Lab 2: Rib, Anterior Cervical/Thoracic Counterstrain

Question 1

AC1 Mandible

Answer 1

• Location: Posterior surface of ascending ramus of mandible
• Setup:
  
  • Patient: Supine
  • Doctor: Head of table - push posterior to anterior
• Sidebend Away, Rotate Away (SARA)

Question 2

AC1 TP

Answer 2

• Location: C1 transverse process midway between ramus of mandible and mastoid process
• Setup:
  
  • Patient: Supine
  • Doctor: Head of table - push lateral to medial
• Sidebend Away, Rotate Away (saRA)

Question 3

AC2-6

Answer 3

• Location: Anterior aspect of transverse processes of corresponding vertebrate
• Setup:
  
  • Patient: Supine
  • Doctor: Head of table
• Flex, Sidebend Away, Rotate Away (F SARA)

Question 4

AC7

Answer 4

• Location: Posterosuperior surface of proximal clavicle where SCM muscle inserts
• Setup:
  
  • Patient: Supine
  • Doctor: Head of table
• Flexed, Sidebend Towards, Rotate Away (F STRA)

Question 5

AC8

Answer 5

• Location: Clavicular insertion of SCM muscle, near sternal notch
• Setup:
  
  • Patient: Supine
  • Doctor: Head of table
• Flexed, Sidebend Away, Rotate Away (F SARA)

Question 6

AT1

Answer 6

• Location: Midline on suprasternal notch
• Setup:
  
  • Patient: supine
  • Doctor: Head of table
• Treatment:
  
  • Cervical and thoracic flexion to level of the TP
  • Doctor can place knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae. More flexion needed the lower the TP’s

Question 7

AT2

Answer 7

• Location: Midline on manubrium at sternal angle
• Setup:
  
  • Patient: supine
  • Doctor: Head of table
• Treatment:
  
  • Cervical and thoracic flexion to level of the TP
  • Doctor can place knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae. More flexion needed the lower the TP’s

Question 8

AT3-4

Answer 8

• Location: Midline at the level of costal cartilage related to named vertebra
• Setup:
  
  • Patient: supine
  • Doctor: Head of table
• Treatment:
  
  • Cervical and thoracic flexion to level of the TP
  • Doctor can place knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae. More flexion needed the lower the TP’s

Question 9

AT5

Answer 9

• Location: Midline at the level of costal cartilage related to named vertebra - 1 inch superior to xiphoid
• Setup:
  
  • Patient: supine
  • Doctor: Head of table
• Treatment:
  
  • Cervical and thoracic flexion to level of the TP
  • Doctor can place knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae. More flexion needed the lower the TP’s

Question 10

AT6

Answer 10

• Location: Midline at the level of costal cartilage related to named vertebra - at sternal-xiphoid junction
• Setup:
  
  • Patient: supine
  • Doctor: Head of table
• Treatment:
  
  • Cervical and thoracic flexion to level of the TP
  • Doctor can place knee under patient’s head/neck or trunk to use as a wedge to flex patient to involved vertebrae. More flexion needed the lower the TP’s

Question 11

AT7

Answer 11

• Location: Can be midline or lateral to midline ¼ distance from tip of xiphoid and umbilicus
• Setup:
  
  • Patient: seated
  • Doctor: standing behind patient, place foot on side opposite tender point (if lateral TP)
• Treatment: F STRA
  
  • Use leg to sidebend torso towards TP and rotate torso away

Question 12

AT8

Answer 12

• Location: Can be midline or lateral to midline halfway distance from tip of xiphoid and umbilicus - 1.5 inches inferior to xiphoid
• Setup:
  
  • Patient: seated
  • Doctor: standing behind patient, place foot on side opposite tender point (if lateral TP)
• Treatment: F STRA
  
  • Use leg to sidebend torso towards TP and rotate torso away

Question 13

AT9

Answer 13

• Location: Can be midline or lateral to midline ¾ distance from tip of xiphoid and umbilicus - 1-2 cm superior to umbilicus
• Setup:
  
  • Patient: seated
  • Doctor: standing behind patient, place foot on side opposite tender point (if lateral TP)
• Treatment: F STRA
  
