Lab 2: Counterstrain

Question 1

PC 1 Inion

Answer 1

Location: Inferior nuchal line, just lateral to inion

Procedure: Flex, Sidebend Toward, Rotate Away

Question 2

PC 1 Occiput

Answer 2

Location: On the inferior nuchal line, midway between inion and mastoid

Procedure: a little to a lot of Extension, Sidebend away, Rotate away

Question 3

PC 2 Occiput

Answer 3

Location: On the inferior nuchal line within the semispinalis capitis muscle associated with the greater occipital nerve

Procedure: a little to a lot of Extension, Sidebend away, Rotate away

Question 4

PC 2

Answer 4

Location: On the inferior tip or inferolateral aspect of the spinous process of C2

Procedure: a little to a lot of Extension, Sidebend away, Rotate away

Question 5

PC 1 Inion

Answer 5

Location: On the inferior tip or inferolateral aspect of the spinous process of C2

Procedure: a little to a lot of Flexion, Sidebend Away, Rotate Away

Question 6

PC 4-8

Answer 6

Location: On the inferior or inferolateral aspect (tip) of the spinous process.

• Ex: PC4 is inferior to the C3 spinous process,
• Ex: PC5 is inferior to the C4 spinous process of C4

Procedure: a little to a lot of Extension, Sidebend away, Rotate away

Question 7

PT 1-3 Spinous Process

Answer 7

Location: Midline, on the inferior aspect of the spinous process of the dysfunctional segment

Procedure: Extension

1. Patient supine.
2. 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.

Question 8

PT 4-6 Spinous Process

Answer 8

Location: Midline, on the inferior aspect of the spinous process of the dysfunctional segment

Procedure: Extension

1. Patient prone, with arms draped over side of table.
2. 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).

Question 9

PT 7-12 Spinous Process

Answer 9

Location: Midline, on the inferior aspect of the spinous process of the dysfunctional segment

Procedure: Extension

1. 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).
2. 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).

Question 10

PT 1-3 Transverse Process

Answer 10

Location: On the transverse process of each thoracic vertebra

Procedure: Extension, Sidebend Away, Rotate Away

1. Patient supine. Physician seated at head of table supporting patient’s head.
2. Use the neck as a lever to extend, sidebend away, and rotate away from the tenderpont.

Question 11

PT 4-9 Transverse Process

Answer 11

Location: On the transverse process of each thoracic vertebra

Procedure: Extension, Sidebend Away, Rotate Toward

• Patient prone with head rotated toward side of tender point.
• 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.

Question 12

PT 10-12 Transverse Process

Answer 12

Location: On the transverse process of each thoracic vertebra

Procedure: Extension, Sidebend Away, Rotate Away (torso)/Rotate Toward (pelvis)

1. Patient supine. Physician standing opposite side of patient.
2. The patient’s legs are positioned to the side which produces the greatest reduction of tenderness (sidebend away).
3. 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.
4. Pulling the ipsilateral ASIS inferiorly will induce sidebending away from the tenderpoint.

Question 13

PL 1-5 Spinous Process

Answer 13

Location: On the respective inferolateral aspect of the spinous processProcedure: Extension, Adduct, Rotate Away (torso)/Rotate Toward (pelvis)

1. Patient prone. Physician opposite side of patient.
2. 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.
3. The lower extremity is extended to induce extension in the lumbar spine. Adduction is added to induce lumbar sidebending away from the tenderpoint.

Question 14

PL 1-5 Transverse Process

Answer 14

Location: On the respective transverse process of the lumbar vertebrae

Procedure: Extension, Sidebend Away, Rotate Away (torso)/Rotate Toward (pelvis)

1. Patient prone. Physician opposite side of patient.
2. The physician contacts the ASIS on the same side as the tenderpoint.
3. 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).
4. Pushing the ipsilateral ASIS inferiorly will produce lumbar sidebending away from the tenderpoint.

Question 15

Upper Pole L5

Answer 15

Location: Superior medial surface of the posterior superior iliac spine (PSIS)

Procedure: Extension, Adduct, Internal/External Rotation

1. Patient prone. Physician opposite side of patient’s tender point.
2. The LE ipsilateral to the tenderpoint is extended and adducted.
3. Internal or external rotation are added to achieve the most reduction in patient tenderness.

Question 16

Lower Pole L5

Answer 16

Location: On the ilium just inferior to PSIS pressing superiorly

Procedure: Flexion, Internal Rotation, Adduct

1. Patient prone. Physician same side of patient’s tender point.
2. The patient lies as close to the edge of the table as possible.
3. The lower extremity ipsilateral to the tenderpoint is flexed off of the table, with knee and hip flexed to 90 degrees.
4. 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%.

Question 17

High Ilium Sacoiliac (HISI)

Answer 17

Location: 2–3 cm lateral to the PSIS pressing medially toward the PSIS

Procedure: Extension, Abduct, External Rotation

1. Patient prone. Physician same side of patient’s tender point.
2. Use the lower extremity that is ipsilateral to the tenderpoint.
3. Extend, abduct, and externally rotate the leg to achieve a reduction of at least 70% at the HISI tenderpoint.

Question 18

PL 3 and 4 Gluteus

Answer 18

Location:

• PL 3: 2⁄3 lateral from PSIS to tensor fasciae latae (upper outer portion of the gluteus medius at the level of the PSIS)
• PL 4: Posterior margin of tensor fasciae latae (upper outer portion of the gluteus medius at the level of the PSIS)

Procedure: Extension, Abduct, External Rotation

1. Patient prone. Physician same side of patient’s tender point.
2. 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.