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ECOS 1 Final Exam > Introduction to Counterstrain > Flashcards

Introduction to Counterstrain Flashcards

1
Q

Founder of Counterstrain

A

Dr. Lawrence Jones in 1955

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2
Q

Location of Tender Points

A

Muscle, Tendon, Ligaments, Fascia

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3
Q

Do Tender points have characteristic pain patterns?

A

No, only locally tender

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4
Q

Do Tender Points present with taut band of tissue that twitches when palpated?

A

No taut band or twitch response

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5
Q

Indications for CounterStrain

A
  • 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
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6
Q

Contraindications to Counter Strain

A
  • 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
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7
Q

What type of technique is counter strain?

A

Passive Indirect

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8
Q

Treatment position for counter strain:

A

Position of ease

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9
Q

Maverick

A

Tender point that bucks treatment trend of the region

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10
Q

Steps of Counterstrain

A

(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)

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11
Q

Alpha Motor Neuron

A

Provides motor signal to intrafusal (small) muscle fibers

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12
Q

Gamma Motor Neuron System

A
  • 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
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13
Q

Sensitization

A
  • result of overwhelmed regulation of muscle perfusion
  • reduced metabolic recovery -> inflammatory neuropeptides and tenderness
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14
Q

Position of ease moves muscle to:

A

shifted neutral to trigger contraction relaxation

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15
Q

Phases of Counterstrain

A

(1) Relaxation
(2) Normalization of nociceptive and proprioceptive input phase
(3) Washout
(4) Slow return to neutral

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16
Q

Phases of Counterstrain: Relaxation Phase

A
  • after TP is found, body is localized into a position of ease (shifted neutral)
  • TTA abnormality will significantly decrease
  • tenderness will significantly reduce (<70%)
17
Q

Phases of Counterstrain: Normalization of Nociceptive and Proprioceptive Input Phase

A
  • 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
18
Q

Phases of Counterstrain: Washout Phase

A
  • 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)
19
Q

Phases of Counterstrain: Slow Return to Neutral Phase

A
  • 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
20
Q

Counterstrain Steps

A

(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

21
Q

Reasons for Unsuccessful Counterstrain

A
  • 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
22
Q

TP: Supraspinatus
(1) Location
(2) Treatment Position

A

(1) Belly of the supraspinatus muscle
(2) Shoulder flexed, abducted, externally rotated (F Abd ER)

23
Q

TP: Infraspinatus
(1) Location
(2) Treatment Position

A

(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

24
Q

TP: Rhomboids
(1) Location
(2) Treatment Position

A

(1) Along medial border of the scapula at the attachment of the rhomboid muscles
(2) Shoulder extended and adducted

25
Q

TP: Levator Scapulae
(1) Location
(2) Treatment Position

A

(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

26
Q

TP: Subscapularis
(1) Location
(2) Treatment Position

A

(1) Anterolateral border of the scapula on the subscapularis muscle pressing from an anterior lateral to posteromedial direction
(2) Shoulder extended and internally rotated

27
Q

TP: Long Head of Biceps
(1) Location
(2) Treatment Position

A

(1) Over the tendon of the biceps muscle in the bicipital groove
(2) Elbow flexed, shoulder flexed and abducted and internally rotated

28
Q

TP: Short Head of Biceps/Coracobrachialis
(1) Location
(2) Treatment Position

A

(1) Inferolateral aspect of the coracoid process
(2) Elbow flexed, shoulder flexed and adducted and internally rotated

29
Q

TP: Pectoralis Minor
(1) Location
(2) Treatment Position

A

(1) Inferior and medial to the coracoid process
(2) Arm adducted, scapula protracted (f-F Add)

30
Q

TP: Radial Head Lateral
(1) Location
(2) Treatment Position

A

(1) Anterolateral aspect of the radial head at the attachment of the supinator
(2) Elbow fully extended, supinated, slight valgus force

31
Q

TP: Medial Epicondyle
(1) Location
(2) Treatment Position

A

(1) Medial epicondyle of the humerus at the common flexor tendon and the attachment of pronator teres
(2) Forearm flexed, pronated, and slightly adducted

32
Q

TP: Dorsal Wrist
(1) Location
(2) Treatment Position

A

(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

33
Q

TP: Palmar Wrist
(1) Location
(2) Treatment Position

A

(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

34
Q
A

ECOS 1 Final Exam (11 decks)

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