2. Counterstrain lecture

Question 1

_____ _____ is a gentle passive indirect OMM technique for MSK pain

Answer 1

Counterstrain

Question 2

What is the overflow “flow” of a counterstrain diagnosis and technique?

Answer 2

TART
Tender points
“fold and hold”
“spontaneous release”

Question 3

A ______ ____ is a non radiating area of tenderness that is located within muscle, tendon, ligaments, or fascia, that reduces when placed into a position of ease

Answer 3

tender point

Question 4

Dr. ______ _______ founded counterstrain in 1955 after treating a patient with a 2.5 month history of psoas syndrome

Answer 4

Dr. Lawrence H Jones

Question 5

After doing treatments, what did Dr. Jones determine was the best amount of time to hold the patients in the counterstrain position?

Answer 5

90 seconds

Question 6

A _____ ______ is

1. located only in muscle
2. has a characteristic pain pattern
3. locally tender and radiates pain
4. presents with taut band of tissue that will twitch when palpated

Answer 6

Trigger point

Question 7

A ______ ______ is

1. located in muscle, tendon, ligament, and fascia
2. no characteristic pain
3. only locally tender
4. no taut band or twitch response

Answer 7

Tenderpoint

Question 8

What kind of positioning do you need to do for a counterstrain treatment?

Answer 8

Regional

Question 9

What kind of treatment is counterstrain?

Answer 9

passive and indirect

Question 10

What are indications of using counterstrain?

Answer 10

Patient must be ABLE and WILLING To be positioned and relax

***Can use with very fragile patients

Question 11

What are contraindications of counterstrain?

Answer 11

Severe trauma, illness, or instability

Patient is unable to voluntarily relax

Unable to position without extreme pain or anatomic changes

Question 12

How do you name tender points?

Answer 12

1. Laterally, anterior, posterior and the vertebrae
   ex: L PCA 4 (left posterior cervical 4)
2. By the anatomic structure that is being treated
   ex: L psoas muscle

Question 13

What is the positional treatment?

Answer 13

Go to the position of ease; where does the patient feel a decrease in pain in the tenderpoint area?

***Be sure to say that in the neutral position that AT that tenderpoint that should be the WORST pain that they should feel and use that as the baseline

Question 14

________ is a tenderpoint with treatment position opposite of rest of region

Answer 14

Maverick

Question 15

______ is a distinct palpable TTA without tenderness

Answer 15

Stoic

Question 16

Describe the nociceptive perspective

Answer 16

Initiated by nociceptors in a strained tissue

ex: with an ankle sprain, there is nocicpetive properties in the muscles, tendons, ligaments, and fascia

produces a reflexive contraction to protect the tissue

stuck in a reflex loop

Question 17

Describe the proprioceptive perspective

Answer 17

A muscle spindle fiber determines the length and stretch of a muscle

you work with the spinal gamma motor neurons (LMN)

Determine the length of the agonist and antagonist muscles through alpha motor neurons to prevent sudden changes

Rapid stretch causes protective contraction (gamma motor neuron system)

Question 18

This is what causes the protective contraction of a muscle when it is stretched too much too fast

Answer 18

Gamma motor neurons

Question 19

______ _______ can overwhelm the sympathetic and parasympathetic regulation of muscle perfusion

Answer 19

Sustained contracture

Question 20

In regards to the muscle, what is a consequence of a sustained contracture?

Answer 20

Reduced metabolic recovery of muscle

Question 21

______ ______ leads to the sensitization of nerve endings

Answer 21

Lactic acid

Question 22

__________ produces cascade of neuropeptides in the muscle

Answer 22

Nociceptive

Question 23

What are the effects of nociceptive cascade of neuropeptides?

Answer 23

Localized edema

sensitizes nerve endings

Question 24

The contracture of the muscles that is produced by both the nociceptive and proprioceptive perspectives is called the ______ ______

Answer 24

Pathologic neutral

Question 25

______ _______ is where we position our indirect techniques

Answer 25

Pathologic neutral

Question 26

What does "neutral" mean

Answer 26

the position where the muscles are relaxed

Question 27

List the phases of counterstrain

Answer 27

1. Relaxation phase 2. Normalization of nociceptive and neuro input phase 3. washout phase 4. slow return to neutral phase

Question 28

In this phase of couterstrain, the tissues are shortened into the position of ease

Answer 28

Relaxation phase

Question 29

In this phase, the nociceptive input resolves in the position of ease and the spindle fiber length resets and gamma loop is restored to normal input

Answer 29

Normalization of nociceptive and neurons input phase

Question 30

_______ _______ begins 10-15 seconds after optimal position is achieved

Answer 30

Metabolic washout

Question 31

This phase involves metabolic washout and a peak washout

Answer 31

washout phase

Question 32

Peak washout occurs after about ____ ________ (time)

Answer 32

1 minute

Question 33

In this phase, the tissues return to neutral and the muscle spindles will typically remain facilitated for 24 hours

Answer 33

Slow return to neutral

Question 34

What is a concern about the slow return to neutral phase (last phase)

Answer 34

That a rapid return to neutral could reactivate the muscle spindle activity and cause contraction

Question 35

List the steps of the counterstrain

Answer 35

1. Find most significant Tenderpoint. 2. Physician establish a tenderness scale. 3. Monitor Tenderpoint throughout 4. Place patient in “Position of Ease” of at least 70% improvement 5. Hold 90 seconds. 6. Slowly return to neutral. 7. Recheck tenderness.

Question 36

Where should you start when attempting to find a tender point?

Answer 36

Near the area of TART; because there will probably be a point close to that

Question 37

Why is it important to monitor the tenderpoint throughout?

Answer 37

So that you can feel for any changes and stay on the exact point because you may not find it again

Question 38

Which step does the phrase "fold and hold" apply to?

Answer 38

The fourth step; placing the patient in the position of ease

Question 39

What year was counterstrain first used? And who discovered it?

Answer 39

1955 Dr. Lawrence H Jones ***This was in the lecture legit like 3 times