Counterstrain

Question 1

What are direct. treatments

Answer 1

Go TO the barrier

• Soft tissue/ ART,
• Muscle energy
• HVLA
• Myofascial release

Question 2

What are indirect treatments?

Answer 2

Away. from barrier

1. Counterstrain
2. Myofascial release
3. cranial
4. BLT

Question 3

who invtented coutnerstain

Answer 3

lawrence jones DO

Question 4

what is counterstrain

Answer 4

considers dysfunction to be a continuing, inapp strain relfex that is inhibited by applying. a position of mild strain in the OPPOSIRE direction to that of the false strain reflex;

to do this: find a POT followed by. a specific direction to. acheive response.

Question 5

how does L5 rotate

Answer 5

1. to the deep sulcus
2. opposite rotation of sacrum

Question 6

Who was lawrence jones

Answer 6

A DO who thought. of countstrain in 1955

he was a patient with pain for over 4 months and treated for. 6 weeks

Question 7

what did he say?

Answer 7

“Maybe I could respond to your treatment if I could just sleep at night.”

• Discovered posterior tender points

Question 8

what. did larry. jones develop

Answer 8

1. POSTEIOR tender points assx with somatic dysfunction
2. way to treat points

Question 9

Spontaneous Release by Positioning” book year

HE FOUND ANERIOR TENDERPOINTS ON A. RUPTURED GROIN PT

Answer 9

1964

Question 10

Strain and Counterstrain

Answer 10

1980

Question 11

what is a tender point?

pattern of pain:

Located:

tender?

jump sign?

radiation when pressed?

taut band present?

Twitch response?

Dermographia present?

Answer 11

-no pain pattern

muscles, tendons, ligaments and fascia

locally tender

Yes= jump sign

No radiation

Taut band NO present

Twitch= NO

Dermographia = NO

Question 12

what is a trigger point?

pattern of pain:

Located:

tender?

jump sign?

radiation when pressed?

taut band present?

Twitch response?

Dermographia present?

Answer 12

1. characteristic pattern of pain

2. Located in muscle tissue

3. locally. tender
4. YES jumpsign
5. YES radiating patter
6. Presentin WITHIN a taut. band of tissue
7. Caues twich with snapping palpation

8. Dermographia of skin over point!

Question 13

how to treat TRIGGER POINTS

Answer 13

1. Spray. and stretch
2. Trigger point. injection

Question 14

Tx for tenderpoint

Answer 14

1. Spontanous release by positioning. (counterstrain)

Question 15

what. is a nociceptor

Answer 15

sensory receptor for pain

Question 16

trauma can cause:

Answer 16

1. Change in myfascial tissue at. microscoptic and biochemical level
2. Damage to myofibrals and microcirculation-> fuck up chemistry. of actin and mysoin -> cause tissue sensitiy by disrupting and chemical changes
3. Damage microcirculation-> i_ncrease in intramuscular pressure and function_ -> muscle fatigue d/t decreased cellular metabolism

Question 17

3 theories of countstrain

Answer 17

1. nociceptive model

2. Propioceptive model

3. 4 phases of counterstain

Question 18

According to the nociceptive model

what does it say

Answer 18

1. Tissue strain (muscle, tendon, L) -> recruit nociceptors
2. Tissue will undergo reflexive contraction
3. Contraction of tissue becomes the new neutral

Question 19

ex for nocieptive model

Answer 19

1. Stain ankle-> + nociceptors
2. Reflexive contraction of ankle
3. Contraction of ankle -> new normal

Question 20

Propioceptive model says

Answer 20

we will maintain tone after stimulus is ended

1. Rapid stretch of primary speindle cell
2. -> extrafusal fibers contract to protext
3. maintain contraction even after stimulus ended

Question 21

What. is the happens in propioceptibe model

Answer 21

1. Agonist- muscle is strained rapidly, without recruiting noiceptots
2. causes antagonist m. to be shorted. -> decrease spindle firing rate)
3. Agonist also sensed sensory info. to CNS -> rapidly. shorten
4. CNS turns up gamma system bc not gettin enough info
   - > CNS send more. motor input through gamma motoro neuron -> spindle -> will improve sensory input. to CNS
   - > RESULT: increase gamma motor gain that will maintain the abfnormal new “neutral” length of myofascial structures

Question 22

angtaongist contraction will become

Answer 22

“neutral”

Question 23

whiplash according to propioceptive m.

Answer 23

1. Posteior cervical muscles are strained
2. Anterior cervical muscles shorten-> CNS turns up gain for antagonist gamma system
3. ANT contraction = new normal

Question 24

Nociceptor

-> nociceptor recruitment

Agonist (affected muscle) ______

Agonist tissue shorting -> _______ nociceptore recreit

Answer 24

shorted

no nociceptor recruitment

Question 25

Proprioceptor ANT \_\_\_\_\_\_

Answer 25

ANT. is shorted -\> becomes new neutral

Question 27

how are nociceptor. and proioceptive model **similar**?

