Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OS3 Exam II > Intro to counterstrain > Flashcards

Intro to counterstrain Flashcards

1
Q

Counterstrain developed by

A

-Lawrence H. Jones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Counterstain Definition

A
  • an osteopathic system of diagnosis and indirect treatment in which the patient’s SD is: diagnosed by an associated myofascial tender points
  • treated by using a passive position, resulting in spontaneous tissue release and at least 70% decrease in tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Counterstain Treatment Guidelines

A
  • relevant structural exam
  • regional TP examination
  • find worst TP
  • establish a tenderness scale
  • place patient in position of ease
  • hold for 90 seconds continuously monitoring TP for tenderness and tissue texture changes with periodic checks
  • slow, passive return to pretreatment position (first few degrees of motion are most important)
  • re-check TP
  • examine region to assess remaining TART changes, assessing need for further treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Expanding Role of Muscle Spindle

A
  • muscle spindles are complex receptors and the stretch reflex is only one constituent of an entire informational spectrum
  • gamma motor neurons set and fine-tune the activity of the moment-to-moment fine adjustment of posture and locomotion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sherrington’s Law

A

-when a muscle receives a nerve impulse to contract, its antagonists, receive, simultaneously, an impulse to relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The muscle spindle

A
  • through the gamma system, provides proprioceptive info and mediates proprioceptive reflexes
  • SD caused by sudden contraction of the biceps causes triceps to have increased gamma activity and to be reflexively contracted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Counterstrain Treatment

A

-by brining a hypertonic muscle, whose spindles “report strain where there is none,” into a shortened position the physician can reverse the hyperactivity of the spindles, restoring the normal stretch reflex and the normal range of motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Evidence base for Counterstrain

A
  • single blind randomized controlled trial of crossover design showed no electrically recorded reflexes of calves observes in response to treatment
  • peak force and time to reach peak force both increased in the post-treatment measurements
  • significantly more pronounced in the counterstain mode
  • significant relief of symptoms, most pronounced immediately after treatment and still present 48 hours later
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tissue Trauma Pathogenesis

A
  • trauma produces changes in myofascial tissue at microscopic and biochemical levels
  • more specifically trauma causes damage to myofibrils and their microcirculation
  • nociceptive information carried to the CNS
  • the tissue disruption an subsequent chemical changes cause the tissue to become more sensitive and may contribute to the formation of a tender point
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Three Proposed pathways of tissue trauma pathogenesis

A
  • strain-counterstrain: reflex mediated through gamma motor neuron pathway
  • trauma–direct injury to tissues results in nociceptive maintained TPs
  • secondary to SD: TART
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Respiratory/Circulatory Model Micro level

A

-The TTA associated with a TP indicates compromised circulation on a cellular level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Respiratory/Circulatory Model Macro level

A
  • superior thoracic aperture is bounded by: T1, the first ribs, the costal cartilage of the 1st rib and the superior border of the manubrium
  • restore microcirculation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Posture/Motion model

A

-balance posture and function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Behavior model

A

optimize function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Neurologic model

A

interrupt pathophysiologic reflexes and pain pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Metabolic model

A

-improve physiology and exercise ability

17
Q

16 yo with ankle pain. Playing basketball and had an inversion sprain 2 weeks ago. He has lateral ankle pain. PE has a preference for inversion at the ankle. What most likely describes the underlying neuropathology involved in this patient’s described somatic dysfunction?

A

-increased gamma motor activity of the inverters

18
Q

Indications for Counterstrain treatment

A
  • presence of a tender point
  • can be found in acute and chronic musculoskeletal conditions
  • may be associated with a viscerosomatic reflex
  • may be the primary indication of a somatic dysfunction
  • may be secondary to another primary (ex. joint restriction)
  • reluctant/afraid patients
  • frail patients
  • trial of OMT to assess patient tolerance
19
Q

Absolute Contraindications to Counterstrain

A
  • fracture
  • torn ligament
  • patient refusal
20
Q

Relative Contraindications to counterstrain

A
  • stressed patients who can’t relax
  • uncooperative children
  • severe osteoporosis
  • C-spine treatment in patients with vertebral artery disease
  • severely ill patients who may not tolerate a treatment reaction (metastatic cancer, cervicals in RA, medically not stabilized)
21
Q

Finding Tender Points: History

A
  • may be primary (i.e. from a strain)
  • examine area of CC for TPs
  • knowing the position of the strain can help determine the muscles involved and the position of treatment
  • may be secondary to another type of somatic dysfunction (arthrodial, myofascial, viscerosomatic)
22
Q

Finding Tender Points: PE

A
  • postural examination may give clues to TPs

- TART changes: TPs are usually associated with TART

23
Q

Tender Point Identification

A
  • usually located in the muscle belly or the tendinous insertions
  • typically discrete, small, tense, and edematous
  • usually 4x as tender as adjacent tissue
  • enough force to blanch your fingernail
  • significant TP results in patient wincing
  • Viscerosomatic TPs will return in minutes to hours
24
Q

Tender Points in Testing and monitoring

A
  • normal tissue requires 4x the level of digital pressure to elicit tenderness as the amount of pressure necessary to elicit tenderness in a counterstrain point
  • TP checks should be administered in short, quick pushes
  • Observed TTA changes should be confirmed with TP checks
  • Maintain monitoring finger on TP at all times
25
Q

4 Reasons to maintain contact with a TP

A
  • TTA change can be monitored more easily and aid in determining the end point of treatment
  • TP may need further ‘fine-tuning’ while maintaining the optimal position of comfort, because the position may change slightly during treatment
  • Both the patient and the practitioner can be confident of the location of the TP
  • observation of the ‘therapeutic pulse’–possibly related to localized, sympathetically-mediated vasodilation
26
Q

Folding toward TPs

A
  • passive process
  • when TTA changes occur recheck TP: goal is for a “3” or less on tenderness scale; if not <3 continue to explore for optimal position
  • maintain light contact with TP
  • initial positioning usually requires large, slow movement, then “fine-tuning” is necessary
27
Q

Presence of therapeutic pulse in counterstrain indicates

A

good myofascial relaxation

28
Q

Inability to reduce tenderness to zero means

A

that there is usually another associated TP

29
Q

Anterior TPs typically require

A

flexion

30
Q

Posterior points typically require

A

extension

31
Q

Midline TPs typically require

A 
pure flexion (anterior)/extension (posterior) 
-increased deviation from midline requires more rotation and/or side bending
32
Q

Post-treatment instructions for counterstrain

A
  • starts before the patient leaves the table
  • warn patients not to test previously restricted motions and avoid extremes of motion for several days (especially true if the movement approximates the original position of injury)
  • emphasize hydration with H2O (optimal hydration maximizes waste elimination; abstinence from alcohol is recommended for 3 days)
  • post-treatment soreness is not uncommon
  • follow-up recommended in 3-7 days after initial treatment
33
Q

Triggerpoints

A
  • described by Janet Travell, MD
  • specific referral patterns/radiation
  • firm/taut band of muscle with localized tenderness of palpable nodule
  • treated with dry needle, injection, or topical vapocoolant–spray and stretch
  • may occur in any skeletal muscle
  • single or multiple
  • latent TrPs are, most likely, tender points
34
Q

60 yo female with lower back pain. Cannot stand up straight. What is the most likely tender point?

A

AL2

35
Q

Chapman’s Points vs TPs

A
  • considered a viscerosomatic reflex
  • consistent association between structures
  • palpatory findings–pea sized tapioca ball (boba), TTA…
  • generally doesn’t respond to CS treatment

OS3 Exam II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions