Flashcards in Counterstrain Deck (36)
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1
Theories of somatic dysfunction initiating
Mechanoreceptor intiated
Nociceptor initiated
Nocifensive reflexes responding to nociception activation
Metabolic and blood flow imbalance
2
Counter strain defined
Indirect treatment that passively places a segment of muscle(s) in the position of comfort
Halts inappropriate nocieption and proprioception actions
3
Tenderpoint
Point on an anatomical location which exhibits tenderness when probed.
-usually at musculotendinous junctions to belly of muscles
4
Generic tenderness is caused by what?
Inflammation, infection, tumors, or trauma
*SOMATIC DYSFUNCTION IS NOT TISSUE DAMAGE* often accompanies it though.
5
Treatment of tenderpoint
Not actually treating the tenderpoint. Since it usually manifested via a somatic dysfunction of the involved joint and muscles that cross said joint.
Tenderpoints are not symptoms, they are signs
6
Positioning phases during CS
Gross movement: actually placing patient in classic CS position
Fine tuning: small movements to the parts that further decrease the sensitivity at the tender-point
Treatment position is often very specific (too much or too little reduction can cause increased tenderness
7
Why do we shorten the muscle for 90 seconds
Gives enough time for proprioception and mechanorecption to decrease. This allows the CNS to rest to normal resting length, remove pressure of small vessels, allow better blood flow, decrease noxious stimuli and increase tone of sympathetic nervous system.
8
Treatment with regards to patient
Patient should remain relaxed throughout the treatment.
Physician finger should monitor the tenderpoint and and only apply pressure every 30 seconds to recheck
After treatment, Patient should remain relaxed and be placed back into neutral passively by the physician ONLY. Physician should move slowly and keep finger on tenderpoint
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Advantages of CS
Non-traumatic
Increases patient confidence quickly if done properly
Easy and effective
Easy to record diagnosis
10
Disadvantages of CS
Size difference between patient and physician can be problematic
Quantifying pain is completely subjective to patient
Can have reactions afterwards up to 36 hours
- water and acetaminophen/ibuprofen should be used when needed
11
Mechanism of a joint at rest
Primary sensory nerve endings of muscle spindle fibers send normal rate of impulse to the CNS to induce tonic muscle contraction
12
Mechanism of strain
Severe overstretch of one muscle and understretching of another
Overstretched = increases impulses from primary and secondary nerve endings
Undertretched = decreased impulses from primary and secondary nerve endings
Results in imbalance of muscles which elects pain.
*Strain is almost always NOT the point of injury*
*can elicit a sharp reflex muscle contraction if returning to neutral too quickly*
13
Nocifensive reflex
Seen in strains
understretched muscle cannot straighten out to normal and the overstretched muscle causes hyper stretching of B when it tries to return to neutral (pain).
14
Mechanism of counter strain in patients with strain
Moving the patient back to the position of the strain turns off the CNS action. The physician then returns the understretched muscle or abnormal proprioceptive muscle to a shortened position.
This allows the overstretch muscle to return to normal when the CNS activity returns
Must be done passively to not reactivate understretched muscle and slowly to not reactivate muscle spindle fibers in the overstretch muscle.
15
Difference between trigger and tender points
Trigger point:
- located in muscle tissue
- presents with characteristic pain pattern
- elicits radiating pain
- taut band is present
- elicits twitch response
- follows dermatome map
Tenderpoint
- all the opposites
16
What muscles are mostly commonly the cause of thoracic and lumbar somatic dysfunctions?
Multifidus and Rotatores
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Syndromes where CS is very helpful
Arthropathies
Shoulder disorders
Lateral and medial epicondylitis
Carpal tunnel
De Quervain tenosynovits
Generalized hand pain
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Stature of liberty position
Alternative to classic supraspinatus positioning with just 135 degrees of flexion of the humerus, however it is difficult in patients with shoulder problems
19
Levator scapulae
Patient lays prone w/ head ways from the tenderpoint
Physician grasps wrist, internally rotates, 10 degrees of abduction and mild/moderate traction alone affected arm.
