CPA 1.2: LAB Counterstrain Flashcards
PC1 Inion Tender point
***On the inferior nuchal line, just lateral to the inion
Treatment Position
For all: Patient is supine with physician seated at head of the table
– Can flex the head by inducing cephalad traction on the occiput while inducing caudad motion on anterior aspect of the head
F ST RA
PC1 Occiput tender point
***On the inferior nuchal line midway between inion and mastoid. Associated with the splenius capitis and/or the rectus capitis posterior major/minor and obliquus capitis superior muscles.
Physician at head of table
e-E SA RA
PC2 Occiput tender point
***On the superior or superior lateral aspect/tip of the spinous process of C2. May correlate with rectus capitis posterior major/minor and obliquus capitis inferior muscles.
Physician at head of table
e-E SA RA
PC3 tender point
***On the inferior tip or inferolateral aspect of the spinous process of C2. Anatomically may correlate with irritation of the greater and/or third occipital nerve and/or muscles innervated by the C3 nerve root (i.e., middle scalene, longus capitis, longus colli)
doctor at head of table
f-F SA RA
This is a maverick point because we’re flexing the C-spine during treatment rather than extending, as we did on all the other spinous process posterior TPs
PC4-8 Tender point (PTTP)
***On the inferior or inferolateral aspect (tip) of the spinous process. (e.g. PC4 is inferior to the C3 spinous process, PC5 is inferior to the C4 spinous process of C4, etc). May correlate with semispinalis capitis, multifidus, or rotatores.
e-E SA RA
PT 1-3 Spinous processes tender point
***Midline, on the inferior aspect/tip of the spinous process of the dysfunctional segment
Patient supine. Physician standing/seated at head of table and gently extends the patient’s head off of the table. The table levers can also be used to adjust the amount of extension.
e-E
PT 4-6 spinous process tenderness
***Midline, on the inferior aspect/tip of the spinous process of the dysfunctional segment
Patient prone, with arms draped over side of table (left image). Physician standing at head of table and cups patient’s chin with one hand, using the other hand to monitor the tender point. Alternatively, the table levers can be used to extend the thoracic spine, with the patient lying prone (right image).
Pt7-12 Spinous process tender points
***Midline, on the inferior aspect/tip of the spinous process of the dysfunctional segment
Patient prone, with arms draped over top of table with physician’s knee under his/her chest (can also use a pillow) to further extend the thoracic spine (left image). Physician standing at head of table and cups patient’s chin with one hand, using the other hand to monitor the tender point. Alternatively, the table levers can be used to extend the thoracic spine, with the patient lying prone (R image).
e-E
PT1-3 transverse process
***On the transverse process of each thoracic vertebra (medial to articulation with associated rib). Associated with longissimus thoracis, levatores costarum, semispinalus, multifidus, or rotatores.
Patient supine. Physician seated at head of table supporting patient’s head.
Use the neck as a lever to extend, sidebend away, and rotate away from the tenderpont.
E SA RA
PT4-9 Transverse process
***On the transverse process of each thoracic vertebra (medial to articulation with associated rib). Associated with longissimus thoracis, levatores costarum, semispinalus, multifidus, or rotatores.
Patient prone with head rotated toward side of tender point.
E SA RT
Option 1: Physician seated at head of table. The physician’s forearm is placed under the patient’s axilla on the side of the tender point with the hand on the posterolateral chest wall. The physician’s forearm lifts patient’s shoulder to produce extension and rotation to the side of the tender point and side bends the torso by adding more shoulder abduction
Option 2: physician stands at the side opposite the tender point. The patient’s torso may be side bent away and the arm on the side of the tender point abducted to produce even more side bending away. The patient’s left shoulder is pulled posterior and cephalad, which produces extension and rotation toward and side bending away from the side of the tender point
Option 3: Can use physician’s knee under the side of the tenderpoint to help position into E SaRT.
