Counterstrain Lower Limbs

Question 1

Where is the location of the piriformis tender point?

Answer 1

At the midpoint between the lower half of the lateral aspect of the sacrum and the greater trochanter (in the middle of the butt).

Question 2

What is the first step in treatment of the piriformis?

Answer 2

The patient lies prone and the physician stands/sits at the side of the tender point.

Question 3

What is the second step in treatment of the piriformis?

Answer 3

The patient’s leg on the side of the TP is off the edge of the table. The hip is flexed and abducted while the leg rests on the physician’s thigh/knee.

Question 4

Where is the location of the Iliacus tender point?

Answer 4

1/3 of the distance from the ASIS to the midline.

Question 5

What is the first step in treatment of the Iliacus?

Answer 5

Patient lies supine while the physician stands at the side of the table.

Question 6

What is the second step in the treatment of the Iliacus?

Answer 6

The physician flexes the patient’s hips and knees while placing their foot on the table and lying the patient’s knees on their thigh.

Question 7

What is the third step in the treatment of the Iliacus?

Answer 7

Cross the patient’s ankles and externally rotate both of the patient’s hips (ankles are crossed with knees out to the sides).

Question 8

Where is the location of the Psoas Major tender point?

Answer 8

2/3 of the distance from the ASIS to the midline.

Question 9

What is the first step in the treatment of the Psoas Major?

Answer 9

The patient lies supine while the physician stands at the side of the tender point.

Question 10

What is the second step in the treatment of the Psoas Major?

Answer 10

The physician flexes the hips and knees while adding a slight external rotation of the hips.

Question 11

What is the third step in the treatment of the Psoas Major?

Answer 11

Pull the knees toward the tender point to side bend the lumbar spine.

Question 12

Where is the location of the lateral trochanter tender point?

Answer 12

Along the iliotibial (IT) band distal to the greater trochanter.

Question 13

What is the first step in treatment of the lateral trochanter?

Answer 13

Patient lies either supine or prone while the physician stands at the side of the tender point.

Question 14

What is the second step in treatment of the lateral trochanter?

Answer 14

The patient’s hip/thigh is abducted and slightly flexed.

Question 15

What is the first step in the treatment of the medial meniscus?

Answer 15

The patient lies supine while the physician stands at the side of the tender point.

Question 16

What is the second step in the treatment of the medial meniscus?

Answer 16

The patient’s hip/thigh is abducted so that the leg hangs off the table.

Question 17

What is the third step in the treatment of the medial meniscus?

Answer 17

The physician grasps the lateral ankle/foot to control the lower leg.

Question 18

What is the fourth step in the treatment of the medial meniscus?

Answer 18

The patient’s knee is flexed 35-40 degrees with slight abduction and internal or external rotation of the tibia. May require ankle dorsiflexion and eversion.

Question 19

What is the one difference between treatment of the medial and lateral meniscus?

Answer 19

For the lateral meniscus, the tibia is adducted and internally rotated instead of abducted. Additionally, ankle plantar flexion and inversion may be required, as opposed to dorsiflexion and eversion.

Question 20

Where is the location of the gastrocnemius tender point?

Answer 20

Within the proximal gastrocnemius muscles distal to the popliteal margin.

Question 21

What is the first step in the treatment position of the gastrocnemius/extensor ankle?

Answer 21

The patient lies prone, while the physician stands at the side of the tender point and places their foot on the edge of the table.

Question 22

What is the second step in the treatment position of the gastrocnemius/extensor ankle?

Answer 22

The patient’s knee is flexed and the dorsum of the foot is placed on the physician’s thigh.

Question 23

What is the third step in the treatment position of the gastrocnemius/extensor ankle?

Answer 23

The physician applies a compressing force on the patient’s calcaneus to produce marked plantar flexion of the ankle.

Question 24

Where is the location of the lateral ankle/fibularis longus and brevis tender point?

Answer 24

Anterior and inferior to the lateral malleolus in the sinus tarsi (talocalcaneal sulcus).

Question 25

What is the first step in the treatment of the lateral ankle?

Answer 25

The patient lies lateral recumbent and the physician places a pillow under the lateral aspect of the tibia to create a fulcrum.

Question 26

What is the second step in the treatment of the lateral ankle?

Answer 26

The physician applies an eversion force to the foot and ankle with slight external rotation of the foot.