Lecture 1: Intro to Counterstrain

Question 1

Who developed the Counterstrain technique?

Answer 1

Lawrence Jones, DO

Question 2

What is the pain pattern like in a trigger point vs. tender point

Answer 2

Trigger point: patient presents WITH characteristic pain pattern

Tender point: typically NO characteristic pain pattern

Question 3

Elicitation of a radiating pain pattern when pressed is associated with (tender point or trigger point)?

Answer 3

Trigger point

Question 4

Elicitation of a twitch response with snapping palpation is associated with (tender point or trigger point)?

Answer 4

Trigger point

Question 5

What is the typical location of a tender point vs. trigger point?

Answer 5

Tender point: muscle, tendons, ligaments, and fascia

Trigger point: muscle tissue

Question 6

What are the 3 proposed pathways of pathogenesis for Counterstrain points?

Answer 6

1) Strain-Counterstrain: reflex mediated thru gamma motor neuron pathway
2) Trauma: direct injury to tissues results in nociceptive maintained TPs
3) Secondary to SD: TART - one of the “T’s” stands for tenderness

Question 7

When a muscle is strained without recruiting nociceptors, what happens to the antagonist muscle?

Role of the CNS?

What become “neutral”?

Answer 7

• Antagonist muscle is shortened (turns down spindle firing rate)
• CNS turns up gain for antagonist gamma system
• Antagonist contraction becomes “neutral”

Question 8

What is done during phase I of counterstrain?

Answer 8

Shorten the affectd tissue in 3 planes

Question 9

Counterstrain is targeting what fibers vs. muscle energy?

Answer 9

• Counterstrain = muscle spindle fibers
• ME = golgi tendon organs

Question 10

Relieving pain by reduction and arrest of the continuing inappropriate proprioceptor activity. Is accomplished by markedly _______ the muscle that contains the malfunctioning _________ by applying mile strain to its _________ (definition of tx for counterstrain)

Answer 10

Relieving pain by reduction and arrest of the continuing inappropriate proprioceptor activity. Is accomplished by markedly shortening the muscle that contains the malfunctioning muscle spindle by applying mild strain to its antagonist

Question 11

Absolute contraindications for Counterstrain?

Answer 11

1) Fracture (not stabilized)
2) Torn ligament (not stabilized)
3) Patient refusal

Question 12

Relative contraindications for Counterstrain?

Answer 12

• Stressed patient (who can’t relax)
• Uncooperative child
• Severe osteoporosis
• C-spine tx in patients with vertebral artery disease
• Severely ill patients who may not tolerate a treatment reaction (metastatic CA, cervicals in RA, medically not stabilized)

Question 13

What is the rule for how long to hold in postion of ease for tx of tenderpoint?

How about for ribs?

Answer 13

• 90 sec is the rule
• Dr. Jones routinely used 120 sec for rib TP’s

Question 14

Tender points are usually found where?

Answer 14

Muscle belly or tendinous insertions

Question 15

Anterior points usually require _______

Posterior points usually require ______

Midline points typically require ________

Answer 15

Anterior points usually require flexion

Posterior points usually require extension

Midline points typically require pure flexion/extension

Question 16

With increased deviation from the midline, tenderpoints require more?

Answer 16

Rotation and/or sidebending

Question 17

Presents with a taut band of tissue (trigger point or tender point)?

Answer 17

Trigger point