Lab 1: Counterstrain: Posterior Cervical, Thoracic and Lumbar

Question 1

What are the 7 steps involved in Counterstrain?

Answer 1

1) Find a significant tender point
2) Establish a tenderness scale
3) Monitor tender point throughout
4) Place patient in “position of ease” (reduce pain by at least 70%)
5) Hold 90 secs
6) Slowly and passively return to neutral
7) Recheck tenderness

Question 2

Where is the midline PC1 and how do we treat?

Answer 2

• The Inion
• On inferior nuchal line, just lateral to inion
• F St Ra

Question 3

Where is the PC1 Occiput and how do we treat?

Answer 3

• On the inferior nuchal line midway between inion and mastoid
• E Sa Ra

Question 4

Where is the PC2 occiput and how do we treat?

Answer 4

• On the inferior nuchal line midway betwen inion and PC1
• E Sa Ra

Question 5

Where is the midline PC2 and how do we treat?

Answer 5

• Superior or superior lateral aspect/tip of the SP of C2
• e-E Sa Ra

Question 6

Where is the midline PC3 and how do we treat?

Answer 6

• On the inferior tip or inferolateral aspect of the SP of C2
• f-F Sa Ra

Question 7

Where is the midline PC4-8 and how do we treat?

Answer 7

• Inferior or inferolateral aspect (tip) of the SP’s
• e-E Sa Ra

*i.e., PC4 is inferior to the C3 SP; PC5 is inferior to the C4 SP, etc..

Question 8

Where is PC4, PC5, PC6, etc.. found? What muscles are PC4-8 associated with?

Answer 8

• PC4 is inferior to the C3 spinous process
• PC5 is inferior to the C4 spinous process
• PC6 is inferior to the C5 spinous process
• May be associated w/ semispinalis capitis, multifidus, or rotatores

Question 9

Where are the PT 1-12 for the midline?

Answer 9

Midline, on the inferior aspect/tip of the SP of the dysfunctional segment

Question 10

Where are the PT 1-12 for transverse processes?

Answer 10

• On the TP of each thoracic vertebra (medial to articulation w/ associated rib)

Question 11

How do we treat a PT 1-3 spinous process?

Answer 11

• Pt prone with arms draped over side of table
• Physican standing at head of table and cups pt’s chin w/ one hand, using the other hand to monitor the tender point
• e-E

Question 12

How do we treat a PT 4-6 spinous process?

Answer 12

• Pt prone with arms draped over side of table
• Physican standing at head of table and cups pt’s chin w/ one hand, using the other hand to monitor the tender point

- e-E

Question 13

How do we treat a PT 7-12 spinous process?

Answer 13

• Pt is prone with arms draped over top of table w/ physician’s knee under his/her chest (can also use a pillow) to further extend T-spine
• Physician standing at head of table and cups pt’s chin w/ one hand, using the other hand to monitor the tender
• e-E

Question 14

How do we treat a PT 1-3 transverse process?

Answer 14

• Pt is supine
• Physician seated at head of table supporting pt’s head

- E Sa Ra

Question 15

How do we treat a PT 4-9 transverse process; explain both options.

Answer 15

• Pt is prone w/ head rotated toward side of tender point
• E Sa RT

Option 1: Physician seat at head of table. Places forearm under the pt’s axilla on side of the tender point w/ the hand on the posterolateral chest wall. Physician’s forearm lifts pt’s shoulder to produce extension and rotation to the side of the tender point and side bends torso by adding more shoulder ABduction

Option 2: Physician stands at the side opposite the tender point. Pt’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. Pt’s shoulder is pulled posterior and cephalad, which produces extension and rotation toward and side bending away from the tender point

Question 16

How do we treat a PT 10-12 transverse process?

Answer 16

• Pt is prone w/ physician on either side of pt
• Pt’s legs are positioned to the side which produces greatest reduction in tenderness
• Sidebending component may vary depending on which myofascial structures involved.
• Physician grasps the ASIS on side opposite the tender point; leans back, gently lifting upward to induce extension and rotation of the pelvis (lower segment) away from the side of the tender point; and rotates the torso (upper segment) toward the side of the tender point
• If physician is on the SAME SIDE as TP, Ra (pelvis) Rt (torso)
• If physician is on the OPPOSITE SIDE of the TP, Rt (pelvis) Ra (torso)
• e-E Sa Rt (torso), Ra (pelvis)

Question 17

How do we treat a PL1-5 spinous process?

Answer 17

• Patient is prone
• Physician stands opposite the tender point and contacts the respective inferolatral aspect of the spinous process
• e-E Adduct RT (pelvis) RA (torso)

Question 18

How do we treat a PL1-3 transverse process?

Answer 18

• Pt is prone
• Physician stands opposite the tender point and contacts the respective TP
• E Sa RT (pelvis) RA torso

Question 19

How do we treat a Upper Pole L5 (UPL5)?

Answer 19

• Pt is prone
• Physician opposite to TP and contact superior medial surface of the PSIS.
• Lift dysfunctional leg: E Adduct IR/ER

Question 20

How do we treat a Lower Pole L5 (LPL5)?

Answer 20

• Pt is prone
• Physician on same side as TP contacting the ilium inferior to PSIS and pushing superomedially
• Drop dysfunctional leg off the table, flex hip and knee, push in to adduct, and add IR at the hip (F IR Adduct)

Question 21

How do we treat a High Ilium Sacroiliac (HISI)?

Answer 21

• Pt is prone
• Physician on same side as TP and contacting 2-3cm lateral to PSIS; pressing medially towards PSIS
• Lift dysfunctional leg, abduct, and let foot fall towards midline for ER (e-E Abduct ER)

Question 22

How do we treat PL3 Gluteus?

Answer 22

• Pt is prone
• Physician on same side as TP contacting 2/3 lateral from PSIS to tensor fasciae latae
• Lift dysfunctional leg, abduct, ER (E Abduct ER)

Question 23

How do we treat a PL4 gluteus?

Answer 23

• Pt is prone
• Physician on same side as TP contacting posterior margin of tensor fasciae latae/upper portion of gluteus medius at level of PSIS
• Lift dysfunctional leg, abduct, and ER (E Abduct ER)