Counterstrain: Posterior Trunk - Lab/OSCE Flashcards
8 steps of counterstrain
- Locate SD2. Find tender point3. Establish pain scale4. Wrap around tender point while monitoring5. Reduce pain by at least 70%6. Maintain position for 90 sec7. Passively return to neutral8. Reassess
Posterior cervical (all) - treatment position
Supine, physician seated at head
PC1 inion - location and treatment
Location - 1-2 cm inferior to external occipital protuberance, slightly lateral, on insertion of semispinalis capitusTreatment - Cradle head, place monitoring hand on forehead, flex neck to position of comfort
Special feature about PC1 inion
“Maverick point” - treat via lengthening tissues around the point rather than shortening/wrapping around
PC1 - locationPC2 - locationTreatment (both)
PC1 - 3cm below inion, 1cm medial to occipitomastoid suture, press anteromediallyPC2 - main muscle mass about 2-3 cm lateral to midline, just below occiputTreatment - ESARA
PC3 location and treatment
Location - Inferolateral C2 spinous processTreatment - FSARA (flex to 45º), may require FSTRA instead
PC4-7 - location and treatment
Location - Inferolateral spinous process of the spinal NERVE that runs through (ex. PC3 = C2 SP)Treatment - ESARA
PC8 - location and treatment
Location - same as PC 4-7Treatment - FSARA or ESARA, whichever works better
Posterior thoracic points - although the points are MIDLINE, rotating AWAY means _______
AWAY from the side of dysfunction (lateralized)
ALL posterior thoracic points (T1-12) - location
Spinous process of that vertebra
T1-9 posterior thoracic points - common positioning for treatmentWhat changes as you go down the spine?
Prone, doc cups pt’s chin (1 hand) and monitors TP (other hand). ESARA from there- Where pt’s arms are draped- If pillow is used under pt’s chest or not
T1-3 - treatment specifics
Arms draped to SIDES
T4-6 - treatment specifics
Arms draped over TOP of table (to extend T spine)
T7-9 - treatment specifics
Arms draped over TOP of table WITH PILLOW under chest
T10-12 - treatment (all)
Prone, arms draped over TOP of table WITH PILLOW under chest, doc grabs ASIS on side OPPOSITE the dysfunction and induces further lower spine extension
For RIB counterstrain, a posterior tender point means _____
ELEVATED (inhalation dysfunction)
Posterior ribs counterstrain - length of treatment?
120 seconds
PR1 - location and treatment
Location - Posterior rib head under trapezius margin
Treatment - Seated, doc standing behind/to side, pt’s arm on side of dysfunction is draped over doc’s knee, doc SB and R pt’s HEAD toward dysfunction and extends slightly
PR2 - location and treatment
Location - Superior surface of rib angle at medial border of scapula (2-2.5 inches lateral to midline)
Treatment - Seated, doc standing behind/to side, pt’s arm on side of dysfunction is draped over doc’s knee, doc SB and R pt’s TRUNK away from dysfunction, then SB/R head away
PR3-6 - location and treatment
Location - superior surface of rib angles at medial border of scapula, 2-2.5 inches lateral to midline
Treatment - Seated, doc standing behind/to side, pt’s arm on side of dysfunction is draped over doc’s knee, doc SB and R pt’s TRUNK away from dysfunction, then SB/R head away
PL (posterior lumbar) 1-5 MIDLINE - location and treatment
Location - midline on spinous processes
Treatment - Prone, doc stands on side of tender point, extends pt’s same side hip to tender point and fine tune
PL 1-3 Transverse Process - location and treatment
Location - on transverse process
Treatment - Prone, doc stands opposite of TP, extends hip (TP side) to TP and rotates leg towards, fine tuning
UPL5 (upper) - location and treatment
Location - superior medial edge of PSIS
Treatment - Prone, doc stands opposite of TP, extends hip (TP side) to TP and rotates leg towards, fine tuning
LPL5 (lower) - location and treatment
Location - Inferior aspect of PSISTreatment - Prone, leg of TP side hanging to side of table, flex hip and knee to 90º, add adduction and internal rotation to hip
PL3 Lateral - location and treatment
Location - 2/3 lateral btwn PSIS and tensor fascia lata
Treatment - Prone, extend hip on side of TP and fine tune
PL4 Lateral - location and treatment
Location - Posterior margin of tensor fascia lata
Treatment - Prone, extend hip of side of TP and fine tune
PS1 (bilateral) - location and treatment
Location - sacral sulcus (1/2 inch medial to inferior PSIS) b/l
Treatment - Prone, apply anterior pressure diagonally opposite location of TP (ex. PS1 TP on L = doc applies pressure to R ILA)
PS2-4 (Midline) - location and treatment
Location - Midline on sacrum btwn/below sacral spines
Treatment - Prone, apply anterior pressure on midline apex or base of sacrum to produce transverse axis rotation
PS5 (bilateral) - location and treatment
Location - 1/4 inch medial and superior to ILA b/lTreatment - Prone, apply anterior pressure diagonally opposite the TP (ex. PS5 TP on L = doc applies pressure to R sacral sulcus)
High Ilium (HI) - location and treatment
Location - Lateral aspect of PSIS
Treatment - Prone, monitor TP, extend hip and fine tune with abduction/adduction
High Ilium flare-out (HIFO) - location and treatment
Location - 1.75 in below and 1/4 inch medial to lower PSIS
Treatment - Prone, extend leg and induce adduction over opposite leg and slight ER
Piriformis - location and treatment
Location - 1/2 to 2/3 the distance from ILA to greater trochanter
Treatment - Prone, monitor TP, flex leg over side of table to 135º, abducting and externally rotating the hip
Flare-in sacroiliac (FISI) - location and treatment
Location - 4 inches below PSIS, slightly lateral
Treatment - Prone, abduct hip and flex just until knee is below the top edge of table, fine tune with external rotation
