Counterstrain Flashcards
What kind of technique is counterstrain?
passive indirect
What is a tenderpoint?
non radiating area of tenderness located within muscle, tendon, ligaments, fascia that reduces when placed into position of ease; only locally tender; no characteristic pain pattern; no taut band or twitch response
Who was the first doctor that did counterstrain?
Dr. Lawrence H Jones (1955)
How many specific tenderpoints have been recorded?
> 300
What is a trigger point?
located ONLY in muscle, have a characteristic pain pattern, locally tender and radiates pain, present with taut band of tissue that will twitch when palpated
What are contraindications of counterstrain?
severe trauma.illness/instability where management beside OMM is indicated, patient cannot voluntarily relax, unable to position patient without extreme pain or anatomic changes
How are tenderpoints named?
laterality, anterior/posterior and the vertebra; anatomic structure being treated
What is the significance of upper case vs lower case nomenclature?
a lot to a little
Ex. f-F, little to a lot of flexion depending
What is the nociceptive cause of tenderpoints?
Strained tissue stuck in reflex loop that was initially meant to protect tissue from further injury
What is the proprioceptive cause of tenderpoints?
muscle spindle fibers (innervated by gamma motor neurons) determine the length of muscle, when a tissue is injured or rapidly stretched alpha motor neurons are activated to relax or contract different muscle groups
What nerve types keep muscles stuck in contracture?
gamma motor neurons
What are the consequences of a sustained contracture?
overwhelm normal regulation of muscle perfusion, leads to reduced metabolic recover of muscles and a build up of lactic acid causing sensitization of nerve endings
What does the nociceptive physiologic response cause?
neuropeptides release and produce local edema that sensitizes nerve endings
What is the pathologic neutral?
contracture of muscles produces a new position that muscles are most relaxed in
What is the relaxation phase of counterstrain?
tissues are shortened to pathologic neutral
What is the normalization of nociceptive and neuro input phase?
resolve nociceptive input in position of ease and reset fiber length and gamma loop to normal input
What is the washout phase?
metabolic washout begins at 10-15 seconds after optimal position achieved, peak washout at approx. one minute
Why must tissues be returned to neutral slowly?
Rapid return could reactivate spindle cell activity
What are the 7 steps of counter strain?
- Find significant tenderpoint
- Physician establish a tenderness scale
- Monitor tenderpoint throughout
- Place patient in position of ease of at least 70% improvement
- Hold 90 seconds
- Slowly return to neutral
- Recheck tenderness
What is the treatment position for PC1 Inion?
F St Ra
What is the treatment position for PC1 Occiput?
e-E SaRa
What is the treatment position for PC2 Occiput?
e-E SaRa
What is the treatment position for PC2?
e-E SaRa
What is the treatment position for PC3?
f-F SaRa, Maverick point
What is the treatment position for PC4-8?
e-E SaRa
What is the treatment position for PT1-3 Spinous Process?
e-E, pt supine, head off table
What is the treatment position for PT4-6 Spinous Process?
e-E, pt prone, arms draped over side of table, use table lever to extend
What is the treatment position for PT 7-12 Spinous Process?
e-E, pt prone, arms draped over top of table, use table lever to extend
What is the treatment position for PT1-3 TP?
E SaRa, pt supine, head off table
What is the treatment position for PT4-9 TP?
E SaRT
What is the treatment position for PT10-12 TP?
e-E SaRa (torso) or Rt (pelvis)
What is the treatment position for PL1-5 Spinous Process?
e-E Adduct RT (pelvis) RA (torso)
What is the treatment position for PL1-5 TP?
E SaRT(pelvis) RA (torso)
What is the treatment position for UPL5?
E Adduct IR/ER
What is the treatment position for LPL5?
F IR Adduct
What is the treatment position for HISI?
e-E Abduct ER
What is the treatment position for PL3 Gluteus?
E Abduct ER
What is the treatment position for PL4 Gluteus?
E Abduct ER
