LAB - Posterior C/T/L Spine Counterstrain Flashcards
What are the 7 steps to counterstain?
- Find a significant tender point
- Establish a tenderness scale
- Monitor Tender Point Throughout (not pushing hard)
- Place patient in “position of ease”
- Hold 90 seconds
- Slowly return to neutral
- Recheck tenderness
How are you going to deal with “finding a significant tender point”?
You examine all of the affected area to find the most significant tender point and treat that one first.
Where is PC1 inion?
PC1 Occiput?
PC2 Occiput
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.
PC2?
PC3?
PC4-8?
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)
How are you going to start the treatment for every one of these?
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.
PC1 inion (on either side), what motion are you going to do when palpating this region?
F St Ra
F STAR name: Flex, Sideband Towards, Rotate Away
How are we treating PC1 Occiput and PC2 occiput?
E SaRa
You extend, sideband away, rotate away!
remember to lower the head of the table!
How do you treat PC2
where do you find this?
E SaRa
superior/superolateral aspect of C2 spinous process
How do you treat PC4-PC8
where do you find these?
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
How do you treat PC3?
where do you find this?
f-F SaRA
inferior/Inferolateral aspect of C2.
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?
you just extend…
What are the thoracic points and where do you find them?
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).
How do you treat thoracic spinous process 1-4? (set up wise)
they can be supine and you just extend their head off the table and feel it after you extend it.
How do you treat thoracic spinous processes T4-T12?
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)
How do you treat PT 1-3 TP?
what direction are they?
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
How do you treat PT 4-9 TP?
what should you probably do for T8 or T9?
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)
How do you treat P10-P12 TP?
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
How do you treat the L1-L5 spinous process points? where are they?
(PL1-PL5)
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.
What if it’s L1-L5 spinous processes on the inferolateral aspect??
Example: Right Inferolateral PL3
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.
What if it’s L1-L3 Transverse processes?
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
What’s the difference between the TP of lower thoracic 10-12 and the TP of L1-L3?
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!
Where do you find UPL5?
where do you find PLPL5?
High SI? (high ilium sacroiliac)
PL3 gluteus?
PL4 gluteus?
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
How do you treat UPL5 (upper pole L5)
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.
How do you treat LPL5 (lower pole L5)
You flex their hip and knee off the table.
monitor that side and with your other hand F IR ADD –> internally rotate and ADDuct
How do you treat HISI?
e-E ABD ER (a lot of ER)
you monitor, take the leg and extend, ABduct, and Externally rotate
How do you treat PL3 and PL4 Gluteus
External, ABd, er (a little bit)
