24 Questions
What is the primary goal when assessing somatic dysfunction?
To locate tender points and tissue texture changes
What is a contraindication for the strain counterstrain technique?
Open wounds or sutures
When treating multiple tender points, which point should be treated first?
The most severe tender point
What is a benefit of the strain counterstrain technique?
Improved circulation
What is an indication for the strain counterstrain technique?
Somatic referred pain
When treating multiple tender points in a row, which point should be treated first?
The point in the middle
What is a principle of the strain counterstrain technique?
Treat the most severe tender point first
What is the ideal approach to palpating tissue?
Entering the tissue gently and using only necessary pressure
What is a benefit of the strain counterstrain technique in terms of joint mobility?
Increased joint mobility
What is the visual indicator of extreme sensitivity in a patient?
Visual jump sign
What is somatic dysfunction defined as?
A disturbance in the sensory or proprioceptive system
What is the primary function of the fascial system?
To contain, support, and connect tissues throughout the body
What is the goal of the mechanism of SCS?
To produce optimum relaxation of involved tissues
What is the result of force producing injury?
Increased neural impulse and muscle guarding
What is a tender point viewed as in the fascial system?
A point of constriction within the network
What is a consequence of unaddressed somatic dysfunction?
A self-perpetuating cycle of proprioceptive dysfunction
When treating anterior tender points, what position is typically used?
Flexion
What percentage of patients typically experience increased soreness after treatment?
40%
What is the primary purpose of palpation in the muscular release procedure?
To determine point tenderness
When treating tender points on or near the midline, what type of motion is typically used?
Flexion and extension
How long should the release position be held during the muscular release procedure?
90 seconds
What is the primary goal of the muscular release procedure?
To release tension in the target tissue
What can be used to relieve post-treatment soreness?
Gentle exercises and consuming water
What is the purpose of reassessing the target areas after treatment?
To evaluate the effectiveness of treatment
Study Notes
Strain Counterstrain Effect
- Normalizes muscle hypertonicity and fascial tension
- Improves circulation, reduces swelling, and enhances joint mobility
- Decreases pain, increases muscle strength, and facilitates tissue regeneration, growth, and repair
Indications
- Acute, subacute, and chronic pain
- Central sensitization syndrome
- Neuropathic pain
- Somatic referred pain
- Post-concussive syndrome
- Muscle spasm
- Headache
- Myofascial pain syndrome
- Cumulative trauma
- Fibromyalgia
- Visceral dysfunction
- Hypoperfusion
Contraindications and Precautions
- Open wounds
- Sutures
- Healing fractures
- Hematoma
- Skin hypersensitivity
- Systemic or localized infection
- Malignancy
- Aneurysm
- Acute rheumatoid arthritis
Assessment of Somatic Dysfunction
- Based on asymmetry, range of motion, and ARTT (tissue texture changes, tenderness)
Principles of Strain Counterstrain
- Treat most severe tender point first
- Treat more proximal or medial tender point before those that are more distal or lateral
- Treat several areas of extremely sensitive tender points, focusing on the area with the greatest number of tender points
- Treat several equally sensitive tender points in a row, starting with the middle point
- Use gentle but firm pressure to palpate through layers of tissue
Severity of Tenderness
- Extremely sensitive: visual jump sign present and patient expresses extreme sensitivity
- Very sensitive: very tender but no jump sign
- Moderately sensitive: patient states that the point is tender to touch but does not flinch or jump away
- No tenderness
Somatic Dysfunction
- Defined as a disturbance in the sensory or proprioceptive system that results in spinal segmental tissue facilitation and inhibition
- Facilitated segment: overload of a segment of the spinal cord with excessive afferent impulse
Fascial System
- A broad network that contains, supports, and connects tissues throughout the body
- A continuous network that surrounds and penetrates all structures of the body
- Stress on this system from injury can result in fascial tension
- Tender point is viewed as a point of constriction within this network
Mechanism of SCS
- Indirect and passive method
- Severely tender points are located and palpated to guide the position of comfort
- Produces optimum relaxation of involved tissues, allowing for optimal relaxation and reducing inappropriate proprioceptive activities
- Decreases muscle tension, fascial tension, and joint hypomobility
- Improves functional range of motion and decreases pain
Proprioceptive and Nociceptor Response
- Force that produces injury results in protective muscle spasm, increased resting tone, and imbalance between agonist/antagonist
- Chemical mediators present during injury produce muscle guarding reactions and somatic dysfunction
Techniques of Strain Counterstrain
- Determine involved motor units using palpation, motion testing, and evaluation tools
- Palpate with gentle pressure in a neutral position to determine point tenderness or tissue restriction
- Release pressure, maintaining contact, and take the patient into the release position
- Hold the release position for 90 seconds
- Return the patient to a neutral resting position slowly and passively with support
- Reassess the target areas for point tenderness and changes in tone
Immediate Post-Treatment Response
- Patient feels relaxation in the treated area and often finds more ease and less discomfort during motion
- Approximately 40% of patients experience increased soreness in the next 24 to 48 hours
- Post-treatment soreness can be relieved by gentle exercises and consuming water to assist the body in eliminating accumulated metabolites
This quiz covers the effects of the Strain Counterstrain technique, a manual therapy approach that normalizes muscle hypertonicity, fascial tension, and improves circulation, among other benefits. It's indicated for various pain conditions, including acute, subacute, and chronic pain, neuropathic pain, and post-concussive syndrome.
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