Intro to Counterstrain

Question 1

Direct goes towards what? indirect goes towards what? what is Strain/Counterstrain?

Answer 1

towards the barrier

away from the barrier

INDIRECT

Question 2

What is Counterstrain?

Answer 2

applying a mild strain in the opposite of the false strain reflex

Question 3

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?

Answer 3

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.

Question 4

Treatment of trigger points?

Answer 4

Spray and stretch (topical cold coolant in the pattern from the tender point to the pattern of referral)

Trigger point injection

Question 5

Treatment of Tender points

Answer 5

Counterstrain (spontaneous release by positioning)

Question 6

What are the three theories of counterstrain?

Answer 6

Nociceptive model

Proprioceptive Model

Four Phases of Counterstrain

Question 7

Mechanism of action for Nociceptive?

Answer 7

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)

Question 8

Nociceptor and Ankle Sprains?

Answer 8

ankle is strained –> recruiting nociceptors within the tissue –> Reflexive contraction occurs at the lateral ankle –> contraction of the lateral ankle becomes the NEW neutral

Question 9

Main idea for Proprioceptive model?

Answer 9

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

Question 10

Mechanism of action for proprioceptive model?

Answer 10

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”

Question 11

Whiplash and Proprioceptive model?

Answer 11

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.)

Question 12

What do both proprioceptive and nociceptive model do?

Answer 12

causes local constriction and causes:

decreased circulation, causing localized edema and back up of products of metabolism.

Question 13

What are the Phases of Counterstrain?

Answer 13

Relaxation

Reset spindle fibers and nociceptors

Washout

Slow return to neutral

Question 14

Explain Phase 1: Relaxation

Answer 14

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.

Question 15

Explain phase 2: Spindle Reset

Answer 15

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.

Question 16

Explain Phase 3: washout

Answer 16

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

Question 17

“Therapeutic pulse”?

Answer 17

pulsing of metabolic washout happening between 10-15 seconds after treatment and a minute

Question 18

Explain Phase 4: Slow return to neutral

Answer 18

rapid return could reactivate spindle cell activity, so you need to slowly return to normal.

muscle spindles remain facilitated for 24 hours after treatment.

Question 19

Treatment for counterstrain (7 steps)

Answer 19

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

Question 20

How do you find a tender point?

Answer 20

people tend to bend around a tender point.

they’re about the size of a pea or a BB.

Question 21

Contraindications - Absolute of Counterstrain?

Answer 21

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

Question 22

Relative Contraindications of of Counterstrain?

Answer 22

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.