Is counterstrain a direct or indirect technique?
indirect (away from barrier)
Tenderpoint vs Triggerpoint. Which one does counterstrain treat?
- Tenderpoint: pain at that point that does not radiate (treated by counterstrain)
- Triggerpoint: pain at that point that radiates when pressed
Explain the nociceptive model of counterstrain
tissue straining recruits nociceptors in that tissue -> reflexive contraction -> contraction becomes the new neutral position
Explain the proprioceptive model of counterstrain
muscle strained w/o recruiting nociceptors -> antagonist muscle shortened (turns down spindle firing rate) -> CNS turns up antagonist gamma system - antagonist contraction becomes new neutral
Which muscle is affected in the nociceptor model and proprioceptor model of counterstrain?
- nociceptor = agonist
- proprioceptor = antagonist
What are the 4 phases of counterstrain?
- relaxation
- resent of spindle fibers and nociceptors
- washout
- slow return to neutral
When does peak washout occur?
at approximately 1 minute
What are the 7 steps of counterstrain?
- find most significant tenderpoint
- establish tenderness scale
- monitor tender point throughout tx
- place pt in optimal comfort position
- maintain for 90 seconds
- slowly return to neutral
- recheck tender point
How long should you maintain position for ribs in counterstrain?
120 seconds
What are the general tx positions for midline positions in counterstrain?
primarily flexion or extension
What are the general tx positions for positions distant from midline in counterstrain?
primarily sidebending/rotational
What do upper case and lower case letters refer to in counterstrain naming?
- upper case indicates more motion
- lower case indicates less motion
Example: Explain the tx position for fSaRA
small amount of flexion and sidebending away and large amount of rotation away
Example: Explain tx position for FSt
large amount of flexion and small amount of sidebending toward
What is therapeutic pulse?
intensity approximates radial pulse
position of comfort vs position of optimal comfort
- position of comfort: at least 70% of tenderness alleviated
- position of optimal comfort: 100% of tenderness alleviated
Absolute contraindications of counterstrain
- trauma or severe illness w/ strict positional restrictions
- instability of tx area
- vascular/neurological syndromes that might compromise
- severe degenerative spondylosis where tx would take place
Relative contraindications of counterstrain
- pt can’t voluntarily relax
- pt can’t discern level of pain
- pt who can’t understand instructions
- pts w/ underlying conditions in whom positioning exacerbates underlying condition
Benefits of counterstrain
- passive, indirect
- can be used in pts w/ severe osteoporosis, metastatic bone disease and acute injuries
- only absolute requirement is that pt must be willing and able to relax muscles
