Strain-Counterstrain. Harmon Myers, DO and Julie Jernberg, MD

Transcription

1 Strain-Counterstrain Harmon Myers, DO and Julie Jernberg, MD

2 Origin of Counterstrain

3 Lawrence Jones, DO Original Patient: 4 Months of lower back pain, sleep deprivation and high velocity therapy

4 Jones Discovery STRAIN-COUNTERSTRAIN

5 Passive, positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction -Lawrence Jones, DO, FAAO

6 Travell s Discovery MYOFASCIAL PATTERNS OF PAIN

7 Travell s Trigger Points hyperirritable spot in skeletal muscle... hypersensitive palpable nodule in a taut band... tender when pressed and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena." Simons DG, Travell JG, Simons LS. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol1. Upper Half of Body. 2nd ed. Baltimore, Md: Williams & Wilkins; 1999

8 Myers Insight Jones Tender Points Travell s Trigger Points Counterstrain shortens the muscle identified by Travell s Trigger Point

9 Theory: Cause Inappropriate proprioceptor firing somatic dysfunction maintained

10 Theory

11 Theory

12 Theory

13 Theory

14 Application

15 Application -Put antagonist muscle into passively shortened position - reset inappropriate firing in proprioceptor

16 Application 1-Find the pathology 2-Passively shorten muscle 3-Return to neutral slowly 4-Re-evaluate

17 Find the Pathology --What myofascial pattern refers pain to the area? --What muscle hurts to stretch? --Is TP on opposite side of pain? --Which is most tender TP?

18 Treatment Position 1 --Slowly position to shorten muscle --Monitor subjective pain and objective texture of TP --Hold position for 90 seconds

19 Treatment Position 2 --Anterior TP s: flexion --Posterior TP s: extension --Lateral TP s: sidebending, rotation --Midline TP s: sidebending, rotation

20 Treatment Position 3 --Patient should be comfortable; if not, position is wrong --Treat most tender TP first --Treat midline TP s first

21 Return to Neutral --Do not move quickly, as this may reinitiate initial injury --Keep finger in position to monitor --Re-evaluate TP (70% improved?)

22 After Treatment --Lightheaded upon rising (possible) --Warn patient they may feel worse --Sometimes better > hours --Finite session(s) --Fluids

23 Case-- Headache --Sternocleidomastoid --Trapezius --Levator Scapula

24 Sternocleidomastoid

25 Sternocleidomastoid Rx --TP: within body of SCM --Flex, Rotate Away, Sidebend

26 Trapezius

27 Trapezius-proximal Rx --TP: pinch web at junction of neck (Vulcan Nerve Pinch) --Rx: sidebend head TOWARD TP

28 Trapezius--Lateral Rx --TP: lateral (about 2 cm) from proximal trapezius TP --Rx: SIDEBEND head TOWARDS; pull arm above head, through plane of eye

29 Levator Scapula

30 Levator Scapula Rx TP: press medial to lateral on upper edge of medial scapula Rx: sidebend head TOWARDS; flex shoulder (about 45º); ab/adduct slightly; shove shoulder into ear

31 Case--Abdominal Pain --Rectus Abdominis --External Abdominal Oblique --Iliacus --LongissimusThoracis

32 Rectus Abdominis

33 Rectus Abdominis Rx --TP: anywhere in body of muscle --Rx: flex hips and knees (about 90º); sidebend towards slightly; rotate towards slightly

34 External Abdominal Oblique

35 External Abdominal Oblique Rx TP: on medial ASIS Rx: flex hips (about 90º); sidebend AWAY markedly; rotate AWAY

36 Iliacus Clinical Applications of Counterstrain by Harmon Myers, DO

37 Iliacus Rx --TP: deep and lateral to rectus abdominus below umbilicus --Rx: flex hips (90º); frog legs (external rotation); sidebend towards

38 Longissimus Thoracis

39 Longissimus Thoracis Rx --TP: lateral to spine --Rx: extend hip; abduct leg

40 Case--Back pain --Quadratus Lumborum --Longissimus Thoracis --Multifidis --Rectus Abdominis --Soleus

41 Quadratus Lumborum

42 Quadratus Lumborum Rx --TP: lower border of 12th rib; lateral to medial against transverse processes of lumber spine; iliac crest --Rx: extend hip; abduct leg; push leg into hip (gently)

43 Longissimus Thoracis

44 Longissimus Thoracis Rx --TP: lateral to spine --Rx: extend hip; abduct leg

45 Multifidis

46 Multifidis Rx --TP: down against transverse processes of spine or lat med against spinous process --Rx: rotate and extend hip (on same side as TP)

47 Rectus Abdominis

48 Rectus Abdominis Rx --TP: anywhere in body of muscle --Rx: flex hips and knees (about 90º); sidebend towards slightly; rotate towards slightly

49 Soleus

50 Soleus Rx --TP: medial or lateral aspects of soleus --Rx: flex knee; plantar flex foot; bend heel towards TP

51 Case--Knee pain --Rectus Femoris --Vastus Medialis --Vastus Lateralis

52 Rectus Femoris

53 Rectus Femoris Rx --TP: proximal rectus femoris tendon or in body of muscle --Rx: flex hip; hyperextend knee (if knee stable!)

54 Vastus Medialis

55 Vastus Medialis Rx --TP: in body of vastus medialis --Rx: hyperextend knee (if stable) and roll muscle medially into the TP

56 Vastus Lateralis

57 Vastus Lateralis Rx --TP: in body of muscle, lateral to rectus femoris --Rx: hyperextend knee (if stable); roll muscle laterally into the TP

58 Caveat Position of Comfort!

59 Strain-Counterstrain Harmon Myers, DO and Julie Jernberg, MD