(CPA) Upper and LE Counterstrain Flashcards
Counterstrain steps
1) structural exam to locate SD
2) find significant tenderpt
3) establish pain/tenderness scale
4) shorten the local tissues while monitoring
5) reduce pain by at least 70%
6) maintain position for 90 seconds
7) passively return to neutral
8) recheck/reassess (tenderness, asymmetry, ROM)`
tensor fascia latae tender point
Location: inferior to the crest of the ilium in the body of the tensor fascia latae muscle
Treatment position: abduction of the hip/thigh, slight flexion
fABD
lateral trochanter iliotibial band tender point
location: along the iliotibial band distal to the greater trochanter
treatment position: moderate abduction of the hip/thigh, slight flexion
fABD
lateral hamstring, biceps femoris tender point
location: in posterior thigh lateral to the midline approximately halfway down the shaft of the femur
Treatment position: flexion of the knee with external rotation and slight abduction of the tibia and plantar flexion of the ankle by compression of the calcaneus
F ER Abd
lateral meniscus, lateral collateral ligament
location: lateral aspect of meniscus on the joint line
Treatment: moderate knee flexion, slight abduction, internal or external rotation of the tibia. may require ankle dorsiflexion and eversion
F Abd ir/er
medial hamstring, semimembranosus, semitendinosus
location: in posterior thigh medial to the midline, approximately halfway down the shaft of the femur
Treatment: flexion of the knee with internal rotation and slight adduction of the tibia and plantar flexion of the ankle by compression of the calcaneus
F IR Add
medial meniscus, medial collateral ligament
location: anteromedial aspect of the meniscus on the joint line
Treatment: moderate knee flexion, internal rotation, and slight adduction of the tibia
F IR Add
anterior cruciate
location: superior aspect of the popliteal fossa on the hamstring tendons, either medially or laterally
Treatment: place pillow under the distal femur to create a fulcrum. Apply a shearing force by moving the proximal tibia posteriorly on the femur
posterior cruciate
location: in the center or slightly below the center of the popliteal fossa
Treatment: place pillow under the distal femur to create a fulcrum. Apply a shearing force by moving the distal femur posteriorly on the proximal tibia
popliteus
location:in the belly of the popliteus muscle just inferior to the popliteal space
Treatment: slight flexion of the knee with internal rotation of the tibia
F IR
extension ankle gastrocnemius
location: within the proximal gastrocnemius muscles, distal to the popliteal margin
Treatment: marked plantar flexion of the ankle with knee flexion
medial ankle, tibialis anterior
location: inferior to the medial malleolus along the deltoid ligament
Treatment: place a fulcrum on the medial aspect of the ankle. apply an inversion force with slight shear/internal rotation of foot.
INV ir
lateral ankle fibularis/peroneus longus, brevis, tertius
location: inferior and anterior to the lateral malleolus in the sinus tarsi
Treatment: place fulcrum on the lateral aspect of the ankle. Apply an eversion force with slight shear/external rotation of foot
EV er
flexion calcaneus, quadratus plantae
location: anterior aspect of the calcaneus on the plantar surface of the foot at the attachment of the plantar fascia
Treatment: marked flexion of the forefoot approximating the forefoot to the calcaneus
F
supraspinatus
location: in belly of supraspinatus muscle
Treatment: flexion of shoulder, abduction, with marked external rotation
F Abd ER
upper infraspinatus
location: inferior and lateral to the spine of the scapula at the posterior medial aspect of the glenohumeral joint
Treatment: flexion of the shoulder to 90-120 degrees and abduction; may require external rotation of internal rotation
F Abd er/ir
rhomboid major/minor
location: along the medial border of the scapula at the attachment of the rhomboid muscles
Treatment: patient seated or prone: shoulder extension with adduction by pulling arm posterior and medial
E Add
levator scapulae
location: on the superior medial border of the scapula at the attachment of the levator scapula
Treatment: glide the scapula superiorly and medially to shorten the muscle. May alternatively be treated by marked internal rotation of the shoulder with traction and slight abduction
Scap sup/med IR Abd/traction
subscapularis
location: at the anterolateral border of the scapula on the subscapularis muscle pressing from an anterior lateral to posteromedial direction
Treatment: shoulder extension and internal rotation
E IR
long head of biceps
location: over the tendon of the biceps muscle in the bicipital groove
Treatment: flexion of elbow, shoulder flexion, abduction, internal rotation
F abd ir
short head of biceps/coracobrachialis
location: at the inferolateral aspect of the coracoid process
Treatment: flexion of elbow, shoulder flexion, adduction, and internal rotation
F Add ir
pectoralis minor
location: inferior and medial to coracoid process
Treatment: adduction of the arm, protract scapula (medial and caudad)
f-F Add
radial head lateral (supinator)
location: on the anterolateral aspect of the radial head at the attachment of the supinator
Treatment: elbow in full extension, forearm in marked supination, slight valgus force
E SUP Val
medial epicondyle (pronator teres)
location: on the medial epicondyle of the humerus at the common flexor tendon and the attachment of the pronator teres
Treatment: flexion, marked pronation, slight adduction of the forearm with slight flexion of the wrist
F Pro Add
dorsal wrist (second metacarpal)
location: on the dorsal surface of the second metacarpal in the extensor carpi radialis muscle
Treatment: wrist extension, slight abduction
E abd
palmar wrist (second or third metacarpal), flexor carpi radialis
location: at the palmar base of the second or third metacarpal in the flexor carpi radialis muscle
Treatment: wrist flexion, with slight abduction
F Abd
first carpometacarpal (abductor pollicis brevis)
location: at palmar base (radial aspect) of first metacarpal in the abductor pollicis brevis muscle
Treatment: wrist flexion, with slight abduction
F (wrist) Abd (thumb)
lower infraspinatus
location: in lower portion of the muscle inferior to the spine and lateral to the medial border of the scapula
Treatment: flexion of shoulder to 135 degrees with slight abduction and external rotation or internal rotation
F abd er/ir
dorsal wrist, extensor carpi ulnaris
location: on dorsal surface of the fifth metacarpal in the extensor carpi ulnaris muscle
Treatment: wrist extension, with slight adduction
E Add
palmar wrist (fifth metacarpal), flexor carpi ulnaris
location: at the palmar base of the fifth metacarpal in the flexor carpi ulnaris muscle
Treatment: wrist flexion, with slight adduction
F Add
Navicular
Treatment: patient’s knee is flexed, dorsum of foot on docs thigh, plantar flexion of subtalar joint, supination of forefoot until the tenderness is >70% reduction
F Sup
