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*OSII > 2. Introduction to Counterstrain > Flashcards

2. Introduction to Counterstrain Flashcards

1
Q

What type of technique is Counterstrain (active/passive)(direct/indirect)?

What is it primarily used for?

A

Passive Indirect for MSK pain

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2
Q

4 General Steps to Counterstrain Technique?

A
  1. TART
  2. Tenderpoint: non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia, that reduces when placed into a position of ease
  3. “fold and hold”
  4. “spontaneous release”
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3
Q

Who developed Counstrain Technique?

What year?

What fueled this idea?

A
  • Dr. Lawrence H Jones
  • 1955
  • Man w/ 2 ½ month history of psoas syndrome, unable to find relief w/ chiropractic and HVLA
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4
Q

How was the counterstrain technique initiated done?

A

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
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5
Q

Compare Trigger points vs Tenderpoints

A
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6
Q

Why is palpation of tenderpoints during counterstrain treatment crucial?

A

Softening of those points guides the treatment

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7
Q

Indications for Counterstrain

A
  • MSK pain
  • Usable w/ fragile/sensitive pt’s
  • ONLY REQUIREMENT: pt needs to be able/willing to be positioned and RELAX
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8
Q

Contraindications for Counterstrain OMT

A
  • Severe trauma/illness/instability, other management indicated
  • Pt can’t voluntarily relax
  • Unable to position without extreme pain or anatomic changes
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9
Q

What are the 3 ways you name the tenderpoints?

A
  1. Laterality, anterior/posterior and vertebra (L PC4 = Left Posterior Cervical 4)
  2. By anatomic structure that is being treated (L Psoas = Belly of left Psoas Muscle)
  3. If multiple tenderpoints at segment then further define anatomy
    • L PC4 Midline (spinous process) or Lateral (articular process)
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10
Q

How is counterstrain different from muscle energy technique?

A

Muscle energy is active, direct

Counterstrain is passive, indirect

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11
Q

How is counterstrain different from HVLA?

A

HVLA: passive, direct

Counterstrain: passive, indirect

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12
Q

Would you the treatment nomenclature template be?

A

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
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13
Q

What are maverick points?

A

Tenderpoints with treatment positions that are different (opposite) from the rest in that area

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14
Q

What are stoic points?

A

Tissue texture abnormalities that goes away with counterstrain position, but it is NOT TENDER

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15
Q

Describe the Nociceptive Perspective of the Physiologic Basis of Tenderpoints

A
  • 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
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16
Q

Describe the Proprioceptive Perspective of the Physiologic Basis of Tenderpoints

A
  • 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
17
Q

What are the consequences of prolonged contraction?

A
18
Q

What are the consequences of prolonged nociception stimulus in muscles/body?

A
  • produces cascade of neuropeptides
    • Local edema = sensitive nerves
19
Q

Where do we positive our indirect techniques towards?

A

pathologic neutral

20
Q

What are the 4 “phases” of counterstrain?

A
  1. relaxation
  2. normalization of nociceptive and neural input
  3. washout
  4. slow return to neutral
21
Q

What is happening during Phase 1: Relaxation?

A
  • Tissues shortened into position of ease
  • @ Pathologic neutral:
    • palpate TTA at tenderness
    • localize thru 3 planes to normalize tissues
22
Q

What is happening during Phase 2: Normalization of nociceptive and neuro input?

A
  • Nociceptive input resolves in position of ease
  • Spindle fiber length resets and gamma loop is restored to normal input
23
Q

What is happening during Phase 3: Washout?

A
  • begins 10-15 sec after optimal position achieved
    • therapeutic pulse may be felt
  • Peak washout at ~ 1 min
24
Q

What is happening during Phase 4: Slow return to neutral?

A

Tissues moved back normal neutral

  • Muscle spindles remain somewhat facilitated for up to 24 hours after treatment
25
Q

What could happen if you rapidly return the patient to neutral in phase 4?

A

Rapid return could reactivate spindle cell activity

26
Q

What are the 7 Counterstrain Steps?

A
  1. Find most significant Tenderpoint.
  2. Physician establish tenderness scale.
  3. Monitor Tenderpoint throughout
  4. Place patient in “Position of Ease” of at least 70% improvement
  5. Hold 90 seconds.
  6. Slowly return to neutral.
  7. Recheck tenderness.
27
Q

How do you find a tenderpoint? Where might you find them?

A
  • Begin w/ TART screen
  • Where you have most TART, you may find palpable nodules of TTA
    • This will correlate with mapped out tenderpoints
28
Q

What are you feeling for as you monitor tenderpoints throughout the treatment?

What should you avoid as you monitor?

A

must feel the TTA reduce to properly localize

  • if you let go, you will likely not find the exact same point

*OSII (39 decks)

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