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OS IV Exam I SG > Review: Intro to Counterstrain > Flashcards

Review: Intro to Counterstrain Flashcards

1
Q

Is counterstrain direct or indirect

A

Indirect

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2
Q

Who developed counterstrain theory

A

Lawrence Jones, DO in 1955 — first discovered posterior tenderpoints

Later developed comprehensive set of points on the body that may be associated with SD as well as an effective manner of treatment

[anterior tender points were discovered later with “ruptured groin” patient]

Officially named counterstrain in 1980

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3
Q

Differentiate trigger point from tender point in terms of primary vs. secondary SD

A

Trigger points = primary dysfunction (radiating)

Tender points = secondary dysfunctions (locally tender, do not radiate)

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4
Q

Is the following characteristic of tender points or trigger points:

Taut band not present
Twitch response not present
Dermographia not present

A

Tender points

[trigger points present within taut band of tissue, elicit twitch response with snapping palpation, dermographia of skin present over point]

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5
Q

2 models of counterstrain theory

A

Nociceptive model

Proprioceptive model

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6
Q

Nociceptive model of CS

A

A tissue is strained recruiting nociceptors within that tissue

Reflexive contraction of affected tissues —> contraction of affected tissue becomes new neutral

Ex: ankle sprain

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7
Q

Proprioceptive model of CS

A

A muscle is strained without recruiting nociceptors

Antagonist muscle is shortened (turns down spindle firing rate)

CNS turns up gain for antagonist gamma system (GAMMA LOOP)

Antagonist contraction becomes “neutral”

Ex: whiplash

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8
Q

Common theme between nociceptive and proprioceptive model of CS

A

Local constriction of muscles causes decreased circulation, causing localized edema and back up of products of metabolism

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9
Q

4 phases of CS

A
  1. Relaxation
  2. Reset of spindle fibers and nociceptors
  3. Washout
  4. Slow return to neutral
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10
Q

During which phase of counterstrain is the affected tissue shortened in 3 planes and is associated with rapid reduction in nociceptive input?

A

Phase I relaxation

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11
Q

T/F: counterstrain is associated with changes in golgi tendon organs

A

FALSE that’s muscle energy; CS is associated with muscle spindle fibers

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12
Q

Spindle reset affects primary endings of muscle spindle stretch receptors, aka the ______ endings, as well as the secondary endings of muscle spindle stretch receptors, aka the ________ endings

A

Annulospiral

Flower spray

[note that annulospiral are associated with length+rate of change in length(dynamic) and the flowerspray are associated with length but are static]

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13
Q

The ____ phase of CS occurs d/t increased muscular tone inhibiting blood flow which causes buildup of waste products. It begins ______ seconds after optimal position is achieved and a therapeutic pulse may be felt

The peak of this phase occurs at approx _____ seconds into the tx

A

Washout; 10-15

60

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14
Q

How long is CS technique maintained while treating the ribs?

A

120 seconds (only 90 seconds for other body areas)

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15
Q

Where are significant tender points typically found anatomically?

A

Found at point where motor nerve pierces investing fascia and enters muscle

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16
Q

No more than ____ tender points should be treated per visit

A

6

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17
Q

Tender points that do not respond to typical positioning and usually require opposite position from standard

A

Maverick

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18
Q

Absolute contraindications to CS

A 
Trauma
Severe illness
Instability
Vascular or neurologic syndromes
Severe degenerative spondylosis
19
Q

Relative contraindications to CS

A

Pt cannot voluntarily relax

Pt cannot discern level of pain or its change secondary to positioning

Pts who cannot understand instructions

Pts with underling conditions in whom positioning exacerbates the underlying condition (i.e., arthritis, CT diseases)

20
Q

T/F: CS can be used in pts with severe osteoporosis, metastatic bone disease, and acute injuries

A

True

21
Q

Location and tx position for PC1 inion

A

PC1 inion = inferior nuchal line, just lateral to inion

F St Ra

22
Q

Location and tx position for PC1 occiput

A

PC1 occiput = inferior nuchal line midway between inion and mastoid (associated with splenius capitis and/or rectus capitis posterior major/minor and obliquus capitis superior mm)

E Sa Ra

23
Q

All of the posterior cervical counterstrain points are e-E Sa Ra except for which one? Where is it located?

A

PC3 = inferior tip of inferolateral aspect of spinous process of C2 (may correlate with irritation of greater and/or third occipital n and/or mm innervated by C3 such as middle scalene, longus capitis, longus colli)

Tx PC3 — F SaRa

24
Q

Location of PC2 occiput

A

Inferior nuchal line within semispinalis capitis m associated with greater occipital n

25
Q

Location of PC2

A

Superior or superior lateral aspect/tip of spinous process of C2 (may correlate with rectus capitis posterior major/minor m. and obliquus capitis inferior mm)

26
Q

Location of PC4-8

A

Inferior or inferolateral aspect of spinous process; may correlate with semispinalis capitis, multifidus, or rotatores

27
Q

Posterior thoracic spinous process tender point locations

A

Midline on inferior aspect of spinous process of dysfunctional segment

28
Q

Tx for posterior thoracic spinous process TPs

A

e-E

PT1-3 = pt prone with arms over side of table

PT4-6 = pt prone with arms over side of table

PT7-12 = pt prone with arms over top of table

29
Q

locations of PT1-12 transverse process TPs

A

On transverse process of each thoracic vertebra medial to articulation with associated rib; associated with longissimus thoracis, levatores costarum, semispinalis, multifidus, or rotatores

30
Q

Tx for PT1-3 TP

A

E Sa Ra

31
Q

Tx for PT4-9 TP

A

E Sa RT

32
Q

Tx for PT10-12 TP

A

e-E Sa Rt (pelvis), Ra(torso)

[opposite side of pelvis lifted up]

33
Q

Location and tx for PL1-5 SP

A

Located on respective inferolateral aspect of spinous process

e-E Adduct RT(pelvis), RA(torso)

[leg lifted on same side]

34
Q

Tx for PL1-3 TP

A

E Sa RT(pelvis), RA(torso)

[ipsilateral ASIS lifted]

35
Q

Location of UPL5

A

Superior medial surface of PSIS

36
Q

Tx for UPL5

A

Doc stands opposite TP

E Adduct IR/ER

37
Q

Location of LPL5

A

On ilium just inferior to PSIS pressing superiorly

38
Q

Tx for LPL5

A

F IR Adduct

39
Q

Location of high ilium sacroiliac TP

A

2-3 cm lateral to PSIS pressing medially toward PSIS

40
Q

Tx for HISI

A

e-E Abduct ER

41
Q

Location of PL3 gluteus

A

2/3 lateral from PSIS to tensor fascia latae (upper outer portion of gluteus medius at level of PSIS)

42
Q

Tx for PL3 gluteus and PL4 gluteus

A

E Abduct ER

43
Q

Location of PL4 gluteus

A

Posterior margin of tensor fascia latae

OS IV Exam I SG (20 decks)

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