Counterstrain OMT Flashcards
What type of technique is counterstrain?
Indirect and passive
What does counterstrain focus on?
Tenderness
Who created counterstrain?
Dr. Lawrence H. Jones
Describe the story of how Dr. Jones discovered counterstrain
He positioned a man in pain for psoas syndrome into a position of comfort, left to treat another patient and when he came back the man’s pain was gone
What are the 4 characteristics of a tenderpoint?
Located in muscle, tendon, ligaments, fascia
No characteristic pain pattern
No taut band or twitch response
Only locally tender
What guides counterstrain treatment?
Reduction of tenderness
Counterstrain indications?
- Pt must be able to be positioned and relax
- Useable with very fragile, sensitive and recent trauma or surgery patients
- MSK pain
Counterstrain contraindications?
Pt cannot voluntarily relax or be positioned without extreme pain or due to anatomic changes (scoliosis)
Severe trauma, illness, instability
What is used in the diagnostic nomenclature?
Laterality, anterior/posterior and vertebrae
What is used in the treatment nomenclature?
Position of ease :
- Flex or extend (F/E)
- Sidebend away/toward (Sa/St)
- Rotate away/toward (Ra/Rt)
What does it mean if you have a treatment designated as E SaRT?
Extend, sidebend away some and rotate towards ALOT because it is uppercase
Tenderpoint with treatment position opposite of rest of region?
Maverick
Distinct palpable TTA withOUT tenderness?
Stoic
What are the 2 physiological perspectives for muscle contraction?
Nociceptive and Proprioceptive
This perspective is initiated by nociceptors in strained tissue that causes reflex contraction to protect tissues
Nociceptive
This perspective is caused from rapid stretch without recovery of muscle spindle fiber and will cause protective contraction what will be maintained by gamma system
Proprioceptive
What does the contracture of muscles by both perspectives cause?
Shifted neutral (pathologic neutral)
What are the phases of counterstrain?
Relaxation phase
Normalization of nociceptive input - spindle fiber resets
Washout phase - metabolic washout
Slow return to neutral phase - don’t reactivate spindle activity
What are the counterstrain step? (DO NOT SKIP)
- Find most significant tenderpoint
- Establish tenderness scale
- Monitor tenderpoint throughout
- Place pt into position of ease
- Hold for 90 seconds
- Slow return to neutral
- Recheck tenderness
If you say this is a 10/10 now, what must the patient feel in order for treatment to be over?
It is a 3/10 or less!
Treatment for PT1-4SP
Extend head off the table
Treatment for lower PTSP
Use table as a lever for extension
Treatment for R/L PT1-3 TP
Use head to E Sa Ra
Treatment for R/L PT4-9 TP
Use arm to E Sa Rt
Treatment for R/L PT10-12 TP
Torso: E Sa Ra
Pelvis: E Sa Rt
Treatment for PL1-5 SP
Use ipsilateral Lower Extremity to E Adduct and ER
Treatment for PL1-5 TP
Pull ipsilateral ASIS posteriorly and inferiorly to E Sa Rt
Where is upper pole L5 (UPL5)
Superior medial to PSIS
Treatment for UPL5
E Adduct and IR/ER ipsilateral LE
Where is lower pole L5 (LPL5)
Inferior to PSIS
Treatment for LPL5
pt prone with ipsilateral leg off table
F IR Adduct
Where is the high ilium sacroiliac (HISI)
Lateral to PSIS
Treatment for HISI
E ABduct and ER ipsilateral LE
Where are PL3 and PL4
Margins of tensor fascia latae lateral to PSIS
Treatment for PL3 and PL4
E ABduct and ER ipsilateral LE
