Lecture 1: Introduction to Counterstrain Flashcards
What is counterstrain and what are the major steps in this technique?
Passive indirect OMM technique for MSK pain
TART > Tender point > “fold & hold” > spontaneous release
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 seconds
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 tissue texture abnormalities w/o tenderness
Describe nociceptive perspective of tenderpoint development.
Strained tissue recruits nociceptors w/in tissue –> reflexive contraction to protect tissue –> stuck in contraction = pain
Describe proprioceptive perspective of tenderpoint development
gamma motor neurons sense stretch > protective contracture of stretched muscle > stuck in contraction = pain
Where do we position our tissues when doing counterstrain?
Pathologic neutral
What happens during:
- Relaxation phase
- Normalization phase
- Washout phase
- Neutral phase
1) tissues shortened into position of ease
2) tenderness improves as reflex loop resets and returns to normal
3) holding for 90 seconds because metabolic washout happens and peaks at 1 minute, might feel therapeutic pulse
4) 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 (3-5 seconds of returning)
- Recheck tenderness
In the relaxation phase of counterstrain, what are the 3 planes that the affected tissue is shortened?
Flexion/Extension
Sidebending
Rotation
Why is a slow return to neutral important?
-rapid return could reactivate the reflex loop
What is the counterstrain position of comfort (pathologic neutral)?
The point at which at least 70% of tenderness is alleviated