- fine tuned with abduction and internal rotation
20
Subscapularis
Tenderpoint is found between scapula and ribs inferior to arm pit
- requires extension, internal rotation and slight abduction of affected limb
- 4 o’clock when looking lateral, 7 o’clock when looking straight on
- fine-tuning = more internal rotation and some traction
21
Biceps brachii short head
Tenderpoint = inferolateral coracoid process
Treatment = elbow and shoulder flexion of affect limb, horizontal adduction and internal rotation of shoulder
Fine-tuning = more adduction and elbow flexion
22
Long head of biceps
Tenderpoint = in. Bicep groove just inferior and lateral to the head of the humerous
Treatment = flexion of elbow and shoulder, horizontal abduction of arm (10-15 degrees) and internal rotation of shoulder
*scarlet O’hera position should be obtained = dorsal wrist or forearm laying on forehead*
Fine tuning = abduction and elbow flexion
23
Radial head (lateral)
Tenderpoint = anterolateral part of radial head usually at the point of extensor carpi radialis longus or supination muscle bellies.
Treatment = fully extend elbow over knee, supinate arm
Fine-tuning = applying a slight valgus force (abduction of elbow)
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Medial epicondyle (pronator)
Tenderpoint = anteromedial aspect of elbow, just distal to the medial epicondyle on the common flexor tendon and pronator teres muscle body
Treatment= flex elbow 90 degrees, pronate forearm and adduct arm
Fine tune= more pronation and adduction
25
Extensor carpi radialis ME
Tenderpoint = dorsal surface of 2nd metacarpal assocaited with extensor carpi radialis muscle
* can also be in any other extensor muscle*
Treatment position: extension of wrist, radial deviation of fingers
Fine tune = more radial deviation
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Extensor carpi ulnaris
Tenderpoint = Dorsal surface of 5th metacarpal associated with extensor carpi ulnaris
Treatment = wrist extension, ulnar deviation of fingers
Fine tuning = more ulnar deviation
27
Flexor carpi radialis
Tenderpoint = palmar aspect of wrist inbetween the base of the 2nd and 3rd metacarpal
Treatment = wrist flexion and radial deviation of fingers
Fine tuning = more radial deviation
28
Flexor carpi ulnaris
Tenderpoint = Palmar aspect of wrist at the base of the 5th metacarpal
Treatment = flexed wrist and ulnar deviation of fingers
Fine tune = more ulnar deviation
29
Abductor pollicis brevis
Tenderpoint = Palmar base of the 1st metacarpal usually in the belly of the abductor pollicis brevis
Treatment = wrist flexion and thumb is abducted away from fingers
Fine tuning - more thumb abduction
30
Conditions where LE CS is helpful
Arthropathies
Lateral hip or thigh pain
Muscle/tendon strain
Ligament sprains
Inflammation within meniscus
General low back pain
31
MCL/medial meniscus CS
Tenderpoint = antero-medial aspect of the meniscus at the joint line
Treatment= patient supine with affected side of table and leg at 60 degrees of flexion and resting on physician thigh
Physician internally rotates tibia with caudad hand on the ankle/foot and both stabilizes knee and applies a slight varus force to the tibia
Fine tuning = more internal rotation
32
Lateral meniscus/ LCL CS
Tenderpoint: Anterior lateral aspect of the joint line of the meniscus
Treatment: patient lies supine with leg off table at 60 degrees of flexion and resting on physician thigh
Caudad hand on ankle/foot applies internal rotation of tibia with cephilad hand stabilizing knee and applying a slight valgus force on the tibia
Fine tuning = trying external rotation or more internal rotation (direction is variable)
33
Medial hamstring (semimembranous) CS
Tenderpoint = two possible
1) front or behind the medial hamstring attachment (just lateral to radial head)
2) posterior thigh medial to the midline approximately halfway down femur
Treatment:
Patient lies supine or prone w/ hip and knee flexed to 90 degrees. Leg and knee are adducted with strong internal rotation and plantar flexion of ankle by compression on calcaneus.
Fine tune = more internal rotation and plantar flexion
34
Lateral hamstring (Biceps femoris) CS
Tenderpoint: two possible
1) front or behind the lateral hamstring attachment (just lateral to fibular head)
2) posterior thigh medial to the midline approximately halfway down femur
Treatment:
Patient lies supine or prone w/ hip and knee flexed to 90 degrees. Leg and knee are abducted with strong external rotation and plantar flexion of ankle by compression on calcaneus.
Fine tune = more external rotation and plantar flexion
35
IT band (lateral trochanter) CS
Tenderpoint = along IT band distal to the lateral trochanter
Treatment = patient supine or prone with hip/thigh slight abducted and slightly flexed
Fine tune = internal/external rotation and more abduction
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