2. Introduction to Counterstrain Flashcards
What type of technique is Counterstrain (active/passive)(direct/indirect)?
What is it primarily used for?
Passive Indirect for MSK pain
4 General Steps to Counterstrain Technique?
- TART
- Tenderpoint: non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia, that reduces when placed into a position of ease
- “fold and hold”
- “spontaneous release”
Who developed Counstrain Technique?
What year?
What fueled this idea?
- Dr. Lawrence H Jones
- 1955
- Man w/ 2 ½ month history of psoas syndrome, unable to find relief w/ chiropractic and HVLA
How was the counterstrain technique initiated done?
Dr. Lawrence H Jones
- Cont putting pt’s in whole body positions of comfort for extended periods
- Noted specific posterior tenderpoints and tx position
- Noted importance of palpating tendernpoints during tx (TART findings would “soften” and reduce pain
- Refined: shorten time, 90 sec was best
Compare Trigger points vs Tenderpoints
Why is palpation of tenderpoints during counterstrain treatment crucial?
Softening of those points guides the treatment
Indications for Counterstrain
- MSK pain
- Usable w/ fragile/sensitive pt’s
- ONLY REQUIREMENT: pt needs to be able/willing to be positioned and RELAX
Contraindications for Counterstrain OMT
- Severe trauma/illness/instability, other management indicated
- Pt can’t voluntarily relax
- Unable to position without extreme pain or anatomic changes
What are the 3 ways you name the tenderpoints?
- Laterality, anterior/posterior and vertebra (L PC4 = Left Posterior Cervical 4)
- By anatomic structure that is being treated (L Psoas = Belly of left Psoas Muscle)
- If multiple tenderpoints at segment then further define anatomy
- L PC4 Midline (spinous process) or Lateral (articular process)
How is counterstrain different from muscle energy technique?
Muscle energy is active, direct
Counterstrain is passive, indirect
How is counterstrain different from HVLA?
HVLA: passive, direct
Counterstrain: passive, indirect
Would you the treatment nomenclature template be?
Position of ease
_ S_R_
- Extend/Flex, Sidebend away/toward, Rotate away/toward all relative to the tenderpoint
- Diagnosis = R PC6, Treatment = e-E SaRa
- You would EXTEND sidebend AWAY rotate AWAY
What are maverick points?
Tenderpoints with treatment positions that are different (opposite) from the rest in that area
What are stoic points?
Tissue texture abnormalities that goes away with counterstrain position, but it is NOT TENDER
Describe the Nociceptive Perspective of the Physiologic Basis of Tenderpoints
- Body has protective reflexes that are iniated by nociceptors in strained tissues, which produce reflective contraction to protect other muscles
- However, body can get stuck in reflex loop after injury = causing a tenderpoints
Describe the Proprioceptive Perspective of the Physiologic Basis of Tenderpoints
- Muscle spindle fibers determine stretch of muscle, so alpha motor neurons determine length of agonist and antagonist ms to prevent sudden changes/injury
- Ex: whiplash- rapid stretch w/o recovery causes protective contraction by gamma motor neurons
- Prolongerd contraction = lactic acid = sensitizes nerve endings
What are the consequences of prolonged contraction?
What are the consequences of prolonged nociception stimulus in muscles/body?
- produces cascade of neuropeptides
- Local edema = sensitive nerves
Where do we positive our indirect techniques towards?
pathologic neutral
What are the 4 “phases” of counterstrain?
- relaxation
- normalization of nociceptive and neural input
- washout
- slow return to neutral
What is happening during Phase 1: Relaxation?
- Tissues shortened into position of ease
- @ Pathologic neutral:
- palpate TTA at tenderness
- localize thru 3 planes to normalize tissues
What is happening during Phase 2: Normalization of nociceptive and neuro input?
- Nociceptive input resolves in position of ease
- Spindle fiber length resets and gamma loop is restored to normal input
What is happening during Phase 3: Washout?
- begins 10-15 sec after optimal position achieved
- therapeutic pulse may be felt
- Peak washout at ~ 1 min
What is happening during Phase 4: Slow return to neutral?
Tissues moved back normal neutral
- Muscle spindles remain somewhat facilitated for up to 24 hours after treatment
What could happen if you rapidly return the patient to neutral in phase 4?
Rapid return could reactivate spindle cell activity
What are the 7 Counterstrain Steps?
- Find most significant Tenderpoint.
- Physician establish 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.
How do you find a tenderpoint? Where might you find them?
- Begin w/ TART screen
- Where you have most TART, you may find palpable nodules of TTA
- This will correlate with mapped out tenderpoints
What are you feeling for as you monitor tenderpoints throughout the treatment?
What should you avoid as you monitor?
must feel the TTA reduce to properly localize
- if you let go, you will likely not find the exact same point
