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OS Exam II > Counterstrain > Flashcards

Counterstrain Flashcards

1
Q

What are direct. treatments

A

Go TO the barrier

  • Soft tissue/ ART,
  • Muscle energy
  • HVLA
  • Myofascial release
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2
Q

What are indirect treatments?

A

Away. from barrier

  1. Counterstrain
  2. Myofascial release
  3. cranial
  4. BLT
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3
Q

who invtented coutnerstain

A

lawrence jones DO

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4
Q

what is counterstrain

A

considers dysfunction to be a continuing, inapp strain relfex that is inhibited by applying. a position of mild strain in the OPPOSIRE direction to that of the false strain reflex;

to do this: find a POT followed by. a specific direction to. acheive response.

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5
Q

how does L5 rotate

A
  1. to the deep sulcus
  2. opposite rotation of sacrum
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6
Q

Who was lawrence jones

A

A DO who thought. of countstrain in 1955

he was a patient with pain for over 4 months and treated for. 6 weeks

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7
Q

what did he say?

A

“Maybe I could respond to your treatment if I could just sleep at night.”

• Discovered posterior tender points

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8
Q

what. did larry. jones develop

A
  1. POSTEIOR tender points assx with somatic dysfunction
  2. way to treat points
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9
Q

Spontaneous Release by Positioning” book year

HE FOUND ANERIOR TENDERPOINTS ON A. RUPTURED GROIN PT

A

1964

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10
Q

Strain and Counterstrain

A

1980

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11
Q

what is a tender point?

pattern of pain:

Located:

tender?

jump sign?

radiation when pressed?

taut band present?

Twitch response?

Dermographia present?

A

-no pain pattern

muscles, tendons, ligaments and fascia

locally tender

Yes= jump sign

No radiation

Taut band NO present

Twitch= NO

Dermographia = NO

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12
Q

what is a trigger point?

pattern of pain:

Located:

tender?

jump sign?

radiation when pressed?

taut band present?

Twitch response?

Dermographia present?

A
  1. characteristic pattern of pain

2. Located in muscle tissue

  1. locally. tender
  2. YES jumpsign
  3. YES radiating patter
  4. Presentin WITHIN a taut. band of tissue
  5. Caues twich with snapping palpation

8. Dermographia of skin over point!

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13
Q

how to treat TRIGGER POINTS

A
  1. Spray. and stretch
  2. Trigger point. injection
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14
Q

Tx for tenderpoint

A
  1. Spontanous release by positioning. (counterstrain)
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15
Q

what. is a nociceptor

A

sensory receptor for pain

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16
Q

trauma can cause:

A
  1. Change in myfascial tissue at. microscoptic and biochemical level
  2. Damage to myofibrals and microcirculation-> fuck up chemistry. of actin and mysoin -> cause tissue sensitiy by disrupting and chemical changes
  3. Damage microcirculation-> i_ncrease in intramuscular pressure and function_ -> muscle fatigue d/t decreased cellular metabolism
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17
Q

3 theories of countstrain

A

1. nociceptive model

2. Propioceptive model

3. 4 phases of counterstain

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18
Q

According to the nociceptive model

what does it say

A
  1. Tissue strain (muscle, tendon, L) -> recruit nociceptors
  2. Tissue will undergo reflexive contraction
  3. Contraction of tissue becomes the new neutral
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19
Q

ex for nocieptive model

A
  1. Stain ankle-> + nociceptors
  2. Reflexive contraction of ankle
  3. Contraction of ankle -> new normal
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20
Q

Propioceptive model says

A

we will maintain tone after stimulus is ended

  1. Rapid stretch of primary speindle cell
  2. -> extrafusal fibers contract to protext
  3. maintain contraction even after stimulus ended
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21
Q

What. is the happens in propioceptibe model

A
  1. Agonist- muscle is strained rapidly, without recruiting noiceptots
  2. causes antagonist m. to be shorted. -> decrease spindle firing rate)
  3. Agonist also sensed sensory info. to CNS -> rapidly. shorten
  4. CNS turns up gamma system bc not gettin enough info
    - > CNS send more. motor input through gamma motoro neuron -> spindle -> will improve sensory input. to CNS
    - > RESULT: increase gamma motor gain that will maintain the abfnormal new “neutral” length of myofascial structures
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22
Q

angtaongist contraction will become

A

“neutral”

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23
Q

whiplash according to propioceptive m.

A
  1. Posteior cervical muscles are strained
  2. Anterior cervical muscles shorten-> CNS turns up gain for antagonist gamma system
  3. ANT contraction = new normal
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24
Q

Nociceptor

-> nociceptor recruitment

Agonist (affected muscle) ______

Agonist tissue shorting -> _______ nociceptore recreit

A

shorted

no nociceptor recruitment

25
Q

Proprioceptor

ANT ______

A

ANT. is shorted -> becomes new neutral

26
Q
A
27
Q

how are nociceptor. and proioceptive model similar?

