrain Flashcards
Counterstrain type of technique
Passive, indirect
Use for Counterstrain
Musculoskeletal pain
How is diagnosing for Counterstrain unique?
Focus on tenderness, not preference of motion
When and by who was counterstrain started?
1955, Dr. Lawrence Jones
Story of how counterstrain started
Pt came in with 2.5 months of psoas syndrome, couldn’t get comfortable while sleeping. Physician helped him find a comfortable spot on the table -> left and came back and pt was much improved
What happens to tenderpoint TART findings during counterstrain treatment?
They soften and reduce in pain
Amount of time to hold for counterstrain
90 seconds
Dr. Travell and Dr. Jones
Published about tenderpoints and trigger points
Trigger point vs tenderpoint: location
Trigger point: in muscle only
Tenderpoint: in muscle, tendon, ligaments, or fascia
Pain pattern in trigger pt vs tenderpoint
Trigger point: characteristic pain pattern with local radiation
Tenderpoint: no characteristic pattern and no radiation
Tautness of tissue in trigger point vs tenderpoint
Trigger point: have a taut band of tissue that will twitch when palpated
Tenderpoint: no taught band or twitch response
Only requirement to do counterstrain on a patient
Must be able and willing to be positioned and relax
Two ways to name tenderpoints
- Using laterality + the vertebrae (ex: L PC4)
2. By anatomic structure being treated (ex: L Psoas)
Counterstrain treatment nomenclature steps
- Flex or extend
- Sidebending away or towards tenderpoint
- Rotating away or towards tenderpoint
What would the counterstrain treatment be for R PC6?
E, SaRa
Uppercase vs lowercase letters in counterstrain treatment
Lowercase = a little Uppercase = a lot
Maverick
Tenderpoint with treatment position opposite of the rest of the tenderpoints in its region (doesn’t follow patterns of those around it)
Stoic
Distinct palpable TTA without tenderness
Two perspectives behind counterpoint
Nociceptive perspective, proprioceptive perspective
Nociceptive perspective of tenderpoints
Tenderpoint initiated by nociceptors in strained tissue -> reflexive contraction to protect tissues -> reflex loop
Proprioceptive perspective of tenderpoints
Muscle spindle fibers monitor length of muscles using the gamma and alpha motor neurons
What happens with a sustained contracture?
Overwhelms normal nervous regulation of muscles, reduced metabolic recovery, lactic acid causes sensitization of nerve endings -> area becomes TTP
Four phases of Counterstrain
- Relaxation
- Normalization of nociceptive and neurologic input
- Washout
- Slow return to normal
Seven steps in counterstrain
- Find most significant tenderpoint
- Physician establishes a tenderness scale
- Monitor tenderpoint throughout
- Place patient in position of ease of 70%+ improvement
- Hold for 90 seconds
- Slow return to neutral
- Recheck tenderness
How does physician establish a tenderness scale?
The physician tells the patient that thier most tender spot is a 10/10, and that they will work to get it down to at least a 3/10
What three physiological things occur when patient is in position of ease?
- Muscle tissues shorten and relax
- Nociceptive input resolves
- Spindle fiber length resets + gamma loop restored to normal input
What might be felt while holding the tenderpoint for 90 seconds?
A therapeutic pulse associated with metabolic washout (begins about 10-15 seconds after optimal positioning, ends in about 60 seconds)
What could happen if you dont slowly return patient back to neutral?
Could reactivate muscle spindle cell activity
Treatment position for PL 1-5 SP
E, Add, ER
Treatment position for PL 1-5 TP
E, Sa, Rt
Treatment for UPL5
E, Add, ir/er
Treatment for LPL5
F, Add, IR (only flexion treatment)
Treatment for HSIS
E, ABD, ER (one of the two abd)
Treatment for PL 3 and 4 Glut
E, Abd, er (one of the two abd)
Treatment for PT 1-3 TP AND for PT 10-12 TP AND for PL 1-5 TP
E, Sa, Ra
Treatment for PT4-9 TP
E, Sa, RT
