Intro to Counterstrain

Question 1

What is Counterstrain?

Answer 1

gentle, passive indirect OMM technique for MSK pain

Question 2

Define tenderpoint

Answer 2

non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia that reduces when places into a position of ease

Question 3

Dr. Lawrence H Jones

Answer 3

• 1955
• treatment of 2.5 month history of psoas syndrome
• helped patient find comfortable position to sleep
• 90 seconds
• found over 300 tenderpoints
• only need to do regional positioning

Question 4

Janet Travell MD

Answer 4

was publishing about Trigger point at the same time as Jones was publishing about tenderpoint

Question 5

Trigger Point

Answer 5

• located in muscle
• characteristic pain pattern
• locally tender and radiates pain
• present with taut band of tissue that will twitch when palpated

Question 6

Tender Point

Answer 6

• located in muscle, tendon, ligaments, fascia
• no characteristic pain pattern
• only locally tender
• no taut band or twitch response

Question 7

Only requirement for CS

Answer 7

patient must be able/willing to be positioned and relax

Question 8

Contraindications

Answer 8

• severe trauma, illness, instability where management beside OMM is indicated
• patient cannot voluntarily relax
• unable to position patient without extreme pain or anatomic changes

Question 9

Naming of tenderpoints

Answer 9

• laterality, anterior/posterior and the vertebra

- or by the anatomic structure that is being treated

Question 10

Treatment nomenclature

Answer 10

• position of ease
• upper case = a lot
• lower case = a little

Question 11

Maverick point

Answer 11

tenderpoint with treatment position opposite of the rest of the region

Question 12

Stoic

Answer 12

distinct palpable TTA without tenderness

Question 13

Nociceptive Perspective

Answer 13

• initiated by nociceptors in strained tissue
• produces reflexive contraction to protect tissue
• stuck in reflex loop
• ex) ligament muscular reflex during ankle sprain

Question 14

Proprioceptive Perspective

Answer 14

• muscle spindle fiber determine length/stretch of muscle
• work with spinal gamma motor neurons (LMN)
• determine length of agonist and antagonist muscles through alpha motor neurons to prevent sudden changes
• rapid stretch without recovery (injury/trauma) of spindle fiber will cause protective contraction
• this contracture maintained by gamma motor system

Question 15

Consequence of prolonged contraction/nociception

Answer 15

• overwhelms normal sympathetic and parasympathetic regulation of muscle perfusion
• reduced metabolic recovery of muscles
• lactic acid leads to sensitization of nerve endings
• nociceptive produces cascade of neuropeptides
• local edema
• sensitized nerve endings

Question 16

Pathologic Neutral

Answer 16

• contracture of muscles produced by both models becomes the new pathologic neutral
• neutral = when muscles are most relaxed
• pathologic neutral is where we position our indirect techniques

Question 17

1) Relaxation Phase

Answer 17

• tissues shortened into position of ease

- palpate TTA at tenderpoint, localize through 3 plane to normalize tissue

Question 18

2) Normalization of nocicieptive and neuro input phase

Answer 18

• nociceptive input resolves in position of ease

- spindle fiber length resets and gamma loop is restored to normal input

Question 19

3) Washout phase

Answer 19

• metabolic washout begins 10-15 seconds after optimal position achieved (therapeutic pulse may be felt)
• peak washout occurs at approx 1 minute

Question 20

4) slow return to neutral phase

Answer 20

• tissues are now moved back to normal neutral
• rapid return could reactivate spindle activity
• muscle spindles remain somewhat facilitated for up to 24 hours after treatment
• remind patients to take it easy after treatment

Question 21

Counterstrain steps

Answer 21

1) find most significant tender point
2) establish tenderness scale
3) monitor throughout
4) place patient in position of ease of at least 70% improvement
5) hold for 90 seconds
6) slowly return to neutral
7) recheck tenderness

Question 22

Finding a tenderpoint

Answer 22

-TART

Question 23

Tenderness scale

Answer 23

• tell patient tender point is a 10 out of 10

- move to position of ease until they feel a 3 out of 10