Anterior Cervical, Thoracic, Rib COUNTERSTRAIN

Question 1

What is the anterior cervical AC1 (LC1) location and treatment?

Answer 1

-posterior surface of the ascending ramus or mandible

-pt supine doc at head of table
RA head (rotate head away from TP)

Question 2

What is the location and treatment for AC2-6?

Answer 2

-anterolateral aspect of TP of affected vertebrae

• pt supine doc at head of table
• F SARA

Question 3

What is the location and treatment for AC7?

Answer 3

-posterosuperior surface of proximal clavicle (lateral to AC8)

• pt supine doc at head of table
• F STRA

Question 4

What is the location and treatment for the AC8?

Answer 4

-MEDIAL end of clavicle at sternal attachment of SCM

• pt supine doc at head of table
• F SARA

Question 5

Where are the Anterior thoracic AC 1-12 TPs?

Answer 5

AT1- midline Supra stern also notch
AT2- midline manubrium
AT3- midline at costal cartilage of named vertebrae
AT4- midline at costal cartilage of named vertebrae
AT5- midline superior to xyphoid 
AT6- midline at sternal-xiphoid junction
AT7- midline tip of xiphoid 
AT8- midline inferior to xiphoid 
AT9- midline superior to umbilicus
AT10- midline inferior to umbilicus 
AT11- midline 3-4cm below umbilicus 
AT12- BILATERAL mid-axillary line on ILIAC CREST

Question 6

How will you treat At1-8 TPs?

Answer 6

• pt supine with feet flat on table doc at head of table
• place knee under pt head/neck or trunk to wedge into FLEXION at the involved vertebrae
• support head/neck and fine tune flexion

**more flexion for lower TP’s

Question 7

How will you treat AT9-12 TPs?

Answer 7

• pt supine doc on same side as TP with foot on table
• doc uses pts legs to cause FLEXION at waist, and hips and knees bent to 90
• fine tune with rotation towards doc

Question 8

Where are the anterior lateral thoracic TP and how do you treat them?

Answer 8

• AL 5-6T = at costosternal joint at affected level
• AL 7-8T = inferior medial surface of costal cartilage inferolateral from xiphoid
• pt SEATED doc behind with leg on table under pts arm on UNAFFECTED side
• F STRA

Question 9

Where are anterior rib points AR1 and 2 and how do you treat them?

Answer 9

• AR1 = inferior to clavicle on rib 1 inf to SC joint lat manubrium
• AR2 = lateral to manubrium on rib 2 in MIDCLAVICULAR line
• pt supine doc at head of table
• F STRT (treat depressed rib, inhalation dysfunction)

Question 10

Where at anterior rib points AR3-6 and how would you treat them?

Answer 10

-AR3-6 = anterior axillary line on ribs 3-6

• pt SEATED doc behind with pts arm over doc knee on UNAFFECTED side
• F STRT
• treat depressed rib, inhalation dysfunction

Question 11

What is the location and treatment for PC1 inion TP?

Answer 11

-inferior to external occipital protuberance, lateral, on insertion of semispinalis capitis

• cradle head in monitoring hand and other hand on pts forehead
• FLEX pts neck into comfort position and fine tune

Question 12

What is the location and treatment for PC1, PC2 TP?

Answer 12

• PC1 = 3 cm below inion and medial to OM suture, press anterior/medial
• PC2 = main muscle mass 2-3cm lateral to midline and below occiput

-E SARA (and fine tune)

Question 13

What is the location and treatment for PC3 TP?

Answer 13

-inferolateral aspect of C2 SP

• F SARA (FLEX and not extend–> exception *MAVERICK)
• flex to 45 may also require you to STRA instead depends on pt

Question 14

What is the location and treatment for PC4-7 TP?

Answer 14

-on the inferolateral aspect of SP for the spinal nerve
Ex) PC5 are on SP C4

-E SARA

Question 15

What is the location and treatment for PC8 TP?

Answer 15

-located on SP C7

F SARA or E SARA depending on pt

Question 16

What is the location and how would you treat PT 1-3 TP?

Answer 16

-on SP of respective vertebrae

• pt PRONE with arms draped over SIDES of table
• doc cups pts chin wiht one hand other on TP
• slowly and passively EXTEND pts neck (fine tune with SB/R away)

Question 17

What is the location and treatment for PT 4-6?

Answer 17

-on SP of respective vertebrae

• pt PRONE with arms draped of TOP of table (aide T spine extension)
• doc cups pts chin and monitors TP
• slowly passively extend pts neck (fine tune with SB/R away)

Question 18

What is the location and treatment for PT7-9 TP?

Answer 18

-on SP of respective vertebrae

• pt is PRONE with arms draped of TOP of table with PILLOW under chest to further extend T spine
• doc cups chin and slowly extends pts neck
• fine tuning with SB/R away

Question 19

What is the location and treatment for PT10-12 TP?

Answer 19

-on SP of respective vertebrae

• pt PRONE with arms draped of TOP of table with PILLOW under chest to further extend T spine
• doc grasp pt ASIS on side OPPOSITE dysfunction raising pts hip and inducing extension of lower T spine

Question 20

What is the location and treatment for posterior rib 1 TP?

Answer 20

-posterior margin of rib HEAD beneth margin of trapezius m

• pt seated doc behind with pts arm on side of dysfunction on knee
• doc SB and rotates HEAD toward dysfunction and slightly extends
• E STRT (HEAD)

Question 21

What is the location and treatment for posterior rib 2 TP?

Answer 21

-superior surface of angles of ribs at medial border of scapula

• pt seated doc behind with pts arm on side of dysfunction on knee
• doc flexes head and SB/R TRUNK and NECK away from TP
• F SARA

Question 22

What is the location and treatment for posterior ribs 3-6 TP?

Answer 22

-superior surface of angle of ribs at medial border of scapula

• pt seated, doc behind with pts arm on side of dysfunction on knee
• grasp pts shoulder on dysfunction side and SB/R TRUNK away
• SARA