Hbd3: Counterstrain, Cox

Front 1

Founder of counterstrain

Back 1

Lawrence Jones

Front 2

A system of diagnosis and indirect tx in which the patients somatic dysfunction (tender point) is treated using a position of spnataneous tissue release while monitoring the tender point

Back 2

Counterstrain

Front 3

What do alpha and gamma neurons innervate

Back 3

A - motor neurons, stimulate large muscle fibers

Gamma - motor neurons, innervate the intrafusal fibers

Front 4

What is a muscle spindle

Back 4

machanoreceptor inside the belly of a muscle

contains nuclear bag and chain.

It has both sensory and motor innervation.

Senses muscle length and the rate of change

Purpose - prevent tissue disruption, muscle contracts whent the muscle is streched

Front 5

What happens to the rate of firing of the muscle spindle when the muscle is stretched

Back 5

It increases

(note: there is always some baseline receptor firing)

Front 6

2 primary functions of the Gamma motor neurons

Back 6

1. Muslce contraction as a result of intrafusal fiber contraction (e.g. maintain posture)

2.Cause the intrafusal fibers to contract and stretch close to threshold so that they are more sensitive

Front 7

What are two examples of gamma dysfunction?

Back 7

1.Firing to frequently (prolonged stimulus)

2.Sudden stretch of unprepaired muscles...results in muscle contraction and spasm through gamma neuron. Sensory signal is also sent to the brain but it cannot interpret it...sends gamma stimulation which maintains spasm (causing tender point)

Front 8

Rapid shortening of agonsit muscle to protect against damage and then antagonit rapidly lenghtened. CNS interprets this as...

Back 8

Strain, resulting in hypertonic antagonist

Front 9

Why do we hold the position for 90sec in counterstrain?

Back 9

This is how long it takes for the spinal cord to learn the new pattern

Front 10

physiological bases behind counterstrain producing the desired outcome

Back 10

position of comfort is usually position of shortening...allows muscle spindle to decreasein firing...CNS can now interpret the signal properly and reset the gamma innervation or firing rate

Front 11

4 characteristics of tender points

Back 11

1.related to nociceptive activity
2.Related to somatic dysfunction
3.Anatomical location is constant from one patient to another
4.Tender points are located close to monitoring points...where the nerve pierces the fascia

Front 12

Chapmans points Vs Tender points

Back 12

Chapmans points are mediated by viscerosomatic reflexes

Front 13

Trigger points Vs Tender points?

Back 13

Specific referrel or radiation pattern...there is a frim taut band of muscle w/ a tender nodule...spray and stretch is the tx.

Front 14

Don't forget the counterstrain steps

Back 14

1.locate somatic dysfunction
2.find a tender point
3.Establish a pain scale
4.Wrap patient around the tender point
5.Redcue pain by 70% (make sure patient feels better)
6.maintain position for 90Sec while monitoring the point
7.passivley return to neutral
8.Reasses

Front 15

These tender points are usually treated in flexion, paitent presents w/ increased kyphosis and finds comfort in the flexed position, the pain is diffuse. The injury was rapid flexion from and extended point.

Back 15

Anterior tender points

note: if stretches are prescribed, use extension

Front 16

These tender points are treated in extension. patient has a flat thoracic spine and history of comfrot in extended position. Pain is SPECIFIC

Back 16

Posterior tender points

Note: if stretcher are needed do them in flexion

Front 17

How does the pain differ in anterior vs posterior tender points

Back 17

Anterior pain is diffuse

Posterior pain is specific

Front 18

What are 4 good indications for counterstrain tx?

Back 18

1.acute spsasm or strains
2.Osteoporosis
3.Muscle strains/chronic tissue changes
4.common but difficult to tx complaints (e.g. plantar fasciitis or piriformis dysfunction)

Front 19

Contraindications to counterstrain

Back 19

1.open wound or fracture
2.lack of somatic dysfunction/tender point
3.when placing patient into extreme flexion or extension
4.when patient cannot communicate

Front 20

What do you tx first the thoracic vertebrae or the ribs?

Back 20

THORACIC VERTEBRAE

note: ribs can require 120sec

Front 21

Do you push on the tender point once you have the patient positioned?

Back 21

NO, just monitor

Front 22

What does an anterior Vs a posterior rib tender point indicate?

Back 22

Anterior - depressed rib

Posterior - Elevated rib

Front 23

two ways to stimulate the muscle spindle

Back 23

lengthen the entire muscle

contract the endpoints of the intrafusal fibers