Counterstrain

Question 1

counterstrain uses an indirect or direct method

Answer 1

passive indirect

Question 2

how long do you hold the whole body in positions of comfort?

Answer 2

90 seconds

Question 3

what is a tenderpoint?

Answer 3

non radiating area of tenderness that is located within m, tendon, ligaments, fascia

reduces when placed into a position of ease

Question 4

who came up with counterstrain in what year?

Answer 4

1955 by Lawrence H Jones to help a man with psoas syndrome to find a position to sleep

palpation of pt is crucial

Question 5

What is the difference in trigger point vs tenderpoint?

Answer 5

trigger point

• only in m
• characteristic pain pattern
• locally tender and radiates pain
• taut band of tissue that twitches w palpation

tenderpoint

• in m, tendon, ligament, fascia
• no pain pattern
• locally tender
• no taut band or twitch response

Question 6

indications to do CS?

Answer 6

use for fragile, sensitive pt

must be willing/able to be positioned and relax

Question 7

contraindications to do CS?

Answer 7

trauma, illness, instability
can’t voluntarily relax
unable to position pt without extreme pain or anatomic changes

Question 8

What do multiple tenderpoints indicate?

Answer 8

defines the anatomy

it targets a m group

Question 9

what does it mean to have an upper case vs lower case in the nomenclature?

ex: SaRA

Answer 9

SaRA

upper case: a lot, so rotate a lot away

lower case: little movement, sb a little a way

Question 10

what is a maverick?

Answer 10

TP w treatment position opposite of the rest of the region

Question 11

What is a stoic?

Answer 11

distinct palpable TTA w/o tenderness

has tissue texture abnormalities

Question 12

How does nociceptors cause tenderpoints?

Answer 12

nociceptors in strained tissue shuts down m to prevent strain
produces reflex contraction to protect tissue
stuck in reflex loop

Question 13

How does proprioceptors cause tenderpoints?

Answer 13

m spindle fiber determine length and stretch of m agonist and antagonist through alpha motor neurons to prevent sudden changes (shuts it down or activates)

works w spinal gamma motor neurons

Question 14

What does the gamma motor system do in the tenderpoint?

Answer 14

causes protective contraction of injured spindle fiber to decrease pain nociceptors

Question 15

prolonged proprioception and nociception leads to what?

Answer 15

sustained contraction

• lactic acid increases
• reduced metabolic recovery of m
• increased sym and parasymp reg of m perfusion

noci produces cascade of neuropeptides
-local edema, sensitive nerve endings

Question 16

what is pathologic neutral?

Answer 16

where we position our indirect techniques

most relaxed m

Question 17

what are the phases of counterstrain?

Answer 17

relaxation

normalization of nociceptive and neuro input (pos of ease, resets gamma and spindle length)

washout (10-15 sec after, 90sec total, reduces tenderness)

slow return to neutral phase (rapid could reactivate m spindles, must be facilitated for 24hr after)

Question 18

what are the steps of counterstrain?

Answer 18

1. find significant tenderpoint (TART)
2. dr makes tenderness scale
3. monitor tenderpoint throughout
4. place pt in position of ease for 70% improvement
5. hold 90 sec
6. slow return to neutral (3-5 sec)
7. recheck tenderness

Question 19

what steps are apart of relaxtion and normalization of nociceptive and neuro input phase?

Answer 19

3. monitor tenderpoint throughout

4. place pt in position of ease for 70% improvement

Question 20

what steps are apart of washout and slow return to neutral phases?

Answer 20

5. hold 90 sec
6. slow return to neutral (3-5 sec)
7. recheck tenderness