Intro to counterstrain Flashcards
Counterstrain developed by
-Lawrence H. Jones
Counterstain Definition
- an osteopathic system of diagnosis and indirect treatment in which the patient’s SD is: diagnosed by an associated myofascial tender points
- treated by using a passive position, resulting in spontaneous tissue release and at least 70% decrease in tenderness
Counterstain Treatment Guidelines
- relevant structural exam
- regional TP examination
- find worst TP
- establish a tenderness scale
- place patient in position of ease
- hold for 90 seconds continuously monitoring TP for tenderness and tissue texture changes with periodic checks
- slow, passive return to pretreatment position (first few degrees of motion are most important)
- re-check TP
- examine region to assess remaining TART changes, assessing need for further treatment
Expanding Role of Muscle Spindle
- muscle spindles are complex receptors and the stretch reflex is only one constituent of an entire informational spectrum
- gamma motor neurons set and fine-tune the activity of the moment-to-moment fine adjustment of posture and locomotion
Sherrington’s Law
-when a muscle receives a nerve impulse to contract, its antagonists, receive, simultaneously, an impulse to relax
The muscle spindle
- through the gamma system, provides proprioceptive info and mediates proprioceptive reflexes
- SD caused by sudden contraction of the biceps causes triceps to have increased gamma activity and to be reflexively contracted
Counterstrain Treatment
-by brining a hypertonic muscle, whose spindles “report strain where there is none,” into a shortened position the physician can reverse the hyperactivity of the spindles, restoring the normal stretch reflex and the normal range of motion
Evidence base for Counterstrain
- single blind randomized controlled trial of crossover design showed no electrically recorded reflexes of calves observes in response to treatment
- peak force and time to reach peak force both increased in the post-treatment measurements
- significantly more pronounced in the counterstain mode
- significant relief of symptoms, most pronounced immediately after treatment and still present 48 hours later
Tissue Trauma Pathogenesis
- trauma produces changes in myofascial tissue at microscopic and biochemical levels
- more specifically trauma causes damage to myofibrils and their microcirculation
- nociceptive information carried to the CNS
- the tissue disruption an subsequent chemical changes cause the tissue to become more sensitive and may contribute to the formation of a tender point
Three Proposed pathways of tissue trauma pathogenesis
- strain-counterstrain: reflex mediated through gamma motor neuron pathway
- trauma–direct injury to tissues results in nociceptive maintained TPs
- secondary to SD: TART
Respiratory/Circulatory Model Micro level
-The TTA associated with a TP indicates compromised circulation on a cellular level
Respiratory/Circulatory Model Macro level
- superior thoracic aperture is bounded by: T1, the first ribs, the costal cartilage of the 1st rib and the superior border of the manubrium
- restore microcirculation
Posture/Motion model
-balance posture and function
Behavior model
optimize function
Neurologic model
interrupt pathophysiologic reflexes and pain pathways
Metabolic model
-improve physiology and exercise ability
16 yo with ankle pain. Playing basketball and had an inversion sprain 2 weeks ago. He has lateral ankle pain. PE has a preference for inversion at the ankle. What most likely describes the underlying neuropathology involved in this patient’s described somatic dysfunction?
-increased gamma motor activity of the inverters
Indications for Counterstrain treatment
- presence of a tender point
- can be found in acute and chronic musculoskeletal conditions
- may be associated with a viscerosomatic reflex
- may be the primary indication of a somatic dysfunction
- may be secondary to another primary (ex. joint restriction)
- reluctant/afraid patients
- frail patients
- trial of OMT to assess patient tolerance
Absolute Contraindications to Counterstrain
- fracture
- torn ligament
- patient refusal
Relative Contraindications to counterstrain
- stressed patients who can’t relax
- uncooperative children
- severe osteoporosis
- C-spine treatment in patients with vertebral artery disease
- severely ill patients who may not tolerate a treatment reaction (metastatic cancer, cervicals in RA, medically not stabilized)
Finding Tender Points: History
- may be primary (i.e. from a strain)
- examine area of CC for TPs
- knowing the position of the strain can help determine the muscles involved and the position of treatment
- may be secondary to another type of somatic dysfunction (arthrodial, myofascial, viscerosomatic)
Finding Tender Points: PE
- postural examination may give clues to TPs
- TART changes: TPs are usually associated with TART
Tender Point Identification
- usually located in the muscle belly or the tendinous insertions
- typically discrete, small, tense, and edematous
- usually 4x as tender as adjacent tissue
- enough force to blanch your fingernail
- significant TP results in patient wincing
- Viscerosomatic TPs will return in minutes to hours
Tender Points in Testing and monitoring
- normal tissue requires 4x the level of digital pressure to elicit tenderness as the amount of pressure necessary to elicit tenderness in a counterstrain point
- TP checks should be administered in short, quick pushes
- Observed TTA changes should be confirmed with TP checks
- Maintain monitoring finger on TP at all times
