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1

What is the definition of counterstrain?

● Spontaneous release by position
● indirect technique
● diagnosed by presence of *non-radiating tender points*
● discovered with palpation and subsequently treated by passively placing the pt into a position that decreases the tenderness of the joint

2

How did originator, Larry Jones, define counterstrain?

○ relieves spinal or other joint pain by passively putting joint into its position of greatest comfort
○ relieve pain by reduction or arrest of continuing appropriate (excessive) proprioceptive activity by *shortening the muscle* that contains the malfunctioning muscle spindle (tender point)

3

What are tender points?

● >300 points found on muscles and ligaments (potentially fascia and joint capsules with neuro feedback from CNS)
○ tendinous attachments
○ muscle bellies
○ myofascial tissues
● reduced/eliminated by putting patient in position of comfort
● area of a tender point: finger pad or smaller
● usually hypertonic
● as an area of swelling of connective tissue, usually muscle fibers, and often assoc with vascular changes
● often feel pulse through hypertonic muscle -> removal of toxic elements, increase of nutrients and oxygen
● acute tenderness with applied pressure

4

In counterstrain, how much pressure should be applied to tender points?

Varies with patient and tissue
● oz to lbs
● general rule: *enough to blanch nail bed*
● use index finger, occasionally thumb
● OK to compare on/off TP
● All tenderness isn't TPs (i.e. fatigued muscles)

5

Describe the mechanism of counterstrain.

Passive and indirect
● Return to position of *strain*
● Direction of ease
● Shortens B (the muscle with abnormal proprioceptor activity)
● firing is reduced when it is passively done to you
● *90 seconds: most effective to cease abnormal activity*
● Treatment: return back to position of injury PASSIVELY by physician
● End of treatment: joints are returned to neutral passively and slowly, so not to stretch muscle spindle fibers quickly (essential to success)

6

What are three other proposed mechanisms for counterstrain?

● Shortens and relaxes strained mm and CT
● interrupts inappropriate nociceptive and proprioceptive activity
● sufficient time is needed (90 s) for spinal defacilitation-reduction of excessive firing between muscles and spinal cord

7

What are indications for counterstrain?

● SD that includes presence of TP or pain
● myofascial, ligamentous, articular injuries
● Acute injuries: whiplash, sports related trauma
● Chronic SD amenable to CS

8

What are contraindications for counterstrain?

● absence of SD
● treatment position may compromise blood flow or impinge nerve (cervical)
● intolerance to tx position (get closer as tenderness decreases)
● As always, pt refusal
● if continued tx on TP doesn't reduce tenderness
● fractures at site of treatment

9

What are some clinical pearls for counterstrain?

● *PT MUST REMAIN RELAXED*
● treat hot/key TPs
● mvmt *away from ideal position* of treatment *increases TP tenderness*
● use reevaluation of what you treated in a prior visit as a way of evaluating "effectiveness" of tx
● *anterior TPs*: pt is generally flexed
● *posterior TPs*: pt is generally extended
● *lateral TPs*: pt is sidebent or rotated
● "wrap" body around the point (common but not always successful)
● For TPs at or near midline, mostly use F/E
● Farther away from midline, add varying degrees of R/SB

10

What are some advantages of counterstrain?

● non-traumatic
● relatively easy
● effective
● excellent way to record tx in a specific and quick format
● increases pt confidence quickly

11

What are some disadvantages of counterstrain?

● some pts have trouble quantifying pain
● stoic patients don't admit to tenderness when palpated
● *Tx Reactions*: 1-2 days post-tx, last up to 36 hours
● takes time to treat: esp multiple TP or learning
○ *6 TPs max*
● some pts (esp. geriatric) cannot be placed in appropriate tx positions
● some pts unable to relax mm sufficiently for positioning to be truly passive or effective
● careful and aware of pt when performing cervical extension and rotation