Intro to Counterstrain Flashcards
What is Counterstrain?
gentle, passive indirect OMM technique for MSK pain
Define tenderpoint
non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia that reduces when places into a position of ease
Dr. Lawrence H Jones
- 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
Janet Travell MD
was publishing about Trigger point at the same time as Jones was publishing about tenderpoint
Trigger Point
- located in muscle
- characteristic pain pattern
- locally tender and radiates pain
- present with taut band of tissue that will twitch when palpated
Tender Point
- located in muscle, tendon, ligaments, fascia
- no characteristic pain pattern
- only locally tender
- no taut band or twitch response
Only requirement for CS
patient must be able/willing to be positioned and relax
Contraindications
- severe trauma, illness, instability where management beside OMM is indicated
- patient cannot voluntarily relax
- unable to position patient without extreme pain or anatomic changes
Naming of tenderpoints
- laterality, anterior/posterior and the vertebra
- or by the anatomic structure that is being treated
Treatment nomenclature
- position of ease
- upper case = a lot
- lower case = a little
Maverick point
tenderpoint with treatment position opposite of the rest of the region
Stoic
distinct palpable TTA without tenderness
Nociceptive Perspective
- initiated by nociceptors in strained tissue
- produces reflexive contraction to protect tissue
- stuck in reflex loop
- ex) ligament muscular reflex during ankle sprain
Proprioceptive Perspective
- 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
Consequence of prolonged contraction/nociception
- 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
Pathologic Neutral
- 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
1) Relaxation Phase
- tissues shortened into position of ease
- palpate TTA at tenderpoint, localize through 3 plane to normalize tissue
2) Normalization of nocicieptive and neuro input phase
- nociceptive input resolves in position of ease
- spindle fiber length resets and gamma loop is restored to normal input
3) Washout phase
- metabolic washout begins 10-15 seconds after optimal position achieved (therapeutic pulse may be felt)
- peak washout occurs at approx 1 minute
4) slow return to neutral phase
- 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
Counterstrain steps
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
Finding a tenderpoint
-TART
Tenderness scale
- tell patient tender point is a 10 out of 10
- move to position of ease until they feel a 3 out of 10