PT10-12 Transverse process tender points
***On the transverse process of each thoracic vertebra (medial to articulation with associated rib).
Patient prone. Physician standing on opposite side of the patient (left image).
e-E SA RA
(LEFT photo): The patient’s legs are positioned to the side which produces the greatest reduction of tenderness (sidebend away). The physician grasps the ASIS on the same side of the tender point, leans back, and gently lifts upward to induce extension and rotation of the pelvis (lower segment) towards the side of the tender point; and rotates the torso (upper segment) away from the side of the tender point. Pulling the ipsilateral ASIS inferiorly will induce sidebending away from the tenderpoint.
(RIGHT photo): The physician can use their knee as a lever to position the patient.
PL1-5 Spinous process Tender points
***On the respective inferolateral aspect of the spinous process
Physician stands opposite the tender point, patient is prone.
e-E Adduct RT (pelvis) RA (torso)
The patient’s ipsilateral lower extremity is externally rotated, which aids in rotating the pelvis towards the tenderpoint and rotates the torso away from the tenderpoint. The lower extremity is extended to induce extension in the lumbar spine. Adduction is added to induce lumbar sidebending away from the tenderpoint. Alternatively, doctor can use their knee to position pt (right img).
PL1-5 Transverse process
***On the respective transverse process
Physician stands opposite the tender point, patient is prone.
E SA RT(pelvis) RA (torso)
The physician contacts the ASIS on the same side as the tenderpoint. The ipsilateral ASIS is pulled posteriorly to produce lumbar extension and rotation of the torso away from the tenderpoint (and rotation of the pelvis towards the tenderpoint). Pushing the ipsilateral ASIS inferiorly will produce lumbar sidebending away from the tenderpoint.
Upper pole L5 (UPL5)
***Superior medial surface of the posterior superior iliac spine (PSIS)
Physician stands opposite the tender point (left image).
E adduct ir/er
The LE ipsilateral to the tenderpoint is extended and adducted. Internal or external rotation are added to achieve the most reduction in patient tenderness. Alternatively, physician stands on same side and uses knee as a lever to position the patient into E Add ir/er.
Lower Pole L5 (LPL5)
***On the ilium just inferior to PSIS pressing superiorly
Doctor at side of table with patient prone.
F IR adduct
The patient lies as close to the edge of the table as possible. The lower extremity ipsilateral to the tenderpoint is flexed off of the table, with knee and hip flexed to 90 degrees. Using the physician’s leg or knee, internally rotate and adduct the lower extremity to reduce the tenderness at the tenderpoint by at least 70%.
High Ilium Sacroiliac (HISI)
***2–3 cm lateral to the PSIS pressing medially toward the PSIS
Patient prone with doctor standing on the same side as the tenderpoint (left image).
e-E Abduct ER
Use the lower extremity that is ipsilateral to the tenderpoint. Extend, abduct, and externally rotate the leg to achieve a reduction of at least 70% at the HISI tenderpoint. Alternatively (R image), stand on ipsilateral side using doctor’s knee to lever the patient to eE Abd ER
PL3 Gluteus
***2⁄3 lateral from PSIS to tensor fasciae latae (upper outer portion of the gluteus medius at the level of the PSIS)
Physician standing on the same side as the tenderpoint, with patient prone.
E Abduct ER
Use the lower extremity ipsilateral to the tenderpoint. Extend the leg, abduct, and externally rotate to achieve a reduction of at least 70% at the tenderpoint.
PL4 Gluteus
***Posterior margin of tensor fasciae latae (upper outer portion of the gluteus medius at the level of the PSIS)
Physician standing on the same side as the tenderpoint, with patient prone.
E Abduct ER
Use the lower extremity ipsilateral to the tenderpoint. Extend the leg, abduct, and externally rotate to achieve a reduction of at least 70% at the tenderpoint.
What is the treatment position for a PTSP (posterior spinous process)
Upper:
Lower:
Treatment for All PTSP: e-E
– Upper PTSP (PT1-PT4):Extend off table
– Lower PTSP: Use doctor’s knee or use the table lifts to increase extension
