14: Intro To Counterstrain

Question 1

Counterstrain type of technique

Answer 1

Passive, indirect

Question 2

Use for Counterstrain

Answer 2

Musculoskeletal pain

Question 3

How is diagnosing for Counterstrain unique?

Answer 3

Focus on tenderness, not preference of motion

Question 4

When and by who was counterstrain started?

Answer 4

1955, Dr. Lawrence Jones

Question 5

Story of how counterstrain started

Answer 5

Pt came in with 2.5 months of psoas syndrome, couldn’t get comfortable while sleeping. Physician helped him find a comfortable spot on the table -> left and came back and pt was much improved

Question 6

What happens to tenderpoint TART findings during counterstrain treatment?

Answer 6

They soften and reduce in pain

Question 7

Amount of time to hold for counterstrain

Answer 7

90 seconds

Question 8

Dr. Travell and Dr. Jones

Answer 8

Published about tenderpoints and trigger points

Question 9

Trigger point vs tenderpoint: location

Answer 9

Trigger point: in muscle only

Tenderpoint: in muscle, tendon, ligaments, or fascia

Question 10

Pain pattern in trigger pt vs tenderpoint

Answer 10

Trigger point: characteristic pain pattern with local radiation
Tenderpoint: no characteristic pattern and no radiation

Question 11

Tautness of tissue in trigger point vs tenderpoint

Answer 11

Trigger point: have a taut band of tissue that will twitch when palpated
Tenderpoint: no taught band or twitch response

Question 12

Only requirement to do counterstrain on a patient

Answer 12

Must be able and willing to be positioned and relax

Question 13

Two ways to name tenderpoints

Answer 13

1. Using laterality + the vertebrae (ex: L PC4)

2. By anatomic structure being treated (ex: L Psoas)

Question 14

Counterstrain treatment nomenclature steps

Answer 14

1. Flex or extend
2. Sidebending away or towards tenderpoint
3. Rotating away or towards tenderpoint

Question 15

What would the counterstrain treatment be for R PC6?

Answer 15

E, SaRa

Question 16

Uppercase vs lowercase letters in counterstrain treatment

Answer 16

Lowercase = a little
Uppercase = a lot

Question 17

Maverick

Answer 17

Tenderpoint with treatment position opposite of the rest of the tenderpoints in its region (doesn’t follow patterns of those around it)

Question 18

Stoic

Answer 18

Distinct palpable TTA without tenderness

Question 19

Two perspectives behind counterpoint

Answer 19

Nociceptive perspective, proprioceptive perspective

Question 20

Nociceptive perspective of tenderpoints

Answer 20

Tenderpoint initiated by nociceptors in strained tissue -> reflexive contraction to protect tissues -> reflex loop

Question 21

Proprioceptive perspective of tenderpoints

Answer 21

Muscle spindle fibers monitor length of muscles using the gamma and alpha motor neurons

Question 22

What happens with a sustained contracture?

Answer 22

Overwhelms normal nervous regulation of muscles, reduced metabolic recovery, lactic acid causes sensitization of nerve endings -> area becomes TTP

Question 23

Four phases of Counterstrain

Answer 23

1. Relaxation
2. Normalization of nociceptive and neurologic input
3. Washout
4. Slow return to normal

Question 24

Seven steps in counterstrain

Answer 24

1. Find most significant tenderpoint
2. Physician establishes a tenderness scale
3. Monitor tenderpoint throughout
4. Place patient in position of ease of 70%+ improvement
5. Hold for 90 seconds
6. Slow return to neutral
7. Recheck tenderness

Question 25

How does physician establish a tenderness scale?

Answer 25

The physician tells the patient that thier most tender spot is a 10/10, and that they will work to get it down to at least a 3/10

Question 26

What three physiological things occur when patient is in position of ease?

Answer 26

1. Muscle tissues shorten and relax 2. Nociceptive input resolves 3. Spindle fiber length resets + gamma loop restored to normal input

Question 27

What might be felt while holding the tenderpoint for 90 seconds?

Answer 27

A therapeutic pulse associated with metabolic washout (begins about 10-15 seconds after optimal positioning, ends in about 60 seconds)

Question 28

What could happen if you dont slowly return patient back to neutral?

Answer 28

Could reactivate muscle spindle cell activity

Question 29

Treatment position for PL 1-5 SP

Answer 29

E, Add, ER

Question 30

Treatment position for PL 1-5 TP

Answer 30

E, Sa, Rt

Question 31

Treatment for UPL5

Answer 31

E, Add, ir/er

Question 32

Treatment for LPL5

Answer 32

F, Add, IR (only flexion treatment)

Question 33

Treatment for HSIS

Answer 33

E, ABD, ER (one of the two abd)

Question 34

Treatment for PL 3 and 4 Glut

Answer 34

E, Abd, er (one of the two abd)

Question 35

Treatment for PT 1-3 TP AND for PT 10-12 TP AND for PL 1-5 TP

Answer 35

E, Sa, Ra

Question 36

Treatment for PT4-9 TP

Answer 36

E, Sa, RT