  • Use leg to sidebend torso towards TP and rotate torso away

Question 14

AT10

Answer 14

• Location: Lateral to midline, ¼ distance from umbilicus to pubic symphysis (1-2 cm inferior to umbilicus)
• Setup:
  
  • Patient: supine
  • Doctor: standing on same side of TP
• Treatment: F STRA
  
  • ​Step 1: Flex patients hips and knees, and place them on physicians thigh, then flex further to desired level, flexion can be assisted w/ a pillow under pelvis or thorax
  • Step 2: Pull patients knees towards the doctor, causing the pelvis and lower segment to rotate toward the TP while the torso and upper segment rotate away.
  • Step 3: Pull patients ankles towards the doctor, which sidebends the dysfunctional segment toward the TP

Question 15

AT11

Answer 15

• Location: Lateral to midline, halfway between umbilicus and pubic symphysis (3-4 cm inferior to umbilicus)
• Setup:
  
  • Patient: supine
  • Doctor: standing on same side of TP
• Treatment: F STRA
  
  • ​​Step 1: Flex patients hips and knees, and place them on physicians thigh, then flex further to desired level, flexion can be assisted w/ a pillow under pelvis or thorax
  • Step 2: Pull patients knees towards the doctor, causing the pelvis and lower segment to rotate toward the TP while the torso and upper segment rotate away.
  • Step 3: Pull patients ankles towards the doctor, which sidebends the dysfunctional segment toward the TP

Question 16

AT12

Answer 16

• Location: Lateral to midline, mid-axillary line on superoanterior surface of iliac crest
• Setup:
  
  • Patient: supine
  • Doctor: standing on same side of TP
• Treatment: F STRA
  
  • ​​Step 1: Flex patients hips and knees, and place them on physicians thigh, then flex further to desired level, flexion can be assisted w/ a pillow under pelvis or thorax
  • Step 2: Pull patients knees towards the doctor, causing the pelvis and lower segment to rotate toward the TP while the torso and upper segment rotate away.
  • Step 3: Pull patients ankles towards the doctor, which sidebends the dysfunctional segment toward the TP

Question 17

AR1

Answer 17

• Location: Inferior clavicle on rib 1, lateral to manubrium (directly inferior to SC joint)
• Setup:
  
  • Patient: supine
  • Doctor: head of table
• Treatment: F STRT
  
  • Treat depressed rib, inhalation restriction —> Exhalation SD

Question 18

AR2

Answer 18

• Location: 1.5 in. lateral to manubrium on rib 2, below mid-clavicular line; may also be found deep in axilla
• Setup:
  
  • Patient: supine
  • Doctor: head of table
• Treatment: F STRT
  
  • ​Treat depressed rib, inhalation restriction —> Exhalation SD

Question 19

AR3-6

Answer 19

• Location: Anterior axillary line on ribs 3-6 (slightly anterior to mid-axillary line)
• Setup:
  
  • Patient: seated
  • Doctor: behind patient, knee under arm on unaffecte side
• Treatment: F STRT
  
  • ​Treat depressed rib, inhalation restriction —> Exhalation SD

Question 20

PR 1

Answer 20

• Location: Posterior margin of rib head beneath margin of trapezius
• Setup:
  
  • Patient: supine/seated
  • Doctor: standing behind/to the side
• Treatment: E SRT
  
  • ​​Treat elevated rib, exhalation restriction —> Inhalation SD
  • Slight extension of head, sidebending to fine tune

Question 21

PR 2

Answer 21

• Location: Superior surface of angles of ribs, at medial border of scapula, about 2.5 inches lateral to midline
• Setup:
  
  • Patient: Seated
  • Doctor: Standing behind/to the side. Doctor places patient’s arm on side of dysfunction on doctor’s knee.
• Treatment: F SARA
  
  • ​​Treat elevated rib, exhalation restriction —> Inhalation SD
  • Flex trunk and head

Question 22

PR 3-6

Answer 22

• Setup:
  
  • Patient: Seated
  • Doctor: Standing behind/to the side. Doctor places patient’s arm on side of dysfunction on knee, grasps patient’s shoulder.
• Treatment: F SARA
  
  • ​​Treat elevated rib, exhalation restriction —> Inhalation SD​
  • Flex trunk and head