Chapter 14 Counterstrain Flashcards
What kind of technique is CS?
Passive indirect
What is a tenderpoint?
Small tense edematous area of tenderness about the size of a fingertip located near attachments of tendons, ligaments or belly of muscle that do NOT radiate pain
How do you determine a tenderpoint is clinically significant?
Compare to same spot on other side
Where should you start tx if there are multiple tenderpoints?
Tx the most tender area first
Where do you place the pt?
Into position of comfort/ease by shortening the muscle
After fine tuning the tx position with small arcs of motion, how much pain should be reduced?
> 70%
What is a maverick point?
Tenderpoints that do not improve with fine tuning
How do you tx maverick points?
Place the pt in a position opposite of what would be used typically
How long must the position be maintained?
90 secs–time takes for proprioceptive firing to decrease
How much tenderness should remain after tx?
Anterior cervical TP location?
Anterior to or on most lateral aspect of lateral masses
Tx position for anterior cervical TP?
SB and rotate head away form side of TP
Anterior cervical maverick point (anterior 7th cervical) location?
2-3cm lateral to medial end of clavical at lateral attachment of SCM
Anterior cervical MP tx position?
Flex, SB toward and rotate away from side of TP
Posterior cervical TP location?
Tip of SP or on lateral side of SP
Posterior cervical TP tx position?
Extend, SB (slightly), and rotate away
Posterior cervical MP/inion (posterior 1st cervical) location?
At inion (posterior occipital protuberance) or just below
Posterio cervical MP inion tx position?
Marked flexion
Anterior thoracic TPs location?
T1-6 = located midline of sternum at attachment of corresponding ribs T7-12 = most located in rectus abdominus m about 1 inch lateral to midline on right or left
Anterior thoracic TPs tx position?
Flex thorax and add small amount of SB and rotation away
Posterior thoracic TPs location?
Either side of SP or on TP
Posterior thoracic TPs tx position?
Extend, rotate away and SB slightly away
Anterior rib TPs are assoc with what rib position?
Depressed ribs (exhalation dysfunction)
Posterior rib TPs are assoc with what rib position?
Elevated ribs (inhalation dysfunction)
How long must rib tx positions be held?
120 secs–allows pt extra time to relax
Anterior rib 1 TP location?
Just below medial end of clavicle
Anterior rib 2 TP location?
6-8cm lateral to sternum on rib 2
Anterior ribs 3-6 TP locations?
Along mid-axillary line on corresponding rib
Anterior rib tx position for ribs 1 and 2?
Flex head, SB and rotate towards
Anterior rib tx position for ribs 3-6?
SB and rotate thorax toward, encourage slight flexion
Posterior rib TP location?
Angle of corresponding rib
Posterior rib TP tx position?
Tx with minimal flexion, SB and rotate away
Anterior lumbar TP L1 location?
Just medial to ASIS
Anterior lumbar TP L2-4 location?
On the AIIIS
Anterior lumbar TP L5 location?
1cm lateral to pubic symphisis on superior ramus
Anterior lumbar TP tx position?
Most treated with pt supine, knees and hips flexed and markedly rotated away
Posterior lumbar TP location?
Either side of SP or on TP; L3-4 may be on iliac crest; L5 may be on PSIS
Posterior lumbar TP tx position?
Most treated with pt prone, extended and SB away (rotation may be towards or away)
Posterior lumbar MPs (lower pole 5th lumbar) location?
Inferior to PSIS as much as 1 cm
Posterior lumbar MP tx position?
Pt prone, hip and knee flexed, leg internally rotated and adducted
Iliacus TP location?
~7cm medial to ASIS
Iliacus tx position?
Pt supine with hip flexed and externally rotated
Piriformis TP location?
In the piriformis m 7cm medial to and slightly superior to greater trochanter
Piriformis TP tx position?
Pt prone, hip and knee flexed, thigh abducted and externally rotated
What percentage of TPs are maverick?
5%
What region is assoc with the greatest number of MPs?
Cervical spine