A

local constriction -> decreased circulation -> localized edema -> back up of products of metabolsim

28
Q

Four Phases of Counterstrain

A
  1. Relaxation
  2. • Reset of Spindle fibers and Nociceptors•
  3. Washout
  4. • Slow return to neutral
29
Q

how do we relax

A

shorted affected tissue. in all. 3 planes (F/E, SB, rotation)

–> this will cause. a rapid reduction of nocicpetive input

30
Q

Phase II: Spindle reset

A
  1. reset. primary. endings of muscle spindle stretch receptors (Annulospiral) -> change length and dynamic (rate of change of length)
  2. reset secondary. ends of muscle spindle stretch recpetors (flow spray )

change length, dont. change dynamis

31
Q

in counterstain, what are we working w?

A

MUSCLE SPINDLE FIBERS!

Not. golgi tendons organs (thats muscle energy)

32
Q

Phase III: washout

A

Increased muscular tone inhibits blood flow-> build up of waste products

– Metabolic washout begins at 10-15 seconds after best position achieved (therapeutic pulse may be felt)

– Peak washout occurs at approximately 1 minute

33
Q

Phase IV: slow return to neutral

A

rapid = reactivate muscle spindle actibity

muscle spindles remain faciliated for up to 24 hours -> thus, remind pt to take it easy

34
Q

counterstrain 7 steps

A
  1. find TP
  2. establish scle
  3. monitor TP thoughout tx
  4. Place pt in a. position of comfort
  5. maintain position for 90 seconds (120 for ribs)
  6. slowly. retrn to neutral
  7. RECHECK AFTER. RETURN TO NEUTRAL
35
Q

how do we find a ternder point

A
  1. OSE
  2. look at. posture
  3. scan region of body for compains

5. ppl tend to bend aroudn a tender point

36
Q

Different myofascial structures including tendons, ligaments, fascia, and muscle bellies have all been found to contain tender points

where are they. found?

A

where motor nerve peices fascia and enters muscle

37
Q

Myotomal, dermatomal, and sclerotomal relationships have been proposed as tender point locations seem to be ________ from person to person

A

consistent

38
Q

TP frequntly. asx with fascial strain that. may:

A

feel like a bb or pee

39
Q

Tender points may be ____ degrees around the body from complaints

ex

A

180

psoas pain -> present as low back pain

40
Q

Maintain Contact Throughout Treatment

A

• Palpate changes

allows fine tuning

acknowledge teratment success

41
Q

midline TP

tx positions tend to be

A

flexed or extended

42
Q

distant from midline positions

tx positions tend to be

A

SB/rotation

43
Q
  1. Maintain position for 90 seconds
A

10-15 seconds to begin washout

1 minute for. FULL washoter

44
Q

Dr. Jones found that holding for shorter periods resulted in

A

greater return of dysfunction

45
Q

• Longer periods resulted in

A

no sig improvement

46
Q

• fSaRA

Upper case letters indicate _____-,

lowercase, ______

A

Uppercase: more motion

Lowercase: less motion

47
Q

where do we document in SOAP noteo

A

objective

48
Q

• fSaRA

describe

A
  1. small amounts of felxion
  2. small amounts of SB away
  3. Large amounts of SB away
49
Q

• _F_St

A

large amounts. of flexion

small amounts of SB toward

50
Q

what should pressure be at tenderpoint

A

light contact; firm pressure makes it hard to relax

51
Q

No more than ____ tender points per treatment

A

6

52
Q

Therapeutic pulse
– Intensity approximates radial pulse

• Position of comfort
– Position at which at least 70% of tenderness is alleviated

• Position of Optimal Comfort
– Position at which 100% of tenderness is alleviated

• Therapeutic reaction
– Situation which occurs in 20-30% of patients treated with Counterstrain

• Maverick
– Tender point that does not respond to typical positioning (~5%)
– Usually requires opposite position from standard

A
53
Q

what is a maverick

A

TP that does not respond to typricl psotion

requires opposite positon from standard

54
Q

• Therapeutic reaction

A

sit. that occurs in 20-30% of ppl tx with coutnerstrain

55
Q

Contraindications - Absolute

A
  • Trauma – if the area would be negatively affected by positioning
  • • Severe illness in where you cannot be in specific position
  • • Instability of treatment area –> can cause neurological or vascular side effects
  • • Vascular or neurologic syndromes which might lead to compromise of these systems
  • • Severe degenerative spondylosis with no motion at the level where treatment would take place
56
Q

Contraindications - Relative

A
  1. pt cannot voluntarily. relax
  2. pt who cannot discern level of pain or change d/t psoiton
  3. cannot undersntand
  4. positions with. illness where positions worsens their conditions: artithirs
57
Q

benefits

A
  1. better doc
  2. treat ppl otthers cant

3. passive, indirect technique

  1. can be used i_n pts with. bad. osteoprosis, bone dz, acute injuries_
  2. ONLY absolute. requirement. is pt must be able and willing to relax musxcles
58
Q

Only absolute requirement

A

patient must be able and willing to relax muscles.

OS Exam II (7 decks)

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