Intro to Counterstrain Flashcards
Direct goes towards what? indirect goes towards what? what is Strain/Counterstrain?
towards the barrier
away from the barrier
INDIRECT
What is Counterstrain?
applying a mild strain in the opposite of the false strain reflex
trigger point vs tender point:
1) characteristic pattern of pain?
2) what kinds of tissue is this present?
3) jump sign?
4) radiates?
5) any taut bands of tissue?
6) twitch response?
7) dermographia?
characteristic pattern of pain, no characteristic pattern of pain
muscle tissue …… any muscle, tendon, ligament,
fascia both elicit a jump sign
radiates ….. does not radiate
trigger points have a taut band of tissue, tender does not twitch response
no twitch response dermographia of skin associated with trigger points.
Treatment of trigger points?
Spray and stretch (topical cold coolant in the pattern from the tender point to the pattern of referral)
Trigger point injection
Treatment of Tender points
Counterstrain (spontaneous release by positioning)
What are the three theories of counterstrain?
Nociceptive model
Proprioceptive Model
Four Phases of Counterstrain
Mechanism of action for Nociceptive?
tissue is strained (trauma) recruiting nociceptors within that tissue (muscle, tendon, ligament)
reflexive contraction of the affected tissue (tightens up) – (through alpha motor neurons)
Contraction of Affected tissue becomes neutral. (shifts neutral position)
Nociceptor and Ankle Sprains?
ankle is strained –> recruiting nociceptors within the tissue –> Reflexive contraction occurs at the lateral ankle –> contraction of the lateral ankle becomes the NEW neutral
Main idea for Proprioceptive model?
You have excessive rapid stretch of the primary spindle cell that induces a protective contraction of extrafusal fibers.. which can MAINTAIN TONE for a period after the stimulus has ENDED (even after the stimulus is gone)
involves the gamma loop (so not a strain that produced trauma, more of a neurologically.. resulting in incrased gamma gain, so in
Mechanism of action for proprioceptive model?
muscle is strained (without recruiting nociceptors) *agonist* (rapidly lengthened). agonist also sends info to the CNS to cause rapid shortening to prevent further damage
antagonist muscle is shortened (turns down spindle firing rate)
CNS turns up gamma gain for antagonist gamma system because its not getting enough information
Antagonist contraction becomes new “neutral”
Whiplash and Proprioceptive model?
Posterior cervical muscles are strained and then rapidly shorten the front side.
so rapid shortening of the anterior cervical muscles
CNS turns up gamma gain for antagonist gamma system (innappropriate neutral and increased tension in anterio muscles)
antagonist contraction becomes the new neutral
(so you normally see a lordosis curve, but after this happen you’ll have the flattening of a curve, because more tension on the anterior aspect.)
What do both proprioceptive and nociceptive model do?
causes local constriction and causes:
decreased circulation, causing localized edema and back up of products of metabolism.
What are the Phases of Counterstrain?
Relaxation
Reset spindle fibers and nociceptors
Washout
Slow return to neutral
Explain Phase 1: Relaxation
shorten the affected tissue in 3 planes (flexion/extension, sidebending, rotation)
sometiems traction or compression is needed
this will lend to a rapid reduction in nociceptive input.
Explain phase 2: Spindle Reset
primary endings of muscle spindle stretch receptors (annulospiral)
length, rate of change in length of muscle (dynamic)
secondary endings of muscle spindle stretch receptors (Flower Spray)
length, but not dynamic changes (static)
they’re resetting gains and resetting gamma motors.
Explain Phase 3: washout
Increased muscular tone inhibits blood flow which causes blood build up of waste product
metabolic washout begins at 10-15s after optimal position achieved
peak washout occurs at approximately 1 minute
“Therapeutic pulse”?
pulsing of metabolic washout happening between 10-15 seconds after treatment and a minute
Explain Phase 4: Slow return to neutral
rapid return could reactivate spindle cell activity, so you need to slowly return to normal.
muscle spindles remain facilitated for 24 hours after treatment.
Treatment for counterstrain (7 steps)
Find a significant tender point
Establish a tenderness scale
Monitor the tender point throughout the treatment
Place patient in a position of optimal comfort (ease)
maintain position for 90 seconds
slowly return to neutral
recheck tender point
How do you find a tender point?
people tend to bend around a tender point.
they’re about the size of a pea or a BB.
Contraindications - Absolute of Counterstrain?
Trauma if the area would be negatively affected by positioning
Severe lllness
Instability of treatment area
vascular or neurological syndromes that could compromise region
degenerative spondylosis with no motion at the level where treatment would take place
Relative Contraindications of of Counterstrain?
Patient can’t voluntarily relax
cannot discern thel elvel of pain or its change secondary to positioning
patient who cannot understand instructions
arthritis, connective tissue disease, etc.
