Counterstrain Lecture and Lab Flashcards
Is counterstrain active or passive?
passive
Counterstain is all about ROM or tenderness?
tenderness
Who cam up with counterstrain?
Dr. Lawrence Jones in 1955
How long do you hold counterstrain?
90 sec.
What is a tender point
Located in muscle, tendon, ligaments, fascia
No characteristic pain pattern
Only locally tender
No taut band or twitch response
what is a trigger point
Trigger is only muscle. Characteristic pain pattern. Locally tender and radiates pains. Present with taut band of tissue that will twitch when palpated
Indications for counterstrain
CS is a passive indirect OMM technique for musculoskeletal pain
Useable with
Very fragile
Sensitive
Recent trauma/surgery
Only requirement: patient must be able/willing to be positioned and relax
Contraindications of counterstrain
Severe trauma/illness/instability where management beside OMM is indicated Patient cannot voluntarily relax Unable to position patient without extreme pain due to anatomic changes
What is a maverick?
Tenderpoint with treatment position opposite of rest of region
What is a Stoic
Distinct palpable TTA without tenderness
What is the MOA of counterstrain?
Initiated by nociceptors in strained tissue
muscle, tendon, ligaments, fascia
Produces reflexive contraction to protect tissue
Stuck in reflex loop
This contracture maintained by gamma motor system
Nociceptive input resolves in position of ease
Spindle fiber length resets and gamma loop is restored to normal input
Metabolic washout begins at 10-15 seconds after optimal position achieved
Peak washout occurs at approximately 1 minute
What are lateral verse midline points?
Lateral is on the Tp and the midline points are just inferior to the SP.
How much improvement to look for in tenderness?
70%
Treatment for all PTSP is?
e-E (shortening the interspinales muscles)
How to extend Upper PTSP (T1-4)
Extend head off table
How to extend lower PTSP (T5-12)
use table to increase extension
How to treat PTTP 1-3?
E Sa Ra (shortening multifidus/rotatores). Use head as lever
How to treat PTTP 4-9
E Sa RT. Put knee under side of tender point to rotates towards. use are to pull into sidebending away.
How to treat PTTP 10-12?
e-E Sa Ra (torso) e-E Sa Rt (pelvis). Push pelvis superior/inferior to get sidebending. Put knee under to pelvis to get rotation toward with pelvis.
How to treat PL 1-5 SP?
e-E Adduction RA (torso) or e-E Adduction RT pelvis.
Stand on same side as tenderpoint and place knee under leg
How to treat PL 1-5 TP
E Sa RA (torso) E Sa RT (pelvis). Stand on same side and put knee under pelvis. Move hip inferiorly to get sidebending away.
What is a Upper Pole L5 (UPL5)
Superior medial surface of the posterior superior iliac spine (PSIS)
What is a Lower Pole L5 (LPL5)
On the ilium just inferior to PSIS pressing superiorly
What is a High Ilium Sacroiliac (HISI)
2–3 cm lateral to the PSIS pressing medially toward the PSIS
What is a PL3 gluteus
– PL3— ⅔ lateral from PSIS to tensor fasciae latae
What is a PL4 gluteus
PL4—posterior margin of tensor fasciae latae
How to treat Upper Pole L5 (UPL5)
E Adduction ir/er. Knee under same side and ir/er
How to treat Lower Pole L5 (LPL5)
F IR Adduction. Hang thigh of the same side as tenderpoint off table with knee flexed. Then IR and adduct
How to treat High Ilium Sacroiliac (HISI)
e-E ABduct ER. Stand on same side as TP and Use ipsilateral leg to extend, Abduct, and ER the leg
How to treat PL 3 and PL 4 Gluteus
E Abduct er .Stand on same side as TP
Use ipsilateral leg to Extend, ABduct, and externally rotate the leg
