Intro to Counterstrain

Question 1

What are the absolute contraindications to counterstrain

Answer 1

Trauma

Severe illness with strict positional restrictions

Instability of treatment area - potential to produce neurological or vascular side effects

Vascular or neurological syndromes which might lead to compromise of these systems

Severe degenerative spondylosis with no motion at the level of treatment

Question 2

What is the counterstrain position of optimal comfort?

Answer 2

The position at which 100% of tenderness is alleviated

Question 3

What are the 7 steps of counterstrain treatment?

Answer 3

1. Find a significant tenderpoint
2. Establish tenderness scale
3. Monitor the tender point throughout treatment
4. Place patient in position of optimal comfort
5. Maintain position for 90 seconds
6. Slow return to neutral
7. Recheck tenderpoint

Question 4

What is the nociceptive model of counterstrain?

Answer 4

When a tissue is strained, it recruits nociceptors within that tissue => reflexive tissue contraction => contraction of affected tissue becomes neutral

Agonist tissue strained => agonist tissue shortening

Question 5

How much pressure should be placed on a tenderpoint during a counterstrain treatment?

Answer 5

Light pressure

(firm pressure discourages relaxation)

Question 6

In the relaxation phase of counterstrain, what are the 3 planes that the affected tissue is shortened?

Answer 6

Flexion/Extension

Sidebending

Rotation

Question 7

The treatment position “fSaRA” indicates what?

Answer 7

Small amount of flexion

Small amount of sidebending

Large amount of rotation

(Magnitude of action indicated by upper and lowercase)

Question 8

What are the direct OMT techniques?

Answer 8

Soft tissue/Articulation Muscle Energy HVLA MFR Cranial

Question 9

What is the likelihood of achieving a therapeutic reaction with counterstrain?

Answer 9

20-30% of pts will have a therapeutic pulse

Question 10

How is a counterstrain dysfunction treated?

Answer 10

Applying position of mild strain in the direction exactly opposite to that of the false strain reflex by the use of specific point tenderness followed by specific directed positioning

Question 11

What are the similarities between a trigger point and a tender point?

Answer 11

Locally tender Elicits jump sign when pressed Located in muscle

Question 12

What occurs during phase 3 of counterstrain?

Answer 12

Washout - metabolic waste products built up because increased muscular tone inhibits blood flow, will be washed out after 1 minute, may feel a therapeutic pulse

Question 13

About how many tender points can you treat in one treatment?

Answer 13

No more than 6

Question 14

What are the indirect OMT techniques?

Answer 14

Strain/Counterstrain MFR Cranial BLT

Question 15

How long must you maintain counterstrain position for ribs?

Answer 15

120 seconds

Question 16

Which phase of counterstrain causes a rapid decrease in nociceptive input?

Answer 16

Relaxation phase

Question 17

What are the benefits of counterstrain?

Answer 17

Passive, indirect technique

Can be used in patients with severe osteoporosis, metastatic bone disease, and acute injuries

The only absolute requirement is that pt must be able and willing to relax muscles

Question 18

What is a maverick tender point?

Answer 18

Tenderpoint that does not respond to typical positioning

Typically requires the opposite position from standard

Question 19

What are the primary endings of muscle spindle stretch receptors responsible for in muscle contraction?

Answer 19

Sense rate of change in length of muscle (length)

Question 20

What is the definition of the counterstrain dysfunction?

Answer 20

Continuing, inappropriate strain reflex

Question 21

Why is phase 4 of counterstrain a slow return to neutral?

Answer 21

Rapid return can reactivate spindle cell activity

Question 22

What are the 4 phases of counterstrain?

Answer 22

1. Relaxation
2. Reset of spindle fibers and nociceptors
3. Washout
4. Slow return to neutral

Question 23

What is the counterstrain position of comfort?

Answer 23

THe point at which at least 70% of tenderness is alleviated

Question 24

What is the proprioceptive model of counterstrain?

Answer 24

Abnormal muscle lengthening causes antagonist muscles to shorten => CNS causes contraction of the antagonist muscle to become the new neutral state

Agonist tissue strained => antagonist tissue shortening

Question 25

What are the differences between a trigger point and a tender point?

Answer 25

Question 26

What are the relative contraindications to counterstrain?

Answer 26

Pt cannot voluntarily relax

Pt cannot discern level of pain or change in pain with positioning

Pt cannot understand instructions

Pt with underlying conditions restricted by positioning (arthritis, connective tissue disease)