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- -counterstrain points
- -trigger points
types of autonomic reflexes
a.Viscero-somatic: organ to skin
b.Somato-visceral- skin to organ
c.Somato-somatic: one aspect of body affects another
d.Viscero-visceral- one organ affects another
–Exit spinal column via ventral roots
–Go to white communicating rami
–White rami carry signals to the prevertebral ganglia
- –White rami also carry signals signals from
- vasculature and viscera back to the spinal nerve
path sympathetic nerves can take
–Innervate prevertebral ganglia at the same spinal cord level
–Pass up or down the sympathetic trunk to innervate different cord levels
- –Proceed through the paravertebral ganglia, join a splanchnic nerve and synapse with a retroperitoneal
- prevertebral ganglia (celiac, Sup. Mesenteric, Inf. Mesenteric, etc.)
mechanisms of somatic dysfunction
Vesceral affects muscles around spine: spasms, twitches
Somatic dysfunction can create facilitation, facilitation can affect organs, creates circuit
Manipulation interrupts circuit to alleviate symptoms
Interneurons of dorsal--> ventral horns that are responsible for somatic dysfunction
Changes orientation of bone, musculature, facia, etc.
•Dull ache to exquisitely painful depending on severity of underlying condition
•Firm or fibrotic feeling if chronic
•Boggy if acute
•Typically induce Type II mechanics of the spine and involve 1 or 2 vertebral segments.
- •If patient presents with chronic and repetitive somatic complaints, think about
- autonomic nervous system mediated reflexes.
•First described in the 1920’s as a viscerosomatic reflex that has both diagnostic and therapeutic value.
•Initially reported as a ganglioform contraction that blocks lymphatic flow and causes inflammation in tissues distal to the blockage.
•Current thoughts link this contraction to concurrent sympathetic nervous system dysfunction.
chapmans reflexes characteristics
•Small, smooth, firm
Discretely palpable or grouped in irregular patches
•Approximately 2 -3 mm in diameter when found singularly.
- •Get a sense of small circumscribed area of edema that is firm and partially fixed on
- the deep aponeurosis or fascia.
chapmanns reflexes decribed by patient
•Located under the finger
•Tend to wince
•Often unnoticed until you push on the sore spot.
treatment of chapmanns reflexes
Apply firm, circular pressure as if trying to release or squeegee the contents of the ganglioform contraction.
•Often treated vicariously through soft tissue techniques preparatory to the use of manipulation
clinical observations of strain/counterstrain points
•There is a distinct relationship with somatic dysfunction
•Constant location in patients
•Appears to occur where the motor nerve pierces the investing fascia to innervate the muscle.
•Described as acutely tender, localized (non radiating) and associated with ligaments, muscles, and tendons.
•Often associated with mechanical injury or with sudden unexpected muscle contraction.
theoretical basis for strain/counterstrain
•Gamma efferent neurologic system:
–Responsible for providing a change in muscle tone to meet changing demands
–Rapid shortening and lengthening sets up an inappropriate reflex
nociceptive inpput of strain/counterstrain dysfunction
–Myofibril damage interferes with the actin-myosin bridges and changes local tissue chemistry.
–Nociceptive information is carried the CNS to alert the body of tissue damage.
- –Local tissue disruption along with the nociceptive afferent input and subsequent chemical
- changes cause increased sensitivity in the tender points to touch
treatment for strain/counterstrain
1.Locate the tender point
2.Establish a new pain scale (10/10)
3.Alleviate the pain to a 3/10 or better (preferably a 0/10)
- the position and gently monitor for the release (may feel therapeutic pulse)
5.Slowly and passively return the patient to neutral
clinical characteristics of trigger points
- •Described as a hyperirritable point in skeletal muscle that is associated with a palpable
- nodule in a taut band.
•When pressed “triggers” a predictable, reproducible and characteristic referred pain.
•May cause “motor dysfunction and autonomic phenomena”.
•Often associated with a twitch response within the myofascial band.
2 types of trigger points
active- refer pain at rest or with muscle activity or palpation
latent- produces pain only with more steady pressure--> frequently overlooked
counterstrain and trigger point overlap
- •Some evidence to suggest that Strain/Counterstrain points may devolve into trigger points when introduced to certain conditions
- (chills, strains, enhanced pain perception, etc.)
•There has been reported a 71% incidence of overlap between trigger points and acupuncture points used for pain management.
mechanism of referred pain
•Trigger points are usually associated with some form of muscular mechanical abuse (muscle overload, myofascial postural stress, prolonged shortened muscle states [especially if further contracted from a shortened state], and muscle chilling).
•Research suggests that referred pain may be due to misdirected nociceptive input to inappropriate dorsal horn neurons.
•Similar to autonomic reflexes.
treatment of trigger points
•Correction of any underlying factors that may precipitate or facilitate recurrence
•Trigger point injections
•Spray and stretch (vapocoolant spray)