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OS Yr II Exam 1 > Counterstrain > Flashcards

Counterstrain Flashcards

1
Q

the 8 steps of counterstrain

A

8 Steps of Counterstrain

  1. Diagnose SD
  2. Find TP
  3. Establish pain scale
  4. Wrap around TP while monitoring
  5. Reduce pain by at least 70% (pt in position of comfort)
  6. Maintain position for 90 seconds
  7. Slowly and passively return patient to neutral
  8. Reassess TP & SD
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2
Q
A

AL1: F STRT

Location: medial ASIS

Treatment position: Pt supine.

Doc on ipsilateral side.

Flex hips/knees to 90

supporting with doc’s leg on table.

Pull ankles (SB) & knees (Rot) towards doc.

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3
Q
A

AL 2: F SARAH

Location: medial AIIS

Treatment position: Pt supine.

Doc contralateral side.

Hips/knees flexed.

Ankles (SB)

knees (Rot) toward Doc, away from TP.

Rot >>> SB

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4
Q

Location: medial AIIS

A

AL2

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5
Q

Location: medial to ASIS

A

A1

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6
Q

Location: lateral and inferior AIIS

A

A3(L), A4(Inf)

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7
Q

AL3 and AL4 counterstrain

A

Treatment position: Pt supine.

Doc ipsilateral w/ ft on table.

Flex knees/hips to 90.

Ankles (SB) away from doc & TP

knees (Rot) toward doc & TP

▫ F SART

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8
Q
  1. F SART
  2. F SARAH
  3. F STRT
A
  1. F SART - A3/A4/A5
  2. F SARAH - A2
  3. F STRT - A 1
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9
Q
A

AL 5

Location: lateral to pubic symphysis

Treatment position: Pt supine.

Doc ipsilateral w/ ft on table.

Flex hip to 135

ankles (SB) away from doc & TP.

Knees (rot.) slightly toward doc & TP.

▫ F SART

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10
Q
A

PL 1-5 Spinous Process

Location: Midline on respective SP

Treatment position: Pt prone

Doc ipsilateral to TP.

Extend hip, fine tune with SB as necessary

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11
Q

PL 1-3 Transverse Process

A

PL 1-3 Transverse Process

Location: on respective TP, can be b/l

Treatment position: Pt prone.

Doc contralateral side.

Extend ipsilateral hip to TP, externally rotate hip towards TP.

TPEE

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12
Q
A

Upper Pole L5 (UPL5)

Location: superomedial PSIS

Treatment position: Pt prone.

Doc contralateral to TP.

Extend hip ipsilateral to TP, externally rotates hip towards TP

*Same motion as PL 1-3 TP. Monitoring at diff. location with different amounts of extension/rotation to address specific tenderpoint*

U-PLP-EE-5

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13
Q
A

Lower Pole L5 (LPL5)

Location: inferior PSIS

Treatment position: Pt prone with dysfunctional side over side of table.

Doc flexes hip & knee to 90.

Add IR/Adduction of hip to fine tune.

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14
Q
A
  1. PL3 Lateral/Gluteus
    1. Location: between PSIS/TFL
    2. Treatment position: Pt prone. Doc ipsilateral. Extend hip, fine tune with Abduction.
    3. Actions of glutes
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15
Q

(same picture, different spot)

A

PL4 Lateral/Gluteus

Location: posterior margin of TFL

Treatment position: Pt prone. Doc ipsilateral. Extend hip, fine tune with Abduction. (Less ext. than PL3)

▫ Actions of glutes

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16
Q

Which PLs require the doctor to stand on the contralateral side?

A

PL1-3 and UPL5

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17
Q

Which PLs require the doctor to be standing ipsilaterl to the TP?

A

PL 1-5 SP, LPPL5, PL 3 Lat Glut, PL 4 Lat Glut

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18
Q

which PLs require external rotation?

A

UPL5

PL1-3 TPs

U-PEE-L5

PL1,2,ThrEE

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19
Q

which PLs require flexion?

A

LPLP5

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20
Q
A
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21
Q
A

Location: RLQ, medial to ASIS, deep in iliac fossa

Treatment position: Pt supine.

Doc ipsilateral w/ foot on table.

Flex hips/knees to 90, crossing ankles over doc’s knee, inducing marked ER

▫ “Frog leg”

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22
Q
A

Low Ilium

Location: superior pubic ramus, where psoas m. crosses pelvic rim

Treatment position: Pt supine.

Doc ipsilateral. Flex hip & knee to >90. Fine tune if nec.

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23
Q
A

Inguinal Ligament

Location: lateral pubic tubercle

Treatment position: Pt supine.

Doc ipsilateral w/ foot on table.

Flex hips/knees to 90, rest on doc’s knee. Cross c/l ankle over i/l leg, pull ankles towards doc (IR of dysfnl. hip)

▫Assoc.: inguinal lig. and/or pectineus m.

24
Q
A

High Ilium Sacroiliac (HISI)

Location: lateral PSIS

Treatment position: Pt prone.

Doc ipsilateral.

Extend hip and fine tune with ab/adduction.

Assoc. with Glut. max., Q. lumborum, or iliolumbar lig.

25
Q
A

High Ilium Flairout (HIFO)

Location: 2” inferior, just medial to PSIS

Treatment position: Pt prone. Doc contralateral. Extend dysfnl leg enough to clear opp. leg. Induce marked adduction/ER pulling leg towards doc.

▫ Assoc. w/ coccygeus m.

26
Q
A

Piriformis

Location: half-way from ILA to greater trochanter in belly of m.

