Counterstrain Lab Flashcards
What do you do if there is more than one tenderpoint?
treat central to peripheral (thoracic to rib)
What is the goal of counterstrain?
take as much tenderness out of that point by positioning, which removes the contracture
How long do you hold the position?
90 seconds to reset the nociception and muscle spindles
How should you return the patient?
slow and passive so you don’t re-irritate muscle spindles
What are the steps to counterstrain?
1) find most significant tenderpoint
2) physician establish tenderness scale
3) monitor tenderpoint throughout
4) place patient in “position of ease” of atleast 70%
5) hold 90 seconds
6) slowly return to neutral
7) recheck tenderness and associated TART findings
PC 1 Inion
Location: just lateral to inion
Treatment: F St Ra
PC 1 Occiput
Location: inferior nuchal line midway between inion and mastoid
Treatment: e-E Sa Ra
PC 2 Occiput
Location: inferior nuchal line midway between PC1 inion and occiput (press anteriorly)
Treatment: e-E Sa Ra
PC 2
Location: on the superior lateral aspect of the spinous process of C2
Treatment: e-E Sa Ra
PC 4-8
Location: on the inferolateral aspect of the spinous process
(ex: PC4 is inferior to the C3 spinous process)
Treatment: e-E Sa Ra
PC 3 Maverick Point
Location: inferior tip or inferolateral aspect of the spinous process of C2 (press posterior to anterior)
Treatment: f-F Sa Ra
-this is a maverick point because we’re flexing the C-spine during the treatment rather than extending as with all of the others
What are the two types of posterior thoracic points?
1) spinous process: midline inferior aspect tip of spinous process
2) transverse process: on transverse process medial to costovertebral joint
Where are the posterior thoracic spinous process tenderpoints?
inferior aspect of spinous process (think about shortening interspinales muscle)
What is the treatment for ALL posterior thoracic spinous processes?
e-E
(PT1-PT4: extend off table)
(Lower PTSP: use doctor’s knee or use the table lifts to increase extension)
Posterior Thoracic 1-3 TP
Treatment: E Sa Ra
-think of shortening multifidus/rotatores
Thoracic 4-9 TP
Treatment: E Sa RT
- retraction of shoulder causes thoracic rotation left and extension towards
- elevation of left shoulder causes thoracic sidebending away
- can also use knee as a lever
Pelvic Motion
- pelvis rotates OPPOSITE the lumbar and thoracic spine
- moving the pelvis superiorly toward the head induces sidebending toward the SAME side
- moving the pelvis inferiorly toward the feet induces sidebending to the OPPOSITE side
Posterior Thoracic 10-12 TP
Treatment: e-E Sa Ra (torso) or e-E Sa Rt (pelvis)
- pelvis rotates opposite of lumbar spine
- doctor stands opposite the TP
- pull the ipisilateral ASIS posteriorly to induce rotation and pull inferiorly to induce sidebending
Posterior Lumbar 1-5 SP
Location: inferolateral aspect of spinous process
Treatment: e-E Adduction RA (torso) RT (pelvis)
-use ipsilateral lower extremity to lever lumbar spine; doctor stands on opposite side
-lift ipsilateral lower extremity (induces lumbar extension)
-externally rotate lower extremity (rotates pelvis toward TP and rotates torso away from TP)
-adduct ipsilateral lower extremity (induces lumbar sidebending)
Posterior Lumbar 1-5 TP
Location: on respective TP
Treatment: E Sa Ra (torso) RT (pelvis)
-pelvis rotates opposite of lumbar
-doctor stands on opposite side as TP
-pulling ipsilateral ASIS posteriorly produces lumbar extension, and rotation
-pushing ipsilateral ASIS inferiorly produces lumbar sidebending away
Upper Pole L5
Location: superior medial surface of the PSIS
Treatment: E adduction ir/er
-use ipsilateral lower leg to lever lumbar, stand on opposite side
-move in ir/er to find which improves patient’s tenderness
Lower Pole L5
Location: on the ilium just inferior to PSIS pressing superiorly
Treatment: F IR Adduction
-sit on same side as TP, patient prone
-flex ipsilateral leg off table
-use ipsilateral knee to IR and adduct leg
High Ilium Sacroiliac (HISI)
Location: 2-3cm lateral to the PSIS pressing medially toward the PSIS
Treatment: e-E Abduct ER
-stand on same side as TP
-use ipsilateral leg to extend, abduct, and ER the leg
PL 3 Gluteus
Location: 2/3 lateral from PSIS to tensor fascia latae
Treatment: E Abduct er
-stand on same side as TP
-use ipsilateral leg to extend, abduct, and externally rotate the leg
PL 4 Gluteus
Location: posterior margin of tensor fasciae latae
Treatment: E Abduct er
-stand on same side as TP
-use ipsilateral leg to extend, abduct, and externally rotate the leg
