Review: Intro to Counterstrain Flashcards
Is counterstrain direct or indirect
Indirect
Who developed counterstrain theory
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
Differentiate trigger point from tender point in terms of primary vs. secondary SD
Trigger points = primary dysfunction (radiating)
Tender points = secondary dysfunctions (locally tender, do not radiate)
Is the following characteristic of tender points or trigger points:
Taut band not present
Twitch response not present
Dermographia not present
Tender points
[trigger points present within taut band of tissue, elicit twitch response with snapping palpation, dermographia of skin present over point]
2 models of counterstrain theory
Nociceptive model
Proprioceptive model
Nociceptive model of CS
A tissue is strained recruiting nociceptors within that tissue
Reflexive contraction of affected tissues —> contraction of affected tissue becomes new neutral
Ex: ankle sprain
Proprioceptive model of CS
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
Common theme between nociceptive and proprioceptive model of CS
Local constriction of muscles causes decreased circulation, causing localized edema and back up of products of metabolism
4 phases of CS
- Relaxation
- Reset of spindle fibers and nociceptors
- Washout
- Slow return to neutral
During which phase of counterstrain is the affected tissue shortened in 3 planes and is associated with rapid reduction in nociceptive input?
Phase I relaxation
T/F: counterstrain is associated with changes in golgi tendon organs
FALSE that’s muscle energy; CS is associated with muscle spindle fibers
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
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]
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
Washout; 10-15
60
How long is CS technique maintained while treating the ribs?
120 seconds (only 90 seconds for other body areas)
Where are significant tender points typically found anatomically?
Found at point where motor nerve pierces investing fascia and enters muscle
No more than ____ tender points should be treated per visit
6
Tender points that do not respond to typical positioning and usually require opposite position from standard
Maverick
Absolute contraindications to CS
Trauma Severe illness Instability Vascular or neurologic syndromes Severe degenerative spondylosis
Relative contraindications to CS
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)
T/F: CS can be used in pts with severe osteoporosis, metastatic bone disease, and acute injuries
True
Location and tx position for PC1 inion
PC1 inion = inferior nuchal line, just lateral to inion
F St Ra
Location and tx position for PC1 occiput
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
All of the posterior cervical counterstrain points are e-E Sa Ra except for which one? Where is it located?
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
Location of PC2 occiput
Inferior nuchal line within semispinalis capitis m associated with greater occipital n
Location of PC2
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)
Location of PC4-8
Inferior or inferolateral aspect of spinous process; may correlate with semispinalis capitis, multifidus, or rotatores
Posterior thoracic spinous process tender point locations
Midline on inferior aspect of spinous process of dysfunctional segment
Tx for posterior thoracic spinous process TPs
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
locations of PT1-12 transverse process TPs
On transverse process of each thoracic vertebra medial to articulation with associated rib; associated with longissimus thoracis, levatores costarum, semispinalis, multifidus, or rotatores
Tx for PT1-3 TP
E Sa Ra
Tx for PT4-9 TP
E Sa RT
Tx for PT10-12 TP
e-E Sa Rt (pelvis), Ra(torso)
[opposite side of pelvis lifted up]
Location and tx for PL1-5 SP
Located on respective inferolateral aspect of spinous process
e-E Adduct RT(pelvis), RA(torso)
[leg lifted on same side]
Tx for PL1-3 TP
E Sa RT(pelvis), RA(torso)
[ipsilateral ASIS lifted]
Location of UPL5
Superior medial surface of PSIS
Tx for UPL5
Doc stands opposite TP
E Adduct IR/ER
Location of LPL5
On ilium just inferior to PSIS pressing superiorly
Tx for LPL5
F IR Adduct
Location of high ilium sacroiliac TP
2-3 cm lateral to PSIS pressing medially toward PSIS
Tx for HISI
e-E Abduct ER
Location of PL3 gluteus
2/3 lateral from PSIS to tensor fascia latae (upper outer portion of gluteus medius at level of PSIS)
Tx for PL3 gluteus and PL4 gluteus
E Abduct ER
Location of PL4 gluteus
Posterior margin of tensor fascia latae
