Counterstrain Flashcards
When and who made Counterstrain?
1955 and Lawrence Jones, DO (spontaneous release by positioning)
What did counterstrain used to be called?
Strain-counterstrain
Define Counterstrain
An Osteopathic system of diagnosis and indirect treatment in which the patient’s somatic dysfunction, diagnosed by an associated myofascial tender point, is treated by using a position of spontaneous tissue release while simultaneously monitoring the tenderpoint
Why was strain-counterstrain once a name for it?
Considered to be related to a continuing inappropriate strain reflex
Describe the counterstrain tenderpoints
Counterstrain tender points are discrete, NON RADIATING, hyperalgesic areas in the myofascial (muscle and fascia) tissues. The named points are found at consistent anatomical locations.
What initial position did Lawrence Jones put the patient in?
One of comfort
Initially only what was identified?
Posterior points, but later determined anterior points as well
What year did Dr. Jones publish his first paper?
1964
When was Dr. Jones thesis published?
1980
What 3 theories provide the clinical efficacy of counterstrain?
- Proprioceptive theory
- Sustained abnormal metabolism theory
- Impaired ligamento-muscular reflex theory
Proprioceptive Theory
Tender points develop when local muscle fibers are maintained in a hypertonic state due to an inappropriate proprioceptive reflex during the initiation of somatic dysfunction
What are the 2 phases to proprioceptive theory?
- Sudden lengthening of a shortened muscle, or overstretching or overloading of a muscle
- Defensively initiated contraction of that muscle in an effort to prevent injury.
Sustained Abnormal Metabolism Theory
Tissue injury alters local body position which affects local microcirculation and tissue metabolism.
What does localized ischemia do?
Reduces nutrient supply and removal of metabolic waste products to affected area
What is increased in SAMT?
Proinflammatory cytokine production
Does SAMT cause lowering of the firing threshold of sensory neurons causing localized neuronal sensitization?
Yes; manifest as localized edema and tenderness
What does the precise body positioning in counterstrain do?
Improves local vascular circulation and reduces localized production of inflammatory mediators
What must the physician ascertain?
The somatic dysfunction, its severity, its tissue location and type, and whether any of these precautions or contraindications are present.
What happens to treatment effectiveness as pain rises?
For every ascending numeric level of pain that remains, an associated 10% of treatment effectiveness is lost
What is the goal?
100% reduction if possible
What do anterior points require?
Flexion
What do posterior points require?
Extension
What happens as tender points move further from the midline?
Greater is the possibility for necessity of more side bending
How long do we maintain the position?
90 seconds
Is the fingerpad putting any therapeutic pressure on the tissues?
No
Do we ever remove the fingerpad point?
No
How do return the patient after 90 seconds?
PASSIVELY through the path of least resistance to original neutral position in which the tender point was illicited
Can the patient help in returning to neutral after the 90 seconds?
NO!!!!!!!
What do we always do at the end?
Recheck!!!
Give the percentage of an improvement example
If the pain is reduced to a 3 after it being a 10, it was 70% treated
What are the 6 shorthand rules?
- Find the tender point associated with the dysfunction.
- Tell the patient the tender point is a 10 or 100 or a dollar’s worth of pain.
- Place the patient in the position that reduces the pain of the tender point 100%, or as close to 100% as possible, but at least 70%.
- Hold this position for 90 seconds.
- Slowly, through a path of least resistance, return the relaxed patient to neutral.
- Recheck the tender point and the other diagnostic components of the dysfunction (TART).
What correlates with soreness?
Treating more than 6 tender points in 1 visit
What do we instruct to do to treat soreness?
Instruct the patient to increase fluids and use ice packs over the sore areas for 15 to 20 minutes every 3 hours as needed
What normal intervals for treatment are normal and how do we determine that?
3-day intervals are appropriate. The patient’s response will determine how often the patient needs treatment
