Counterstrain DSA - Cox Flashcards
Definition of counterstrain.
Dx and INDIRECT (to ease)/PASSIVE (doc does work) treatment in which the person’s SD (dx by a myofascial tender point) is treated using a position of spontaneous tissue release while monitoring the tender point.
Define the physiology of the 2 primary nerve types that arise from ventral motor neurons, exiting the anterior horn to innervate sk m.
- Alpha motor neurons - stim large fibers
- **Gamma motor neurons - innervate small fibers - intrafusal fibers.
Stretching/shortening of muscle spindle fibers does what?
Stretch increases rate of firing.
Shortening decreases rate of firing.
What is the purpose of the muscle spindle?
To prevent tissue disruption and protect the muscle belly, send info about MUSCLE LENGTH and RATE OF CHANGE in muscle length.
2 Primary functions of Gamma MN
1) Cause intrafusal fibers to CONTRACT»_space; mm contraction (postural tone maintenance).
2) Cause intrafusal fibers to contract sufficiently to stretch the muscle spindle towards threshold»_space; increase sensitivity
Gamma MN dysfunction
1) Firing too frequently
2) Sudden stretch of unprepared muscle»_space; gamma stimulation»_space; maintains spasm»_space; causing TENDERPOINT
Does counterstrain strain agonist or antagonist muscles?
AGONIST muscles. It protects against damage antagonist rapidly lengthened
What happens if a shortened muscle is suddenly stretched?
The muscle spindle creates reflex contraction of already shortened muscle.
Goal of counterstrain.
RESET GAMMA MN by placing pt in position of comfort that shortens the muscle, allowing it to slow down.
Where are tender points located? Do they cause referred pain?
Where the motor nerve pierces the fascia and enters the muscle.
Do not cause referred pain, but can increase pain sensitivity.
Do Chapman’s reflex points respond to counterstrain?
No. They’re mediated by viscero-somatic reflexes.
What are trigger points?
Specific referral patterns with firm bands of sk m with localized tenderness of palpable nodule. Tx with needle, injection, topical vapocoolant.
8 Steps of Counterstrain
- Structural exam to locate somatic dysfunction
- Find significant tender point
- Establish pain/tenderness scale
- Wrap person around tender point
- Reduce pain by at least 70%
- Maintain position for 90 seconds.
- Passively return to neutral
- Reassess.
What is the significance of 90sec?
The amount of time it takes for spinal cord to learn a new pattern.
Can a SD have more than one tender point?
Yes
How do you ID a tenderpoint?
- Dime sized areas of tight myofascial tissue.
- Hypersensitive to palpation compared to other tissue.
- Found in specific, symmetrical locations
What does “wrapping the patient around the tender point” normally involve?
What’s the most important aspect of this?
Shortening of the muscle. (Cervical spine may involve lengthening of the muscle.)
*Place person in a position of EASE/COMFORT
Monitor tender point with what pressure?
Light contact, not firm pressure.
What must you emphasize as you return the patient to neutral? Why?
Emphasize that they NOT ASSIST in any way. This prevents retriggering abnormal firing of the mechanorecetpros.
Clinical correlation between a person with anterior v. posterior tender points.
- Treat anterior in flexion and posterior in extension.
- Anterior presents with kyphosis and comfort in flexion. Posterior presnts with flat thoracic spine.
- Anterior - pain is diffuse. Posterior - hx of comfort in extension postures.
- Anterior - Injury may be rapid flexion from extended position. Posterior - pain is specific and posterior.
- Anterior - use extension stretches. Posterior - use flexion stretches.
Indications for counterstrain (4).
- Acute spasm/sprains.
- People with osteoporosis/FRAGILE PATIENTS
- Muscular strains/chronic tissue changes.
- Plantar fasciitis and piriformis spasm/dysfunction.
Contrainidications of counterstrain (4).
- Open wound/fx.
- Lack of SD/tender point… duh.
- When its dangerous to place person into extremes of F/E (severely ill, unstable cervical bony structures, carotid/vertebral artery disease/risks).
- When person is unable to communicate
Complications/precautions of counterstrain (3).
- Tx of more tender points per session increases incidence of tx reaction.
- Post tx pain - muscle soreness
- Tx position associated reactions - dizziness, discomfort, etc.
What do you treat first?
Do you tx thoracics or ribs first?
Treat the most tender tenderpoint first.
Thoracics before ribs.
Once person is positioned correctly, what must doc not do?
Do not push on tenderpoint once person is correctly positioned - this is you monitoring hand to observe changes under your finger.
Considerations with ribs. What do anterior v. posterior tenderpoints mean?
An ANTERIOR rib tenderpoint = DEPRESSED rib = in exhalation.
A POSTERIOR rib tenderpoint = ELEVATED rib = in inhalation.
