Counterstrain Theory

Question 1

Key features of a trigger point

Answer 1

1. characteristic pain pattern
2. dermographia over area
3. locally tender
4. pain radiates in predictable pattern
5. elicits jump sign
6. located in muscle tissue
7. twitch response
8. taut band of tissue

Question 2

Key features of a tenderloin

Answer 2

1. locally tender
2. located in muscle tissue, fascia, tendons, ligaments
3. elicits jump sign

Question 3

What do we treat with CS?

Answer 3

tenderpoints

*NOT trigger points

Question 4

Nociceptive - MOA

Answer 4

1. tissue is strained recruiting nociceptors within that tissue
2. reflexive contraction of affected tissues (body tries to splint the area)
3. contraction of affected tissues becomes neutral (SD becomes the new normal)

Question 5

Proprioceptive - MOA

Answer 5

1. Muscle is strained w/o recruiting nociceptors (agonist)
2. Antagonist muscle is shortened (turns down spindle firing rate)
3. CNS turns up gain fro antagonist gamma system
4. Antagonist contraction becomes neutral

Question 6

Nociceptive vs. Proprioceptive

Answer 6

1. agonist is shortened, agonist tissue shortening no nociceptor recruitment
2. antagonist is shortened, antagonist shortening becomes the new neutral (gamma loop)

*both: local constriction of muscles causes decreased circulation, causing localized edema and back up products of metabolism

Question 7

What is the first phase of CS?

Answer 7

Relaxation - shorten affected tissue in three planes –> rapid reception in nociceptive input

Question 8

What is the second phase of CS?

Answer 8

Spindle reset - primary endings of muscle spindle stretch receptors (annulospiral) and secondary endings of muscle spindle stretch receptors (flower spray)

Question 9

What are we working with in CS?

Answer 9

muscle spindle fibers

*NOT golgi tendon organs (that’s MET)

Question 10

What is the third phase of CS?

Answer 10

Washout - begins 10-15 seconds after optimal position achieved, and peaks at one minute

Question 11

What is the fourth phase of CS?

Answer 11

Slow return to neutral

Question 12

7 steps of CS treatement

Answer 12

1. establish most significant TP
2. establish pain scale
3. monitor point throughout
4. move to position that reduces pain by 70%
5. hold for 90 seconds
6. return to neutral - slowly
7. reassess

Question 13

How many points can you treat in one session?

Answer 13

no more than six

Question 14

Therapeutic pulse

Answer 14

intensity approximates radial pulse

Question 15

Position of comfort

Answer 15

position at which you reduce pain by 70%

Question 16

Position of optimal comfort

Answer 16

position at which 10% of tenderness is alleviated

Question 17

Therapeutic reaction

Answer 17

situation which occurs in 20-30% of patients treated with CS

Question 18

Maverick

Answer 18

tender point that does not respond to typical positioning (5%); usually requires opposite position from standard

Question 19

Contraindications - absolute

Answer 19

Trauma

Severe illness

Instability of treatment area

Vascular or neurological syndromes

Severe degernative spondylolsis

Question 20

Contraindications - relative

Answer 20

Patient cannot voluntarily relax

Patient cannot discern the level of pain or its change in 2nd position

Patient cannot understand instructions

Patient with underlying conditions that are exacerbated by positioning (arthritis, CT disease…)

Question 21

What is the only absolute requirement?

Answer 21

patients be able and willing to relax muscles