Block 1_Strain/Counterstrain Flashcards
Is strain-counterstrain a direct or indirect technique?
Indirect.
Is strain-counterstrain passive or active?
Passive.
What is strain-counterstrain attempting to fix?
Based on identifying tender points and positioning the patient to eliminate tenderness at that point.
What are the steps to strain-counterstrain?
- Locate/palpate tender point.
- Communicate/Establish the pain scale (10/10).
- Passively position patient.
- Palpate tender point (find >3/10)
- Hold patient in position for 90 seconds
- Passively return patient to neutral
- Recheck tender point (should be >3/10)
What is the theory behind tender points?
Rapid lengthening of muscle instigates inappropriate reflex. In other words, when a muscle is rapidly and unexpectedly lengthened, afferent feedback causes rapid contraction to prevent damage (think about overcorrecting in a car) which results in excessive contraction (strain).is excessive/too short = strained). Sudden shortening of the antagonist muscle results in no efferent signals causing the muscle to be too relaxed. Result is shortened agonist muscle and lengthened antagonist muscle. Nociceptive feedback from lengthened antagonist is interpreted as strain (even though no mechanical strain).
How do you perform strain-counterstrain for supraspinatus?
Tender point in belly or distal tendon of supraspinatous. Flexion, abduction, external rotation of arm by approximately 45 degrees in each direction.
How do you perform strain-counterstrain for levator scapulae?
Inferior attachment of elevator scapulae muscle at the superior-medial border of scapula. Patient’s head on pillow. Pull arm behind back to medially rotate scapula. Place hand on inferior angle and apply cephalad push.
How do you perform strain-counterstrain for latissimus dorsi?
Patient laying on side with tender point facing up. In muscle belly located in posterior axillary fold or at the iliac crest attachment. Extension, internal rotation, slight abduction while applying mild traction.
How do you perform strain-counterstrain for biceps, long head?
On tendon of long head of biceps in bicipital groove of humerus. Patient supine. Flex elbow and supinate forearm to shorten biceps, then flex, adduct, and internally rotate humerus about the glenohumeral joint.
How do you perform strain-counterstrain for coracobrachialis?
Near coracoid process. Patient supine. Forearm flexed and elbow grasped by operator to flex, adduct, and internally rotate humerus about the glenohumeral joint.
How do you perform strain-counterstrain for brachialis?
Proximal portion of brachialis. Patient supine. Flexion of elbow with palm in a pronated position. Forearm placed immediately lateral to the upper arm.
How do you perform strain-counterstrain for supinator?
Lateral aspect to supinator muscle near radial head. Extension, supination, and slight abduction of forearm.
How do you perform strain-counterstrain for pronator?
Proximal forearm on pronator teres attachment. Flexion, pronation, and slight adduction of forearm.
How do you perform strain-counterstrain for extensor carpi radialis?
Muscle belly on lateral aspect of posterior forearm OR tendinous insertion on lateral aspect of the posterior surface of wrist. Patient seated or supine. Stabilize elbow. Grasp patient’s hand, induce extension at wrist and elbow with slight radial deviation.
How do you perform strain-counterstrain for extensor carpi ulnaris?
Found in muscle belly on medial aspect of the posterior forearm OR in the tendinous insertion on the medial aspect of the posterior surface of the wrist. Patient seated or supine. Stabilize elbow. Grasp patient’s hand, induce extension at wrist and elbow with slight ulnar deviation.
