Introduction to Counterstrain Flashcards
Founder of Counterstrain
Dr. Lawrence Jones in 1955
Location of Tender Points
Muscle, Tendon, Ligaments, Fascia
Do Tender points have characteristic pain patterns?
No, only locally tender
Do Tender Points present with taut band of tissue that twitches when palpated?
No taut band or twitch response
Indications for CounterStrain
- presence of tender point
- acute/chronic MSK conditions
- patient hesitant to forces used in other types of tx
- frail patient
- trial of manipulation to assess tolerance
Contraindications to Counter Strain
- severe trauma/illness/instability where treatment besides OMM is indicated
- patient cannot voluntarily relax (ex. children)
- unable to position patient due to extreme pain and/or anatomic changes
What type of technique is counter strain?
Passive Indirect
Treatment position for counter strain:
Position of ease
Maverick
Tender point that bucks treatment trend of the region
Steps of Counterstrain
(1) Palpate target tissue (muscle, tendon, ligaments, fascia)
(2) Localize to the Indirect position (shifted neutral) – regional position of ease (indirect)
(3) Apply activating force (wait 90 seconds)
Alpha Motor Neuron
Provides motor signal to intrafusal (small) muscle fibers
Gamma Motor Neuron System
- Provides motor signal to intrafusal (small) muscle fibers
- balances length of multiple muscle fibers
- prevents sudden changes: length and tone
- Central sensory component = senses changes of small (intrafusal) fibers being displaced by large fibers of alpha motor system
Sensitization
- result of overwhelmed regulation of muscle perfusion
- reduced metabolic recovery -> inflammatory neuropeptides and tenderness
Position of ease moves muscle to:
shifted neutral to trigger contraction relaxation
Phases of Counterstrain
(1) Relaxation
(2) Normalization of nociceptive and proprioceptive input phase
(3) Washout
(4) Slow return to neutral
Phases of Counterstrain: Relaxation Phase
- after TP is found, body is localized into a position of ease (shifted neutral)
- TTA abnormality will significantly decrease
- tenderness will significantly reduce (<70%)
Phases of Counterstrain: Normalization of Nociceptive and Proprioceptive Input Phase
- nociceptive input resolves as tenderness decreases
- spindle fiber length begins to reset
- gamma motor system resumes normal function with new normal input
- tissue begin to release and lengthen
Phases of Counterstrain: Washout Phase
- metabolic washout begins at 10-15 seconds after optimal position is achieved
- resumption of normal local perfusion
- decrease in sensitizing neuropeptides
- peak washout occurs at approximately 1 minute (90 SECONDS!; clue: therapeutic pulse)
Phases of Counterstrain: Slow Return to Neutral Phase
- tissues now moved back to original neutral
- rapid return could reactivate spindle cell activity
- muscle spindles remain sensitive ~24hrs after treatment
- remind patients to take it easy 1 day after treatment
Counterstrain Steps
(1) Find most significant TP
(2) Physician establishes tenderness scale (scale of 1-10)
(3) Monitor TP throughout treatment (TTA must reduce to properly localize; DO NOT LET GO)
(4) Place in Position of Ease (need atleast 70% improvement of tenderness; patient must state tenderness has improved to a minimum 3/10 when asked)
(5) Apply activating force = hold for 90 seconds
(6) Slowly return to neutral (prevents reactivation of muscle spindles)
(7) Recheck tenderness FIRST prior to checking other
Reasons for Unsuccessful Counterstrain
- Ergonomics: not optimal position
- Tenderness scale not established
- Position changed during tx
- Lost contact with TP
- Returned to neutral too quickly or not passively
- Did not perform steps in correct order
TP: Supraspinatus
(1) Location
(2) Treatment Position
(1) Belly of the supraspinatus muscle
(2) Shoulder flexed, abducted, externally rotated (F Abd ER)
TP: Infraspinatus
(1) Location
(2) Treatment Position
(1) Upper is located inferior and lateral to spine of scapula at the posterior medial aspect of the glenohumeral joint; lower located in lower portion of the muscle inferior to the spine and lateral to the medial border of the scapula
(2) Shoulder flexed, abducted, externally or internally rotated
TP: Rhomboids
(1) Location
(2) Treatment Position
(1) Along medial border of the scapula at the attachment of the rhomboid muscles
(2) Shoulder extended and adducted
TP: Levator Scapulae
(1) Location
(2) Treatment Position
(1) Superior medial border of the scapula at the attachment of the levator scapula
(2) Scapula glided superiorly and medially; can alternatively be treated by marked internal rotation of the shoulder with traction and slight abduction
TP: Subscapularis
(1) Location
(2) Treatment Position
(1) Anterolateral border of the scapula on the subscapularis muscle pressing from an anterior lateral to posteromedial direction
(2) Shoulder extended and internally rotated
TP: Long Head of Biceps
(1) Location
(2) Treatment Position
(1) Over the tendon of the biceps muscle in the bicipital groove
(2) Elbow flexed, shoulder flexed and abducted and internally rotated
TP: Short Head of Biceps/Coracobrachialis
(1) Location
(2) Treatment Position
(1) Inferolateral aspect of the coracoid process
(2) Elbow flexed, shoulder flexed and adducted and internally rotated
TP: Pectoralis Minor
(1) Location
(2) Treatment Position
(1) Inferior and medial to the coracoid process
(2) Arm adducted, scapula protracted (f-F Add)
TP: Radial Head Lateral
(1) Location
(2) Treatment Position
(1) Anterolateral aspect of the radial head at the attachment of the supinator
(2) Elbow fully extended, supinated, slight valgus force
TP: Medial Epicondyle
(1) Location
(2) Treatment Position
(1) Medial epicondyle of the humerus at the common flexor tendon and the attachment of pronator teres
(2) Forearm flexed, pronated, and slightly adducted
TP: Dorsal Wrist
(1) Location
(2) Treatment Position
(1) Dorsal surface of the second metacarpal in the extensor carpi radialis muscle; dorsal surface of 5th metacarpal in the extensor carpi ulnaris muscle
(2) Wrist extended with slight abducted or adducted
TP: Palmar Wrist
(1) Location
(2) Treatment Position
(1) Palmar base of the second or third metacarpal in the flexor carpi radialis muscle; palmar base of the fifth metacarpal in the flexor carpi ulnaris muscle
(2) Wrist flexed, slightly abducted or adducted
