Treatment using counterstrain is directed at discrete areas of tender tissue called tender points. Tender points are painful to the touch and they can be found in acute and chronic conditions and may be the primary indicator of somatic dysfunction or appear secondary to another medical cause. Tender points are theorized to arise from an antagonist muscle in a state of “panic,” lengthening in response to a strained and painful agonist muscle.
Counterstrain is an indirect, passive technique in which the patient is positioned away from a restrictive barrier of motion. When performing counterstrain, the manual osteopath places the symptomatic joint in the position of least discomfort while at the same time monitoring the degree of tenderness at a nearby tender point. This position of minimal discomfort is usually a position where the muscle is at its shortest length. The position is held for 90 seconds and the joint is slowly and passively returned to the neutral position. By placing the body into a position of maximal ease and comfort, the somatic dysfunction of the strained muscle should begin to resolve. Treatment is repeated until a 70-percent reduction in tenderness is reported by the patient.
The prolonged contracted state of a muscle causes shortening of both the intrafusal (muscle spindle) and extrafusal fibers. The gamma motor neurons then increase their firing rate to maintain tone in the muscle, and the muscle spindle fibers become hypersensitive. If the hypersensitive muscle is now lengthened too rapidly, a reflex overstimulation of the alpha motor neurons will occur. This sensory input travels to the higher centers of the central nervous system, which may misinterpret this input and respond with excessive gamma motor stimulation, maintaining the spasm. Reshortening the muscle by using counterstrain technique allows the muscle spindle to shorten and resume normal firing. The central nervous system then resets its gamma motor neurons after about 90 seconds. Absolute contraindications for counterstrain occur in patients with fractures or torn tendons in areas of dysfunction.
Counterstrain is an indirect, passive technique in which the patient is positioned away from a restrictive barrier of motion. When performing counterstrain, the manual osteopath places the symptomatic joint in the position of least discomfort while at the same time monitoring the degree of tenderness at a nearby tender point. This position of minimal discomfort is usually a position where the muscle is at its shortest length. The position is held for 90 seconds and the joint is slowly and passively returned to the neutral position. By placing the body into a position of maximal ease and comfort, the somatic dysfunction of the strained muscle should begin to resolve. Treatment is repeated until a 70-percent reduction in tenderness is reported by the patient.
The prolonged contracted state of a muscle causes shortening of both the intrafusal (muscle spindle) and extrafusal fibers. The gamma motor neurons then increase their firing rate to maintain tone in the muscle, and the muscle spindle fibers become hypersensitive. If the hypersensitive muscle is now lengthened too rapidly, a reflex overstimulation of the alpha motor neurons will occur. This sensory input travels to the higher centers of the central nervous system, which may misinterpret this input and respond with excessive gamma motor stimulation, maintaining the spasm. Reshortening the muscle by using counterstrain technique allows the muscle spindle to shorten and resume normal firing. The central nervous system then resets its gamma motor neurons after about 90 seconds. Absolute contraindications for counterstrain occur in patients with fractures or torn tendons in areas of dysfunction.
No comments:
Post a Comment