Counterstrain Lab

Question 1

What do you do if there is more than one tenderpoint?

Answer 1

treat central to peripheral (thoracic to rib)

Question 2

What is the goal of counterstrain?

Answer 2

take as much tenderness out of that point by positioning, which removes the contracture

Question 3

How long do you hold the position?

Answer 3

90 seconds to reset the nociception and muscle spindles

Question 4

How should you return the patient?

Answer 4

slow and passive so you don’t re-irritate muscle spindles

Question 5

What are the steps to counterstrain?

Answer 5

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

Question 6

PC 1 Inion

Answer 6

Location: just lateral to inion
Treatment: F St Ra

Question 7

PC 1 Occiput

Answer 7

Location: inferior nuchal line midway between inion and mastoid
Treatment: e-E Sa Ra

Question 8

PC 2 Occiput

Answer 8

Location: inferior nuchal line midway between PC1 inion and occiput (press anteriorly)
Treatment: e-E Sa Ra

Question 9

PC 2

Answer 9

Location: on the superior lateral aspect of the spinous process of C2
Treatment: e-E Sa Ra

Question 10

PC 4-8

Answer 10

Location: on the inferolateral aspect of the spinous process
(ex: PC4 is inferior to the C3 spinous process)
Treatment: e-E Sa Ra

Question 11

PC 3 Maverick Point

Answer 11

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

Question 12

What are the two types of posterior thoracic points?

Answer 12

1) spinous process: midline inferior aspect tip of spinous process
2) transverse process: on transverse process medial to costovertebral joint

Question 13

Where are the posterior thoracic spinous process tenderpoints?

Answer 13

inferior aspect of spinous process (think about shortening interspinales muscle)

Question 14

What is the treatment for ALL posterior thoracic spinous processes?

Answer 14

e-E
(PT1-PT4: extend off table)
(Lower PTSP: use doctor’s knee or use the table lifts to increase extension)

Question 15

Posterior Thoracic 1-3 TP

Answer 15

Treatment: E Sa Ra

-think of shortening multifidus/rotatores

Question 16

Thoracic 4-9 TP

Answer 16

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

Question 17

Pelvic Motion

Answer 17

• 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

Question 18

Posterior Thoracic 10-12 TP

Answer 18

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

Question 19

Posterior Lumbar 1-5 SP

Answer 19

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)

Question 20

Posterior Lumbar 1-5 TP

Answer 20

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

Question 21

Upper Pole L5

Answer 21

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

Question 22

Lower Pole L5

Answer 22

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

Question 23

High Ilium Sacroiliac (HISI)

Answer 23

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

Question 24

PL 3 Gluteus

Answer 24

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

Question 25

PL 4 Gluteus

Answer 25

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