Counterstrain

Question 1

8 steps of counterstrain

Answer 1

• find df
• find tp
• establish pain scale
• wrap arouhnd
• reduce pain to 30
• hold for 90
• passivley return to neutral
• reassess

Question 2

posterior lateral trochanter

Answer 2

• location: superolateral aspect of the posterior surface of the greater trochanter (lateral aspect of the piriformis muscle)
• Tx: pt prone, doc stands at side of df
• doc monitors tp and extends pts leg with marked external rotation and fine-tunes with abduction

Question 3

Lateral trochanter

Answer 3

• Location: 5-6 inches inferior to greater trochanter in mid-coronal line
• tx: pt prone, doc at side of df
• doc monitors tp and abducts pt’s hip and may slightly flex

Question 4

Sartoriuss

Answer 4

• location: 2-3 cm inferior to ASIS
• tx: pt supine, doc on same side of df
• doc monitors TP with one hand, flex knee/hip 135, slight external rotation with other hand

Question 5

Patellar tendon

Answer 5

• location: onpatellar ligament tendon, just below the patella
• tx: pt supine, doc standing at table on side of df
• doc places pillow under distal tib/fib
• doc monitors tp and pushes anterior to posterior on the distal femurand hyperextends knee

Question 6

Medial hamstring

Answer 6

• location: on the medial hamstring muscle/tendon near its distal attachment at the posterior medial surface of tibial condyle
• Tx: pt supine, doc at side of df with foot on table, may place pts foot under docs knee for support
• doc monitor tp with cephalad hand while flexing pts knee, ER tibia on femur and fine tune with adduction

Question 7

PCL

Answer 7

• locatin: close to middle of popliteal space
• tx: pt supine, doc at side of df, place a rolled up towel on table beneath proximal tibia
• doc monitors tp and places caudad hand on tp, pushes femur posteriorly with cephalad hand (which shortens the PCL)

Question 8

ACL

Answer 8

• location: on medial and lateral aspects of the popliteal fossa
• tx: pt supine, doc at side of df, place a rolled up towel on table beneath distal femur
• doc monitors tp and places caudad hand on tp , pushes tibia posteriorly with caudad hand (which shortens the ACL)

Question 9

Lateral ankle

Answer 9

• location: anterior and inferior to lateral malleolus in the sinus tarsi
• tx: pt lateral recumbent on affected side, with knee bent and foot over the edge of table with rolled up towel under ankle to protect fibula…. doc standing at end of table
• doc monitors tp and applies force with heel of hand 3 cm below the medial malleolus causing eversion of whole foot with mild external rotation

Question 10

medial ankle

Answer 10

• location: small arc below medial malleolus
• tx: pt lateral recumbent on non-affected side, with knee bent and foot over edge of the table with rolled up towel under ankle… doc standing at end of table
• doc monitors tp and inverts foot without much IR

Question 11

-extension ankle

Answer 11

• location: on both gastroc heads and both sides of achilles tendon
• tx: pt prone, doc standing on side of df, with distal leg on table
• doc monitors tp and flexes pts affected knee, plantar flexes ankle and place dorsum of ankle on doctor’s thigh
• doctor adds axial compression through ankle, keeping pressure high on instep to avoid straining metatarsals

Question 12

flexion ankle

Answer 12

• location: high in front of ankle in a depressio medial to the big extensor tendon
• tx: pt prone, doc standing at table on side of df
• doc monitors tp, flexes pt’s affected knee, and exerts force on the ball of the foot to dorsiflex the ankle (fine-tune with slight tibial rotation)