What are the absolute contraindications to counterstrain
Severe illness with strict positional restrictions
Instability of treatment area - potential to produce neurological or vascular side effects
Vascular or neurological syndromes which might lead to compromise of these systems
Severe degenerative spondylosis with no motion at the level of treatment
What is the counterstrain position of optimal comfort?
The position at which 100% of tenderness is alleviated
What are the 7 steps of counterstrain treatment?
- Find a significant tenderpoint
- Establish tenderness scale
- Monitor the tender point throughout treatment
- Place patient in position of optimal comfort
- Maintain position for 90 seconds
- Slow return to neutral
- Recheck tenderpoint
What is the nociceptive model of counterstrain?
When a tissue is strained, it recruits nociceptors within that tissue => reflexive tissue contraction => contraction of affected tissue becomes neutral
Agonist tissue strained => agonist tissue shortening
How much pressure should be placed on a tenderpoint during a counterstrain treatment?
(firm pressure discourages relaxation)
In the relaxation phase of counterstrain, what are the 3 planes that the affected tissue is shortened?
The treatment position "fSaRA" indicates what?
Small amount of flexion
Small amount of sidebending
Large amount of rotation
(Magnitude of action indicated by upper and lowercase)
What are the direct OMT techniques?
Soft tissue/Articulation Muscle Energy HVLA MFR Cranial
What is the likelihood of achieving a therapeutic reaction with counterstrain?
20-30% of pts will have a therapeutic pulse
How is a counterstrain dysfunction treated?
Applying position of mild strain in the direction exactly opposite to that of the false strain reflex by the use of specific point tenderness followed by specific directed positioning
What are the similarities between a trigger point and a tender point?
Locally tender Elicits jump sign when pressed Located in muscle
What occurs during phase 3 of counterstrain?
Washout - metabolic waste products built up because increased muscular tone inhibits blood flow, will be washed out after 1 minute, may feel a therapeutic pulse
About how many tender points can you treat in one treatment?
No more than 6
What are the indirect OMT techniques?
Strain/Counterstrain MFR Cranial BLT
How long must you maintain counterstrain position for ribs?
Which phase of counterstrain causes a rapid decrease in nociceptive input?
What are the benefits of counterstrain?
Passive, indirect technique
Can be used in patients with severe osteoporosis, metastatic bone disease, and acute injuries
The only absolute requirement is that pt must be able and willing to relax muscles
What is a maverick tender point?
Tenderpoint that does not respond to typical positioning
Typically requires the opposite position from standard
What are the primary endings of muscle spindle stretch receptors responsible for in muscle contraction?
Sense rate of change in length of muscle (length)
What is the definition of the counterstrain dysfunction?
Continuing, inappropriate strain reflex
Why is phase 4 of counterstrain a slow return to neutral?
Rapid return can reactivate spindle cell activity
What are the 4 phases of counterstrain?
- Reset of spindle fibers and nociceptors
- Slow return to neutral
What is the counterstrain position of comfort?
THe point at which at least 70% of tenderness is alleviated
What is the proprioceptive model of counterstrain?
Abnormal muscle lengthening causes antagonist muscles to shorten => CNS causes contraction of the antagonist muscle to become the new neutral state
Agonist tissue strained => antagonist tissue shortening
What are the differences between a trigger point and a tender point?
What are the relative contraindications to counterstrain?
Pt cannot voluntarily relax
Pt cannot discern level of pain or change in pain with positioning
Pt cannot understand instructions
Pt with underlying conditions restricted by positioning (arthritis, connective tissue disease)