Anterior Counterstrain

Question 1

Counterstrain Steps

Answer 1

1) Diagnose the somatic dysfunction
2) Find a significant tender point (TP)
3) Establish a pain scale
4) Wrap around the TP while monitoring
5) Reduce pain at least 70% (patient in a position of comfort)
6) Maintain position for 90 seconds
7) Slowly and passively return patient to neutral
8) Reassess Somatic Dysfunction (tender point) `

Question 2

AC1 Mandible

Answer 2

SaRa

Location: on the posterior surface of the ascending rams of the mandible

Question 3

AC1 TP

Answer 3

SaRa

Location: on C1 transverse process found midway between rams of mandible and mastoid process

Question 4

AC2-6

Answer 4

F SaRa

Location: Anterior aspect of Transverse processes of corresponding vertebrae

Question 5

AC7

Answer 5

F StRa

Location: Posterosuperior surface of proximal clavicle where SCM muscle inserts (2-3 cm lateral to the AC 8 TP)

Question 6

AC8

Answer 6

FSaRa

Location: Clavicular insertion of SCM muscle, near the sternal notch

Question 7

AT1

Answer 7

F

Location: Midline on suprasternal Notch

Question 8

AT2

Answer 8

F

Location: Midline on the manubrium at sternal angle (Angle of Louis)

Question 9

AT3 and AT4

Answer 9

F

Location: Midline at the level of the costal cartilage related to the named vertebra

Question 10

AT5

Answer 10

F
Location: Midline at the level of the costal cartilage related to the named vertebra
(about 1 inch superior to the Xiphoid)

Question 11

AT6

Answer 11

F
Location: Midline at the level of the costal cartilage related to the named vertebra
(At sternal-xiphoid junction)

Question 12

Treatment Position for AT1-AT6

Answer 12

Patient- Supine
Physician- at the head of the table, cervical and thoracic flexion to the level of the TP. Doctor can place their knee under the patient’s head/neck or trunk to use as a wedge to flex the patient. More flexion will be needed the further down the TP is located

Question 13

AT7

Answer 13

F StRa
Location: Can be midline OR lateral to midline
1/4 from the tip of the xiphoid and the umbilicus

Question 14

AT8

Answer 14

F StRa
Location: Can be midline OR lateral to midline
halfway between the xiphoid and umbilicus
(1.5 inches inferior to the xiphoid)

Question 15

AT9

Answer 15

F StRa
Location: can be midline OR lateral to midline
3/4 the distance from xiphoid tip to the umbilicus
(1-2 cm superior to the umbilicus)

Question 16

Treatment Position for AT7-AT9

Answer 16

Patient- seated
Physician- standing behind the patient, place foot on the side OPPOSITE the tender-point then use the leg to sidebend the torso toward and rotate the patient away

Question 17

AT10

Answer 17

F StRa

Location: Lateral to midline, 1/4 distance from the umbilicus to the pubic symphysis (1-2 cm inferior to umbilicus)

Question 18

AT11

Answer 18

F StRa

Location: Lateral to midline, halfway between umbilicus and pubic symphysis (3-4 cm below the umbilicus)

Question 19

AT12

Answer 19

F StRa

Location: Lateral to midline, mid-axillary line on the superoanterior surface of iliac crest

Question 20

Treatment Position for AT10- AT12

Answer 20

Patient- Supine
Physician- Stand on the same side as the TP; flex the patient’s hip and knees and place them on the physician’s thigh (flex further as needed); pull patient’s knees toward the doctor, causing the pelvis and lower segment to rotate toward the TP while the torso and upper segment rotate away; pull patient’s ankles towards the doctor which sidebends the dysfunctional segment towards the TP

Question 21

AR1

Answer 21

F StRt

Location: inferior to clavicle on rib 1, literal to manubrium (directly inferior to SC joint)

Question 22

AR2

Answer 22

F StRt

1.5 inch lateral to manubrium on rib 2, below mid-clavicular line; may also be found deep in axilla

Question 23

Treatment Position AR1-AR2

Answer 23

Patient- supine
Physician- head of the table
Treats a depressed rib, inhalation restriction

Question 24

Anterior Rib

Answer 24

Exhalation SD

AR tender points are usually depressed ribs

Question 25

Posterior Rib

Answer 25

Inhalation SD

PR tender points are usually elevated ribs

Question 26

AR 3-6

Answer 26

F StRt

Location: Anterior axillary line on ribs 3-6 (slightly anterior to mid-axillary line)

Question 27

Treatment Position AR3-6

Answer 27

Patient- supine
Physician- behind patient, knee under the arm on unaffected side (OPPOSITE)
Treats a depressed rib, inhalation restriction

Question 28

PR1 (treatment included)

Answer 28

E SaRa
Maverick Point
Location: posterior margin of rib head beneath margin of trapezius
Find the connection between the rib and the vertebra and then go out to the angle
Treatment: Patient- supine; physician- standing behind the patient or on the same side; may also be done from a seated position

Question 29

PR2 (including treatment)

Answer 29

F SaRa
Location: superior surface of angles of ribs at medial border of scapula, about 2 1/2 inches lateral to midline
Treatment: Patient- seated; physician- standing behind/ to the side, the doctor places the patient’s arm on the side of the dysfunction (SAME SIDE)

Question 30

PR3-6 (include treatment)

Answer 30

F SaRa
Location: superior surface of angles of ribs at medial border of scapula, about 2 1/2 inches lateral to midline
Treatment: Patient- seated; physician- standing behind/ to the side, the doctor places the patient’s arm on the side of the dysfunction (SAME SIDE)