LAB - Posterior C/T/L Spine Counterstrain

Question 1

What are the 7 steps to counterstain?

Answer 1

1. Find a significant tender point
2. Establish a tenderness scale
3. Monitor Tender Point Throughout (not pushing hard)
4. Place patient in “position of ease”
5. Hold 90 seconds
6. Slowly return to neutral
7. Recheck tenderness

Question 2

How are you going to deal with “finding a significant tender point”?

Answer 2

You examine all of the affected area to find the most significant tender point and treat that one first.

Question 3

Where is PC1 inion?

PC1 Occiput?

PC2 Occiput

Answer 3

midline of the superior nuchal line of the occiput. on the inferolateral aspect of that is the PC1 Inion tender point.

from PC1 inion and go out lateral to the mastoid process of the temporal bone. 2/3 away from PC1 inion to the mastoid is the PC1 tender point

PC2 Occiput is between PC1 inion and PC1 Occiput.

Question 4

PC2?

PC3?

PC4-8?

Answer 4

on the superior or superior lateral aspect/tip of the spinous process of C2. (above C2 spinous process)

PC3 is on the inferior tip or inferolateral aspect of the spinous process of C2.

PC4 is on 3, 5 is on 4, 6 is on 5, 7 is on 6, 8 is on 7 (inferior/inferolateral aspect)

Question 5

How are you going to start the treatment for every one of these?

Answer 5

You poke the tenderpoints and see which one is worse. establish your pain scale as that feeling right there is a 10 and we’re trying to get it down to a 3. then do the motions (90 seconds). bring back to neutral SLOWLY, reassess.

Question 6

PC1 inion (on either side), what motion are you going to do when palpating this region?

Answer 6

F St Ra

F STAR name: Flex, Sideband Towards, Rotate Away

Question 7

How are we treating PC1 Occiput and PC2 occiput?

Answer 7

E SaRa

You extend, sideband away, rotate away!

remember to lower the head of the table!

Question 8

How do you treat PC2

where do you find this?

Answer 8

E SaRa

superior/superolateral aspect of C2 spinous process

Question 9

How do you treat PC4-PC8

where do you find these?

Answer 9

e-E SaRa

the higher we are in the cervical spine, the less we’ll have to extend the neck, the lower.. the more extension

inferior/inferolateral aspect of C3-C7

Question 10

How do you treat PC3?

where do you find this?

Answer 10

f-F SaRA

inferior/Inferolateral aspect of C2.

Question 11

Wait a minute.. it says inferior or inferolateral but also to Extend and sidebend away and rotate away.. what do I do if the tender point is right in the middle?

Answer 11

you just extend…

Question 12

What are the thoracic points and where do you find them?

Answer 12

They are all midline, on the inferior aspect/tip of the spinous process!

there are 12.. one for each thoracic vertebra.

There are also 12 transverse process points (24 total).

Question 13

How do you treat thoracic spinous process 1-4? (set up wise)

Answer 13

they can be supine and you just extend their head off the table and feel it after you extend it.

Question 14

How do you treat thoracic spinous processes T4-T12?

Answer 14

You extend their head up from a prone position. you can put it on your hip or you can just extend them up until you fee motion.

use the table to pull it up to extend them (head side of the table for upper T4-T8, body side for T8-T12)

Question 15

How do you treat PT 1-3 TP?

what direction are they?

Answer 15

E SaRa

they are supine and you can have their head come off the table to treat T1-3 or you can just extend it yourself.

one hand on the head the other on the TP

Question 16

How do you treat PT 4-9 TP?

what should you probably do for T8 or T9?

Answer 16

E SaRT

They’re on their stomach

If it’s on the right side, put your arm under their right arm and touch the TP with that same arm bar.

the other arm you pull it down away to Sideband Away

pulling the arm bar arm towards the TP and up to induce an Extension and rotate toward (rotating right).

for the lower ones, you stand OPPOSITE of the TP and do the same thing but standing (better if you grab the shoulder)

Question 17

How do you treat P10-P12 TP?

Answer 17

e-E Sa (pelvis) Ra (Torso)

this one you are on the SAME side of the TP

so in this case, if it was the left side, you would be on the same side as the TP and reach across, grab the ASIS, rotate it away (to the right) and with that comes sidebending and extending too

Question 18

How do you treat the L1-L5 spinous process points? where are they?

(PL1-PL5)

Answer 18

spinous processes of each one

you just extend by lifting the leg side of the table up so their legs are in the air and their torso is flat on the table.

Question 19

What if it’s L1-L5 spinous processes on the inferolateral aspect??

Example: Right Inferolateral PL3

Answer 19

e-E Add RT (pelvis), RA (torso)

you’re using 1 leg for this one! You ADDUCT the leg and it does everything for you.

so you would be on the left side, tender point on the right side, lifting the right leg and Adducting it.

Question 20

What if it’s L1-L3 Transverse processes?

Answer 20

E Sa RT (pelvis) RA torso

you are OPPOSITE the TP, which is different than T10-T12 where you’re on the same side.

you lift the same side’s ASIS

Question 21

What’s the difference between the TP of lower thoracic 10-12 and the TP of L1-L3?

Answer 21

lower thoracic 10-12 you are on the same side of the TP and lifting the opposite side’s ASIS

upper lumbar 1-3 you are on the OPPOSITE side of the TP and lifting the ASIS of the SAME SIDE as the TP!

Question 22

Where do you find UPL5?

where do you find PLPL5?

High SI? (high ilium sacroiliac)

PL3 gluteus?

PL4 gluteus?

Answer 22

superior medial aspect of the PSIS

inferior aspect of the PSIS

from the PSIS go 2-3cm lateral.

2/3 lateral from PSIS to tensor fasciae latae is PL3

From High SI, and going lateral until you find the posterior border of the tensor fascia latae, that’s PL4

Question 23

How do you treat UPL5 (upper pole L5)

Answer 23

You stand at the opposite side of the tender point (you don’t have to be but it’s easier opposite side)

you lift the ipsilateral leg of the tender point.

you extend and ADDuct

if it loosens up, you’re goo.d. if it doesn’t, add some external or internal rotation and see if it loosens up then.

Question 24

How do you treat LPL5 (lower pole L5)

Answer 24

You flex their hip and knee off the table.

monitor that side and with your other hand F IR ADD –> internally rotate and ADDuct

Question 25

How do you treat HISI?

Answer 25

e-E ABD ER (a lot of ER)

you monitor, take the leg and extend, ABduct, and Externally rotate

Question 26

How do you treat PL3 and PL4 Gluteus

Answer 26

External, ABd, er (a little bit)