2. Counterstrain lecture Flashcards
_____ _____ is a gentle passive indirect OMM technique for MSK pain
Counterstrain
What is the overflow “flow” of a counterstrain diagnosis and technique?
TART
Tender points
“fold and hold”
“spontaneous release”
A ______ ____ is a non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia, that reduces when placed into a position of ease
tender point
Dr. ______ _______ founded counterstrain in 1955 after treating a patient with a 2.5 month history of psoas syndrome
Dr. Lawrence H Jones
After doing treatments, what did Dr. Jones determine was the best amount of time to hold the patients in the counterstrain position?
90 seconds
A _____ ______ is
- located only in muscle
- has a characteristic pain pattern
- locally tender and radiates pain
- presents with taut band of tissue that will twitch when palpated
Trigger point
A ______ ______ is
- located in muscle, tendon, ligament, and fascia
- no characteristic pain
- only locally tender
- no taut band or twitch response
Tenderpoint
What kind of positioning do you need to do for a counterstrain treatment?
Regional
What kind of treatment is counterstrain?
passive and indirect
What are indications of using counterstrain?
Patient must be ABLE and WILLING To be positioned and relax
***Can use with very fragile patients
What are contraindications of counterstrain?
Severe trauma, illness, or instability
Patient is unable to voluntarily relax
Unable to position without extreme pain or anatomic changes
How do you name tender points?
- Laterally, anterior, posterior and the vertebrae
ex: L PCA 4 (left posterior cervical 4) - By the anatomic structure that is being treated
ex: L psoas muscle
What is the positional treatment?
Go to the position of ease; where does the patient feel a decrease in pain in the tenderpoint area?
***Be sure to say that in the neutral position that AT that tenderpoint that should be the WORST pain that they should feel and use that as the baseline
________ is a tenderpoint with treatment position opposite of rest of region
Maverick
______ is a distinct palpable TTA without tenderness
Stoic
Describe the nociceptive perspective
Initiated by nociceptors in a strained tissue
ex: with an ankle sprain, there is nocicpetive properties in the muscles, tendons, ligaments, and fascia
produces a reflexive contraction to protect the tissue
stuck in a reflex loop
Describe the proprioceptive perspective
A muscle spindle fiber determines the length and stretch of a muscle
you work with the spinal gamma motor neurons (LMN)
Determine the length of the agonist and antagonist muscles through alpha motor neurons to prevent sudden changes
Rapid stretch causes protective contraction (gamma motor neuron system)
This is what causes the protective contraction of a muscle when it is stretched too much too fast
Gamma motor neurons
______ _______ can overwhelm the sympathetic and parasympathetic regulation of muscle perfusion
Sustained contracture
In regards to the muscle, what is a consequence of a sustained contracture?
Reduced metabolic recovery of muscle
______ ______ leads to the sensitization of nerve endings
Lactic acid
__________ produces cascade of neuropeptides in the muscle
Nociceptive
What are the effects of nociceptive cascade of neuropeptides?
Localized edema
sensitizes nerve endings
The contracture of the muscles that is produced by both the nociceptive and proprioceptive perspectives is called the ______ ______
Pathologic neutral
______ _______ is where we position our indirect techniques
Pathologic neutral
What does “neutral” mean
the position where the muscles are relaxed
List the phases of counterstrain
- Relaxation phase
- Normalization of nociceptive and neuro input phase
- washout phase
- slow return to neutral phase
In this phase of couterstrain, the tissues are shortened into the position of ease
Relaxation phase
In this phase, the nociceptive input resolves in the position of ease
and
the spindle fiber length resets and gamma loop is restored to normal input
Normalization of nociceptive and neurons input phase
_______ _______ begins 10-15 seconds after optimal position is achieved
Metabolic washout
This phase involves metabolic washout and a peak washout
washout phase
Peak washout occurs after about ____ ________ (time)
1 minute
In this phase, the tissues return to neutral and the muscle spindles will typically remain facilitated for 24 hours
Slow return to neutral
What is a concern about the slow return to neutral phase (last phase)
That a rapid return to neutral could reactivate the muscle spindle activity and cause contraction
List the steps of the counterstrain
- Find most significant Tenderpoint.
- Physician establish a tenderness scale.
- Monitor Tenderpoint throughout
- Place patient in “Position of Ease” of at least 70% improvement
- Hold 90 seconds.
- Slowly return to neutral.
- Recheck tenderness.
Where should you start when attempting to find a tender point?
Near the area of TART; because there will probably be a point close to that
Why is it important to monitor the tenderpoint throughout?
So that you can feel for any changes and stay on the exact point because you may not find it again
Which step does the phrase “fold and hold” apply to?
The fourth step; placing the patient in the position of ease
What year was counterstrain first used? And who discovered it?
1955
Dr. Lawrence H Jones
***This was in the lecture legit like 3 times
