Introduction to Counterstrain Flashcards
What is counterstrain?
passive & indirect OMM technique for MSK pain
Steps for counterstrain
TART
tenderpoint
fold & hold
spontaneous release
What is a tenderpoint?
a non-radiating area of tenderness that is located w/ in a muscle, tendon, ligament or fascia
is reduced when placed into position of ease
Who developed counterstrain?
Dr. Lawrence Jones in 1955
for pt who couldn’t find good sleeping position
How did Dr. Jones develop CS?
placed pts & whole body into positions of comfort for long periods of time
noted posterior tenderpoints that assoc w/ TART findings
What was a problem Dr. Jones encountered w/ CS?
only found posterior tender points on 1/2 of pts
started to find ant tenderpoints
What are trigger points?
located ONLY in muscle
characteristic & radiating pain patterns
locally tender & radiates pain
present w/ taut band of tissue that WILL TWITCH
Indications for CS
fragile pts
sensitive pts
pt must be willing to be positioned & relaxed
Contraindications for CS
severe trauma/illness
pt can’t relax
unable to position pt w/o extreme pain or anatomic changes
How to name tenderpoint
laterality
anterior/posterior
vertebra/anatomic structure
L PC4
left posterior cervical 4 (has 4 possible tender points)
L Psoas
Belly of L psoas muscle
How do you treat R PC6 diagnosis?
extend, sidebend away & rotate away from tenderpoint
What is a maverick point?
tenderpoint w/ treatment position opposite of rest of region
What is a stoic point?
distinct palpable TTA w/o tenderness
Nociceptive perspective of tenderpoints
tell you when something is strained to prevent more strain
Proprioceptive perspective of tenderpoints
muscle spindle fiber determines length & stretch of muscle thru LMN
change in muscle can shut down agonist or anatgonist m (rapid stretch causes protective contraction)
What are the consequences of prolonged contraction/nociception?
sustained contracture
nociceptive produces cascade of neuropeptides
What is sustained contracture assoc w/?
change in muscle perfusion
reduced metabolic recovery of muscles
buildup of lactic acid that sensitizes nerve endings
What is the result of neuropeptide cascade from nociceptive firing?
produces local edema
sensitizes nerve endings
What does pathologic neutral mean?
contracture of muscles that produces a new neutral (where muscles are most relaxed)
In what direction does CS go?
in direction of pathologic neutral
Phases of Counterstrain
Relaxation phase
Normalization of nocicpetive & neuro input phase
Washout phase
Slow return to neutral phase
Relaxation phase of CS
tissues shortened into position of ease
get into pathologic neutral (localize all 3 planes)
Normalization phase of CS
nociceptive input resolves in position of ease
spindle fiber length resets & gamma loop back to normal input
Washout phase of CS
hold position (lasts for 1 min)
Slow return to neutral phase of CS
tissues are moved back to normal neutral
needs to be a slow return (3 to 5 seconds)
Steps of counterstrain
find most signif tenderpoint
establish tenderness scale
monitor tenderpoint
place into position of ease
hold 90 seconds
slowly return to neutral
recheck tenderness
How to find a tenderpoiint
begin w/ TART screen of whole body
need to ask pt if feel tenderness
Establish tenderness scale
talk w/ pt to describe level of pain & where want to get to
can determine how effective treatment will be
What are steps 3 & 4 of CS assoc w?
relaxation & normalizing of nociceptive & neuro input phase
What are steps 5-7 of CS assoc w?
washout & slow return to neutral phases
