Competenct 7: counterstrain for upper and lower extremity

Question 1

7g) extension elbow-

Answer 1

• TP located on side of olecranon process of the ulna near triceps tendon
• Tx: pt supine, doc same side as TP; grasp pt elbow w/ caudad hand so thumb is on TP & hand around forearm…supinate wrist, hyperextend elbow over monitoring hand, finetune w/ ab-adduction

Question 2

7p) patellar tendon-

Answer 2

• TP located on patellar tendon
• Tx: pt supine w/ pillow under distal tib/fib, doc standing same side as TP; push anterior to posterior on distal femur & hyperextend knee

Question 3

7k) Extension wrist-

Answer 3

• TP located as a pattern of 2-3 points over dorsal aspect of radioulnar-carpal jxn
• Tx: pt supine, doc seated on same side as TP; extend & ADDuct wrist (ulnar dev.)

Question 4

7v) extension ankle-

Answer 4

• TP located on both gastrocnemius heads & both sides of Achilles tendon
• Tx: pt prone, doc standing on same side of TP w/ doc leg on table; flex pt affected knee, plantar flex ankle & place dorsum of ankle on doc thigh…doc add axial compression through ankle, keeping pressure on instep to avoid straining metatarsals

Question 5

7u) medial ankle-

Answer 5

• TP located in small arc below medial malleolus
• Tx: pt Lateral recumbent on NON-AFFECTED side, w/ knee flexed & ipsilateral foot over edge of table w/ rolled up towel under ankle, doc standing at end of table; apply force to foot/ankle causing inversion of whole foot

Question 6

7n) lateral trochanter-

Answer 6

• TP located inferior- 5 to 6 in inf to greater trochanter in mid-coronal line
• Tx: pt prone, doc standing on same side of TP; Abduct hip, slightly flex

Question 7

7j) flexion wrist & thumb-

Answer 7

• FW TP- located at base of any of the proximal 2nd to 5th metacarpals in the mm of the flexor carpi radialis & ulnaris
• FT TP- located on ant/lat aspect of base of the 1st metacarpal bone
• Tx: pt supine, doc seated at side of TP; flex pt entire wrist w/ slight radial/ulnar deviation….thumb-flex wrist, Abduct thumb

Question 8

7b) PAC-

Answer 8

• TP located over posterior AC joint

* Tx: Pt prone, doc opposite side of TP; pull pt arm into extension/slight horizontal adduction, apply traction at wrist

Question 9

7w) flexion ankle-

Answer 9

• TP located high in the front of the ankle in a depression medial to the big extensor tendon
• Tx: pt prone, doc standing same side of TP; exert force onto the ball of the foot, dorsiflexing the ankle…finetune w/ slight rotation

Question 10

7c) subscapularis-

Answer 10

• TP located on ant/lat border of scapula, deep in axilla

* Tx: Pt supine, doc same side of TP; place UE over side of table w/ shoulder extended/IR/slightly Abducted…NO traction

Question 11

7s) ACL-

Answer 11

• TP located on medial/lateral aspects of popliteal fossa
• Tx: pt supine w/ pillow under distal femur, doc standing same side as TP; push anterior to posterior on the TIBIA (shortens ACL)

Question 12

7e) long head and short head of biceps-

Answer 12

• Long head TP- located over the long head of biceps tendon in bicipital groove
• Short head TP- located inf/lat to coracoid process
• Tx: pt supine, doc same side as TP facing cephalad; pt arm flexed/IR w/ dorsum of hand/forearm lying on forehead….for short head add ADDUCTION w/ arm more across chest

Question 13

7f) supraspinatus-

Answer 13

• TP located in belly of supraspinatus mm, in supraspinatus fossa above spine of scapula
• Tx: pt supine, doc same side as TP; pt arm Abducted/flexed/ER to 45 deg (mm should become very soft)

Question 14

7q) medial hamstring-

Answer 14

• TP located on medial hamstring mm/tendon near its distal attachment at the posterior medial surface of tibial condyle
• Tx: pt supine, doc standing same side as TP; flex pt knee, ER the tibia on femur, finetune w/ ADDuction at the knee

Question 15

7L) Extensor carpometacarpal & metacarpophalangeal-

Answer 15

• Extensor CMC TP- located along jxn of carpal & metacarpal bones on dorsum of hand
• MCP TP- located on metacarpal bones on dorsum of hand
• Tx: pt supine, doc seated same side as TP; extends fingers & wrist

Question 16

7r) PCL-

Answer 16

• TP located close to the middle of the popliteal space
• Tx: pt supine, w/ pillow under proximal tib/fib, doc standing same side as TP; push anterior to posterior pushing the FEMUR posteriorly (shortens PCL)

Question 17

7t) lateral ankle-

Answer 17

• TP located anterior/inferior to lateral malleolus in the sinus tarsi (talocalcaneal sulcus)
• Tx: pt lateral recumbent on AFFECTED side, w/ other knee flexed & ipsilateral foot over the edge of table w/ rolled up towel under ankle to protect fibula, doc standing at end of table; apply force w/ heel of hand 3 cm below medial malleolus causing eversion of whole foot, w/ mild ER

Question 18

7a) AAC-

Answer 18

• TP located slightly medial to tip of clavicle & over the anterior aspect of the AC joint
• TX: pt supine, doc opposite side of TP; pull pt arm into flexion/adduction w/ slight IR & traction across the body

Question 19

7m) posterior lateral trochanter-

Answer 19

• TP located along sup/lat aspect of the posterior surface of the greater trochanter (lateral aspect of piriformis)
• Tx: pt prone, doc standing same side of TP; extend pt ipsilateral leg w/ ER/Abduction

Question 20

7i) radial head-

Answer 20

• TP located on ant/lat border of radial head
• Tx: pt supine, doc same side as TP; supinate elbow & fully extend elbow over doc knee w/ other hand (NO hyperextend)

Question 21

7d) latissimus dorsi-

Answer 21

• TP located deep in axilla on medial side of humerus; slightly posterior to subscapularis TP
• Tx: pt supine, doc same side as TP; pt UE over side of table w/ shoulder extended/IR/slightly Abducted WITH TRACTION

Question 22

7o) Sartorius-

Answer 22

• TP located 2-3 cm inferior to ASIS (near attachment for Sartorius)
• Tx: pt supine, doc standing same side as TP; flex hip/knee 135 deg w/ ER

Question 23

7h) flexion elbow-

Answer 23

• TP located on coronoid process of ulna

* Tx: pt supine, doc same side as TP; flex pt elbow, pronate & Abduct arm, then pull forearm out laterally