Answer 27

**local constriction** -\> decreased circulation -\> localized **edema** -\> back up of **products of metabolsim**

Question 28

Four Phases of Counterstrain

Answer 28

1. Relaxation 2. **• Reset of Spindle fibers and Nociceptors•** 3. Washout 4. • Slow return to neutral

Question 29

how do we relax

Answer 29

shorted affected tissue. in all. 3 planes (F/E, SB, rotation) --\> this will cause. a rapid reduction of nocicpetive input

Question 30

Phase II: Spindle reset

Answer 30

1. reset. **primary. endings of muscle spindle stretch receptors (Annulospira**l) -\> change length and dynamic (rate of change of length) 2. reset s**econdary. ends of muscle spindle stretch recpetors (flow spray )** change length, dont. change dynamis

Question 31

in **counterstain**, what are we working w?

Answer 31

**MUSCLE SPINDLE FIBERS!** _Not. golgi tendons organs (thats muscle energy)_

Question 32

Phase III: washout

Answer 32

**Increased muscular tone** inhibits blood flow-\> build up of waste products – Metabolic washout begins at 10-15 seconds after best position achieved (therapeutic pulse may be felt) – **Peak washout occurs at approximately 1 minute**

Question 33

Phase IV: slow return to neutral

Answer 33

rapid = reactivate muscle spindle actibity muscle spindles remain faciliated for up to 24 hours -\> thus, remind pt to take it easy

Question 34

counterstrain 7 steps

Answer 34

1. find TP 2. establish scle 3. monitor TP thoughout tx 4. Place pt in a. position of comfort 5. maintain position for 90 seconds (120 for ribs) 6. slowly. retrn to neutral 7. RECHECK AFTER. RETURN TO NEUTRAL

Question 35

how do we find a ternder point

Answer 35

1. OSE 2. look at. posture 2. scan region of body for compains **5. ppl tend to bend aroudn a tender point**

Question 36

**Different myofascial structures** including tendons, ligaments, fascia, and muscle bellies have all been found to contain tender points where are they. found?

Answer 36

where motor nerve peices fascia and enters muscle

Question 37

**Myotomal, dermatomal, and sclerotoma**l relationships have been proposed as tender point locations seem to be ________ from person to person

Answer 37

consistent

Question 38

TP frequntly. asx with fascial strain that. may:

Answer 38

feel like a bb or pee

Question 39

Tender points may be ____ degrees around the body from complaints ex

Answer 39

180 psoas pain -\> present as low back pain

Question 40

Maintain Contact Throughout Treatment

Answer 40

• Palpate changes allows fine tuning acknowledge teratment success

Question 41

midline TP tx positions tend to be

Answer 41

flexed or extended

Question 42

distant from midline positions tx positions tend to be

Answer 42

SB/rotation

Question 43

5. Maintain position for 90 seconds

Answer 43

10-15 seconds to begin washout 1 minute for. FULL washoter

Question 44

Dr. Jones found that holding for shorter periods resulted in

Answer 44

**greater return of dysfunction**

Question 45

• Longer periods resulted in

Answer 45

**no sig improvement**

Question 46

• fSaRA Upper case letters indicate \_\_\_\_\_-, lowercase, \_\_\_\_\_\_

Answer 46

Uppercase: more motion Lowercase: less motion

Question 47

where do we document in SOAP noteo

Answer 47

objective

Question 48

• fSaRA describe

Answer 48

1. small amounts of felxion 2. small amounts of SB away 3. Large amounts of SB away

Question 49

• _F_St

Answer 49

large amounts. of flexion small amounts of SB toward

Question 50

what should pressure be at tenderpoint

Answer 50

light contact; firm pressure makes it hard to relax

Question 51

No more than ____ tender points per treatment

Answer 51

6

Question 52

**Therapeutic pulse** – Intensity approximates radial pulse ## Footnote **• Position of comfort** – Position at which at least 70% of tenderness is alleviated **• Position of Optimal Comfort** – Position at which 100% of tenderness is alleviated **• Therapeutic reaction** – Situation which occurs in 20-30% of patients treated with Counterstrain **• Maverick** – Tender point that does not respond to typical positioning (~5%) – Usually requires opposite position from standard

Question 53

what is a maverick

Answer 53

TP that does not respond to typricl psotion requires opposite positon from standard

Question 54

• Therapeutic reaction

Answer 54

sit. that occurs in 20-30% of ppl tx with coutnerstrain

Question 55

Contraindications - Absolute

Answer 55

* **Trauma** – if the area would be negatively affected by positioning * **• Severe illness in where you cannot be in specific position** * **• Instability of treatment area** --\> can cause neurological or vascular side effects * • **Vascular or neurologic syndromes** which might lead to compromise of these systems * • **Severe degenerative spondylosis with no motio**n at the level where treatment would take place

Question 56

Contraindications - Relative

Answer 56

1. pt cannot voluntarily. relax 2. pt who cannot discern level of pain or change d/t psoiton 3. cannot undersntand 4. positions with. illness where positions worsens their conditions: artithirs

Question 57

benefits

Answer 57

1. better doc 2. treat ppl otthers cant **3. passive, indirect technique** 4. **can** be used i_n pts with. bad. osteoprosis, bone dz, acute injuries_ 5. ONLY absolute. requirement. is pt must be able and willing to relax musxcles

Question 58

Only absolute requirement

Answer 58

patient must be able and willing to relax muscles.