Counterstrain

Question 1

When and who made Counterstrain?

Answer 1

1955 and Lawrence Jones, DO (spontaneous release by positioning)

Question 2

What did counterstrain used to be called?

Answer 2

Strain-counterstrain

Question 3

Define Counterstrain

Answer 3

An Osteopathic system of diagnosis and indirect treatment in which the patient’s somatic dysfunction, diagnosed by an associated myofascial tender point, is treated by using a position of spontaneous tissue release while simultaneously monitoring the tenderpoint

Question 4

Why was strain-counterstrain once a name for it?

Answer 4

Considered to be related to a continuing inappropriate strain reflex

Question 5

Describe the counterstrain tenderpoints

Answer 5

Counterstrain tender points are discrete, NON RADIATING, hyperalgesic areas in the myofascial (muscle and fascia) tissues. The named points are found at consistent anatomical locations.

Question 6

What initial position did Lawrence Jones put the patient in?

Answer 6

One of comfort

Question 7

Initially only what was identified?

Answer 7

Posterior points, but later determined anterior points as well

Question 8

What year did Dr. Jones publish his first paper?

Answer 8

1964

Question 9

When was Dr. Jones thesis published?

Answer 9

1980

Question 10

What 3 theories provide the clinical efficacy of counterstrain?

Answer 10

1. Proprioceptive theory
2. Sustained abnormal metabolism theory
3. Impaired ligamento-muscular reflex theory

Question 11

Proprioceptive Theory

Answer 11

Tender points develop when local muscle fibers are maintained in a hypertonic state due to an inappropriate proprioceptive reflex during the initiation of somatic dysfunction

Question 12

What are the 2 phases to proprioceptive theory?

Answer 12

1. Sudden lengthening of a shortened muscle, or overstretching or overloading of a muscle
2. Defensively initiated contraction of that muscle in an effort to prevent injury.

Question 13

Sustained Abnormal Metabolism Theory

Answer 13

Tissue injury alters local body position which affects local microcirculation and tissue metabolism.

Question 14

What does localized ischemia do?

Answer 14

Reduces nutrient supply and removal of metabolic waste products to affected area

Question 15

What is increased in SAMT?

Answer 15

Proinflammatory cytokine production

Question 16

Does SAMT cause lowering of the firing threshold of sensory neurons causing localized neuronal sensitization?

Answer 16

Yes; manifest as localized edema and tenderness

Question 17

What does the precise body positioning in counterstrain do?

Answer 17

Improves local vascular circulation and reduces localized production of inflammatory mediators

Question 18

What must the physician ascertain?

Answer 18

The somatic dysfunction, its severity, its tissue location and type, and whether any of these precautions or contraindications are present.

Question 19

What happens to treatment effectiveness as pain rises?

Answer 19

For every ascending numeric level of pain that remains, an associated 10% of treatment effectiveness is lost

Question 20

What is the goal?

Answer 20

100% reduction if possible

Question 21

What do anterior points require?

Answer 21

Flexion

Question 22

What do posterior points require?

Answer 22

Extension

Question 23

What happens as tender points move further from the midline?

Answer 23

Greater is the possibility for necessity of more side bending

Question 24

How long do we maintain the position?

Answer 24

90 seconds

Question 25

Is the fingerpad putting any therapeutic pressure on the tissues?

Answer 25

No

Question 26

Do we ever remove the fingerpad point?

Answer 26

No

Question 27

How do return the patient after 90 seconds?

Answer 27

PASSIVELY through the path of least resistance to original neutral position in which the tender point was illicited

Question 28

Can the patient help in returning to neutral after the 90 seconds?

Answer 28

NO!!!!!!!

Question 29

What do we always do at the end?

Answer 29

Recheck!!!

Question 30

Give the percentage of an improvement example

Answer 30

If the pain is reduced to a 3 after it being a 10, it was 70% treated

Question 31

What are the 6 shorthand rules?

Answer 31

1. Find the tender point associated with the dysfunction. 2. Tell the patient the tender point is a 10 or 100 or a dollar's worth of pain. 3. Place the patient in the position that reduces the pain of the tender point 100%, or as close to 100% as possible, but at least 70%. 4.  Hold this position for 90 seconds. 5. Slowly, through a path of least resistance, return the relaxed patient to neutral. 6. Recheck the tender point and the other diagnostic components of the dysfunction (TART).

Question 32

What correlates with soreness?

Answer 32

Treating more than 6 tender points in 1 visit

Question 33

What do we instruct to do to treat soreness?

Answer 33

Instruct the patient to increase fluids and use ice packs over the sore areas for 15 to 20 minutes every 3 hours as needed

Question 34

What normal intervals for treatment are normal and how do we determine that?

Answer 34

3-day intervals are appropriate. The patient's response will determine how often the patient needs treatment