Counterstrain and FPR

Question 1

AC2-6

Answer 1

slight anterior to or on lateral aspect of lateral masses

Tx: slightly flex, SB and rotate away from side of tenderpoint

Question 2

AC1 mandible

Answer 2

rotate away

Question 3

Anterior C7

Answer 3

2-3 CM lateral to medial end of clavicle at lateral attachment of SCM

Tx: flex, STRA

Question 4

Counterstrain

Answer 4

passive indirect technique, tissue positioned at point of balance or ease, away from restrictive barrier

Question 5

Tenderpoint

Answer 5

small tense edematous areas of tenderness about size of a fingertip

near bony attachments of tendons, ligaments or in belly of some muscles

Do not radiate pain to other locations

Question 6

Steps to counterstrain tx

Answer 6

1. locate significant tenderpoint
2. palpate the tenderpoints
3. place pt in position of optimal comfort - shorten muscle, fine to to 70 percent reduction of pain
4. hold for 90 sec (120 for ribs)
5. slow passive return to neutral
6. recheck

Question 7

Posterior cervical tenderpoints

Answer 7

tip of spinous process or lateral sides of spinous process

tx: extend, SB slightly, rotate away

Question 8

PC1-Inion

Answer 8

at inion (posterior occipital protuberance) or just below

Tx: marked flexion

Question 9

Anterior thoracic tenderpoints

Answer 9

T1-6 midline of the sternum at the attachment of the corresponding ribs

T7-T12 - in the rectus abdominus about 1 inch lateral to midline on the right of left

Tx:
flex thorax and add small amount of sidebending and rotation away

Question 10

Posterior thoracic tender points

Answer 10

either side of the spinous process or on the TP

Tx:
extend, rotate away, side bend slightly away

Question 11

AR 1 and AR 2 (anterior ribs)

Answer 11

Rib 1: tender point just below medial end of clavicle

Rib 2: tenderpoint is 6-8 cm lateral to the sternum on rib 2

Tx: flex head, sidebend and rotate towards

Question 12

AR 3-6 (anterior ribs)

Answer 12

tenderpoints along mid-axillary line on corresponding rib

Tx: sidebend and rotate the thorax toward, encourage slight flexion

Question 13

Posterior rib tenderpoints

Answer 13

on angle of corresponding rib

Tx: minimal flexion, sidebend away, rotation away

Question 14

AL 1

Answer 14

medial to ASIS

Tx: hip flexed, sidebend towards, rotate away

Question 15

AL2-AL4

Answer 15

AL2 - medial to AIIS
AL3 - Lateral to AIIS
AL4 - inferior to AIIS

Tx: hip flexed, sidebend away, rotate towards

Question 16

AL5

Answer 16

one cm lateral to pubic symphysis on superior ramus

Tx: hip flexed, sidebend towards, rotate away

Question 17

Iliacus tenderpoint

Answer 17

1/3 distance from ASIS to midline (approx 7 cm), laterally

tx: supine, hip flexed and externally rotated - figure 4

Question 18

Psoas tenderpoint

Answer 18

1/2 distance between ASIS and umbilicus - deep

tx: supine, hip flexed and externally rotated - figure 4

Question 19

Piriformis tenderpoint

Answer 19

1/2 distance between the greater trochanter and the midpoint between PSIS and ILA

Tx: prone, hip and knee flexed, thigh abducted and externally rotated

Question 20

FPR procedure

Answer 20

neutralize spine
apply facilitating force
shorten muscle or place vertebrae into indirect position (where it likes to live)
hold for 3-5 seconds
move to neutral and recheck