Treatment position: Pt prone, dysfnl side off table. Flex pt’s hip to 135. Abduct and externally rotate by lifting knee superolaterally

27
Q

FISI

A

Location: approx. 4” below PSIS, glut max attachment inferiorly

• Treatment position: Pt prone with dysfnl side at edge of table. Doc ipsilateral. Abduct hip, then flex just enough to clear table edge (in case finetuning with ER is nec.

28
Q

FISI, HIFO, HISI, maneuver X

A

Flair-in sarcal iliac

high iliac flair-our

high ileal sacral iliac

periformis

29
Q

Posterior Lumbar all together

A

PIL-P5L midline

P1L-P3L transverse process

UP5L

LP4L

PL3 Lat

PL4 Lat

30
Q

A1T

A

Midline in suprasternal notch (palpate inferiorly).

31
Q

A2T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

32
Q

A3T-A4T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

33
Q

A5T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

34
Q

A6T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

35
Q

A7T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

36
Q

A7T

A

A2T: Midline on the manubrium

A3-4T: At the level of the costal cartilage related to the named vertebra

A5T: about an inch above the xiphoid junction

A6T: at the sternal-xiphoid junction

A7T: at the tip of the xiphoid

37
Q

A8T

A

A8T: 1 1⁄2 inches below the

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

38
Q

A9T

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

39
Q

A10T

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

40
Q

A11T

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

41
Q

A12T

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

42
Q

AT5-6

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

43
Q

AT7-8

A

A8T: 1 1⁄2 inches below the

Anterior Thoracic Tender Points

xiphoid

A9T: midline below the xiphoid, 1-2 cm above the umbilicus

A10T: Midline about 1-2 cm below the umbilicus

A11T: Midline about 3-4 cm below the umbilicus

A12T: Mid-axillary line on superior-medial surface of the iliac crest (palpate inferior-lat)

AL5-6: On costal cartilages of these levels

AL7-8: On inferior medial surface of costal cartilages, 1 and 2 inches from xyphoid.

44
Q
A

AC1 or LC1 (C1TP)

On the posterior surface of the ascending ramus of the mandible

Pt: supine, Dr: at head of table; RA head

45
Q
A

AC2-6

Anterolateral aspect of the TP of affected vertebra

Pt: supine, Dr: at head of table; F SARA

46
Q
A

Posterosuperior surface of proximal clavicle where sternocleidomastoid muscle inserts (lateral to the AC8 tenderpoint)

AC7

Pt: supine, Dr: at head of table; F STRA

47
Q
A

AC8

Pt: supine, Dr: at head of table; F SARA

On the medial end of the clavicle at the sternal attachment of the sternocleidomastoid muscle.

48
Q
A

AT1 – AT8 Treatment Position:

Pt: supine with feet flat on table,
Dr: at head of table Dr places knee under pt’s. head/neck or trunk

to use as a wedge to flex pt to involved vertebrae. Dr’s operating hand supports upper back and fine tunes flexion. More flexion needed the lower the TP’s

49
Q
A

AT9 – AT12 Treatment Position:

Pt: supine,
Dr: same side of tenderpoint w/ foot on table Dr uses pt’s legs to

cause flexion (at waist) Pt’s hips & knees bent to 90° w/ fine tuning by adding rotation towards Dr. Flexion can be assisted w/ a pillow under pelvis or thorax

50
Q

Pt: seated, Dr: behind pt w/ leg on table under pt’s arm on unaffected side; F STRA

A

AL 5-6T

AL7-8T

51
Q
  1. RA head
  2. F SARA
  3. F STRA
  4. F SARA
  5. F STRA
  6. F STRT
  7. F STRT (again)
A
  1. RA head: AC1 or LC1 (C1TP)
  2. F SARA: AC2-6
  3. F STRA: AC7
  4. F SARA: AC8
  5. F STRA: AL 5-8
  6. F STRT: AR1 -2
  7. F STRT: AR3-6
52
Q
  1. Flex pt’s hip to 135° off the side of the table, induce Abduction and external rotation by lifting the patient’s knee superolaterally
  2. Pt prone with thigh on dysfunctional side suspended over side of table; Dr.: same side. Doctor flexes pt’s hip and knee to 90°, then adds adduction and internal rotation of the hip.
  3. Pt prone; Dr.: same side. Abduct hip, and then flex just enough to allow knee to clear the table. Fine tune with external rotation.
A
  1. Piriformis: Half-way from sacral inferolateral angle (ILA) to greater trochanter
  2. LPL5; TP is inferior PSIS
  3. Flare-In Sacroiliac (FISI): Approx 4” below PSIS, related to glut. max attachment
53
Q
A
54
Q

PS 1

A

Medial to inferior border of PSIS b/l (sacral sulci)

Pt prone; Dr.: same side. Apply a posterior to anterior pressure at the location diagonally opposite the TP (ie, if the Left PS1 is tender, apply pressure at R ILA)

55
Q

PS 2, 3, 4

A

Midline on sacrum, between sacral spines

Pt prone; Dr. standing on pt’s side. Apply posterior to anterior pressure on apex (if PS2) or base (if PS4) of sacrum, producing transverse axis rotation. PS3 may vary where the force is applied, for this point it is important to communicate with your patient, asking in which direction is the tenderness reduced

56
Q

PS5

A

PS 5 (bilateral)

Superomedial ILA bilaterally

Pt prone; Dr. standing on pt’s side. Apply posterior to anterior pressure at the location diagonally opposite the TP. (ie, if Left PS5 is tender, doc applies pressure at R sacral sulcus)

OS Yr II Exam 1 (8 decks)

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