Lecture 1: Introduction to Counterstrain Flashcards
What is counterstrain?
Passive indirect OMM technique for MSK pain
What is a tenderpoint?
Non-radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia, that reduces when placed into a position of ease
How long should patients be kept in a specific position when using counterstrain?
90 secounds
How does a trigger point differ from tender point?
Trigger: only in muscle and will radiate
- characteristic pain pattern
- tissue can twitch
Tenderpoint: muscle, tendon, ligament, fascia
- no characteristic pain pattern
- no taut band or twitch response
What are some contraindications of counterstrain?
- Severe trauma, illness, instability
- Patients that cannot voluntary relax
- Unable to position patients due to pain or anatomic changes
What are maverick points?
Tenderpoint with treatment positions opposite than those in the rest of the region
What are stoic points?
Distinct palpable TTA w/o tenderness
Describe nociceptive perspective.
Strained tissue recruits nociceptors w/in tissue –> reflexive contraction to protect tissue –> contraction of affected tissue becomes neutral
Agonist tissue strained => agonist tissue shortening
Describe proprioceptive perspective.
Abnormal muscle lengthening causes antagonist muscles to shorten –> CNS causes contraction of the antagonist muscle to become the new neutral state
Agonist tissue strained => agonist tissue shortening
-work with spinal gamma motor neurons
Where are counterstrain techniques positioned?
Pathologic neutral
What are the phases of counterstrain?
1) Relaxation phase: tissues shortened into position of ease
2) Normalization of nociceptive and neuro input phase: tenderness improves
3) Washout phase: holding for 90 seconds and might feel therapeutic pulse
4) Slowly return to neutral phase: tissues moved back to normal neutral
What are the steps of counterstrain?
- Find most significant tenderpoint - TART
- Physician establishes a tenderness scale from 1-10
- Monitor tenderpoint throughout
- Place patient in position of ease for 70% improvement
- Hold 90 seconds
- Slowly return to neutral
- Recheck tenderness
In the relaxation phase of counterstrain, what are the 3 planes that the affected tissue is shortened?
Flexion/Extension
Sidebending
Rotation
Which phase of counterstrain causes a rapid decrease in nociceptive input?
Relaxation phase
What are the primary endings of muscle spindle stretch receptors responsible for in muscle contraction?
Sense rate of change in length of muscle (length)
