Strain and Counterstrain

Question 1

Direct Treatment

Answer 1

Engaging the restrictive barrier and directions a force in the direction of the barrier
Find limitation and push beyond it (stretching, joint mobilization)

Question 2

Indirect Treatment

Answer 2

Treatment focused on moving away from the barrier

Find restriction and move away from it (shorten, SCS)

Question 3

SCS

Answer 3

indirect treatment technique in which dysfunctional tissue is placed in a position of comfort to assist in addressing neuromuscular dysfunction

Question 4

L. Jones definition of SCS

Answer 4

inappropriate proprioceptor activity

passively putting tissue into its position of comfort (shortened)

Question 5

Somatic Dysfunction - Acute

Answer 5

Acute traumatic injuries have predictable presentations - inflammation, pain, etc.

Question 6

Somatic Dysfunction - Insidious issues

Answer 6

Insidious issues develop over time as the body’s tissues adapt to the stresses placed on the,

Question 7

Somatic Dysfunction

Answer 7

A combination of the two (acute and insidious) results in dysfunction

Question 8

Muscle spindle

Answer 8

sens to stretch

intrafusal (gamma) and extrafusal (alpha)

Question 9

Review the rationale for SCS

Answer 9

Injury –> agonist legthens, antagonist shortens
Gamma firing of shortened muscle spindle decreases
Stretch reflex of stretch muscle occurs –> muscle contraction and inhibition of shortened muscle
Gamma efferent of shorteneed is increased as lengthening is attempted due to agonist contraction
This causes the muscle spindle of shortened muscle to rest as it thinks this shortened position is normal
This increase in gamma gain continues until there is intervention
Lengthened muscle still tries to shorten but is inhibited from doing so by the shortened muscles reflex
Results in lengthened muscle becoming weaker –> muscle inbalance

Question 10

Tender Point

Answer 10

Localized facilitation of a particular point in a muscle
Results in increased muscle tone –> dec
Localized blood supply –> ischemia –> inc sens to pressure

Question 11

Tender points become more active when

Answer 11

the tissue is stressed

Question 12

Dynamic Neutral

Answer 12

position in which tissue motion is unrestricted and within the range of normal physiological limits

Question 13

Ease

Answer 13

Mid-range of motion where the tissue is at its least tense

The position of ease is often the position of strain - clinicall relevant - stuff stuck in drawer

Question 14

Treatment sequence

Answer 14

Locate muscle/tissue to be treated
Shorten the muscle/tissue
Hold shortened position
Slowly return the muscle passive to neutral

Question 15

Locate area to be treated

Answer 15

feel tissue for quality

look for points (size, tenderness, depth)

Question 16

Shorten the muscle/tissue

Answer 16

One hand maintains light observational pressure
One hand moves the body to shorten the tissue
Look for 70% or better resolution of pain

Question 17

Maintain the shortened position

Answer 17

hold position for 90 seconds to 20 minutes
-allow muscle spindle to rest
Continually monitor the tender point

Question 18

Return tissue to neutral position

Answer 18

Slowly, passively, return the body/tissue to its neutral position
DO NOT allow the patient to assist

Question 19

Re-assessment

Answer 19

Re-assess the level of tenderness of tissue treated
Re-assess ROM, strength, etc
Repeat as necessary

Question 20

Order of treatment

Answer 20

Proximal to distal
Larger joints prior to smaller joints
If multiple pojts, treat most tender first
If points in row; treat center first

Question 21

General rules

Answer 21

No pain
Not too much pressure over point during rx
Warn patient that there may be post-treatment soreness

Question 22

Contraindications

Answer 22

Malignancy
Skin conditions
Infectious conditions

Question 23

Generalized Treatment Order

Answer 23

Address acute issues that prevent use of manual treatment
SCS (indirect)
MET, joint mob (direct tx)
Exercise