Lab 1: Lumbar and Pelvic Counterstrain Flashcards
What are the 7 steps of counterstrain?
- Find significant TP
- Establish pain scale
- Monitor TP throughout tx
- Place pt in position to reduce pain at least 70%
- Maintain position for 90 sec
- Slowly return to neutral
- Recheck
Where is AL1 TP and position for tx?
- Medial to ASIS
- Pt supine w/ doc on same side of TP
- Flex hips/knees (F) to 90, supporting w/ doc’s leg on table
- Pull ankles (SB) and knees (Rot) toward doc = F ST RA
Where is AL2 TP and position for tx?
- Medial to AIIS
- Pt supine w/ doc on contralateral side
- Hip/knees flexed; ankles (SB) and knees (Rot) toward doc = F SA RT
- Rot >>> SB
Where is AL3 and 4 TP and position for tx?
- Lateral (3) and Inferior (4) to AIIIS
- Pt supine and doc contralateral w/ foot on table
- Flex knees/hips to 90; ankles (SB) and knees (Rot) toward doc, away from TP
- F SART
Where is AL5 TP and position for tx?
- Lateral to pubic symphysis
- Pt supine and doc ipsilateral w/ foot on table
- Flex hip to 135 and ankles (SB) away from TP
- Knees (Rot) slightly toward doc and TP = F SARA
Where are the PL1-PL5 spinous process TP’s located?
Inferolateral aspect of the SP’s
Where are the PL1-PL5 transverse process TP’s located?
On the TP of the respetive vertebra
What is the correct position to treat PL1-PL5 spinous process TP’s?
- Pt prone w/ doc on contralateral or ipsilateral side
- Extend hip, fine tune w/ SB as necessary
- E-e RT
What is the correct position to treat PL1-PL5 transverse process TP’s?
- Pt prone w/ doc on contralateral or ipsilateral side of TP
- Rotate hip by ASIS posterior force
- E Sa RT
Where is the UPL5 TP and correct position to tx?
- Superomedial PSIS
- Pt prone w/ doc contralateral to TP
- Extend hip ipsilateral to TP, ER hips toward TP
Where is the LPL5 TP and correct position to tx?
- Inferior aspect PSIS
- Pt prone w/ dysf. side over table and doc on side of TP
- Flex hip and knee to 90
- Add IR/ADduction of hip to fine tune
Where is the PL3 and PL4 gluteus TP’s and correct position to tx?
- PL3 = 2/3 of way btw PSIS/TFL
- PL4 = post. margin of TFL
- Pt prone w/ doc on side of TP
- Extend hip, fine tune with ABduction
Where is the Psoas Major TP and how do you tx?
- 2/3 distance from ASIS to midline, pressing deep toward belly Psoas
- Pt supine and doc on side of TP w/ foot on table
- Marked hip flexion and pull feet and ankles toward TP
Where is Iliacus (IL) TP and position for tx?
- LQ 1-2 in. medial ASIS, deep in iliac fossa
- Pt supine and doc on side of TP w/ foot on table
- Flex hips/knees to 90, crossing ankles over doc’s knee, inducing marked ER (“frog legs”)
Where is Low ilium (LI) TP and position for tx?
- Lateral aspect of superior pubic ramus, where psoas m. crosses pelvic brim
- Pt supine and doc on side of TP
- Flex hip and knee >90, slight ER hip, fine tune w/ AD/AB (only ONE leg)
Where is Inguinal Lig. TP and position for tx?
- Lateral surface of pubic bone (pubic tubercle)
- Pt supine and doc ipsilateral w/ foot on table
- Flex hips/knees to 90, rest on doc’s knee
- Cross c/l ankle over i/l leg, pull ankles toward doc (IR of dysf. hip)
Where is HISI TP and position for tx?
- Lateral aspect of PSIS
- Pt prone and doc on side of TP; pressing lateral to medial on TP
- Extend hip and fine tube w/ AB/ADduction
Where is HIFO TP and position for tx?
- Lateral aspect of ILA, associated w/ coccygeus m.
- Pt prone and doc opposite the TP
- Extend leg on dysf. side enough to clear opposite leg
- Induce marked ADduction/ER pulling leg toward doc
Where is Piriformis TP and position for tx?
- Half-way from ILA to greater trochanter in belly of m.
- Pt prone and doc on same side as TP
- Flex hip to 135 and ABduct/ER by lifting knee superolaterally
Where is PS1 (bilateral) TP and position for tx?
- Medial to PSIS (sacral sulci) bilaterally
- Pt prone and doc on side of TP
- Apply anterior pressure at location diagonally opposite TP
Where are the PS 2-4 TP’s and position for tx?
- Midline on sacrum, btw sacral spines
- Pt prone; apply anterior pressure on apex (if PS2) or base (if PS4)
- PS3 may vary so talk to pt
Where is PS5 (bilateral) TP and position for tx?
- Superomedial ILA bilaterally
- Pt prone and doc on side of TP
- Apply anterior pressure at location diagonally opposite the TP
What is a positive test for abdominal muscle TrPs/TPs using abdominal muscle tension test?
The pain increases
