Lumbar and Pelvic Counterstrain

Question 1

Location and tx position for AL1

Answer 1

Medial to ASIS

Pt supine, Dr on same side as TP w/ foot on table; flex knees/hips >90, knees and ankles pulled TOWARD Dr and the TP (F STRA)

Question 2

Location and tx position for AL2

Answer 2

Medial to AIIS

Pt supine; Dr opposite TP w/ foot on table. Flex knees/hips 90, knees and ankles AWAY from TP and toward Dr = (F SART)

NOTE: tx requires significant rotation of flexed hip away from TP side — Rot&raquo_space; SB

Question 3

Location and tx position for AL3-4

Answer 3

3: lateral to AIIS
4: inferior to AIIS

Pt supine; Dr opposite side of TP with foot on table; flex knees/hips to 90, pull knees and ankles AWAY from TP, towards Dr = (F SART)

Question 4

Location and tx position for AL5

Answer 4

Anterior aspect of pubic bone about 1 cm lateral to pubic symphysis (near pubic tubercle)

Pt supine; Dr same side of TP w/ foot on table; Flex hip 90-135, push ankles AWAY from TP and Dr, and rotate knees slightly toward the TP and Dr = (F SARA)

Question 5

Location and tx position for PL 1-5 SP

Answer 5

Midline on respective spinous process

Pt prone; Dr same side of TP (may stand opposite if more comfortable); extend pts hip ipsilateral to TP, fine tuning as necessary

Question 6

Location and tx position for PL 1-3 TP

Answer 6

On respective transverse processes (can be b/l)

Pt prone; Dr opposite side of TP (may stand same side if more comfortable); Dr extends pts ipsilateral hip to TP and rotates the pt’s leg toward the TP, fine tuning as necessary

Question 7

Location and tx position for UPL5

Answer 7

Superomedial border of PSIS

Pt prone; Dr opposite side of TP (may stand on same side if more comfortable); Dr extends pts ipsilateral hip to TP and externally rotates the pts leg, fine tuning as necessary

Question 8

Location and tx position for LPL5

Answer 8

Inferior aspect of PSIS

Pt prone with thigh on dysfunctional side suspended over side of table; Dr same side of TP; doc flexes hip and knee to 90, then adds adduction and IR of the hip

Question 9

Location and tx position for PL3 Lat (glut.medius)

Answer 9

2/3 of way between PSIS and TFL

Pt prone, dr same side of TP (can stand opposite); EXTEND ipisilateral hip

Question 10

Location and tx position for PL4 lat (glut med)

Answer 10

Posterior margin of TFL

Pt prone; Dr same side of TP. EXTEND ipsilateral hip (may be less extension than for PL3)

Question 11

Location and tx position for iliacus (IL)

Answer 11

In lower quadrant, 1-2 in medial to ASIS deep in iliac fossa (iliacus m.)

Pt supine; dr same side as TP w/ foot on table; flex knees/hips 90, pts ankles crossed on dr. knee with knees separated, marked ER of both hips = “frog legged”

Question 12

Location and tx position for low ilium (LI)

Answer 12

Lateral aspect of superior ramus, where psoas m. crosses pelvic rim

Pt supine; Dr same side of TP; flex hip/knee >90, slight ER hip, fine tune with AD/AB (only one leg)

Question 13

Location and tx position for inguinal ligament (Inlig)

Answer 13

Lateral surface of pubic bone near attachment of inguinal ligament

Pt supine, dr same side of TP w/ foot on table; flex hips/knees 90 and cross opposite ankle over leg on side fo dr, ankles toward Dr (IR hip on side of TP)

Question 14

Location and tx position for psoas major

Answer 14

2/3 distance from ASIS to midline, pressing deep

Pt supine; dr same side of TP w/ foot on table; markedly flex pts knees/hips and rest on dr knees. Pull feet and ankles TOWARD TP and Dr

Question 15

Location and tx position for HISI

Answer 15

Lateral aspect of PSIS

Pt prone, Dr same side, monitoring TP by pressing lateral to medial; extend hip and fine tune with ab/adduction

Question 16

Location and tx position for HIFO

Answer 16

Lateral aspect of ILA, associated with coccygeus m

Pt prone; Dr opposite side; extend on side of dysfunction and induce marked adduction and external rotation by pulling leg towards doc

Question 17

Location and tx position for piriformis

Answer 17

Halfway from sacral ILA to greater trochanter

Pt prone with dysfunctional side at edge of table; dr seated on same side, monitoring TP in piriformis muscle belly; flex hip to 135 off side of table, induce abduction and ER by lifting pts knee superolaterally

Question 18

Location and tx position for PS1 (bilateral)

Answer 18

Medial to inferior border of PSIS b/l (sacral sulci)

Pt prone; dr same side. Apply posterior to anterior pressure at location diagonally opposite the TP

Question 19

Location and tx position for PS 2-4

Answer 19

Midline on sacrum between sacral spines

Pt prone

If PS2 = anterior pressure on apex

If PS3 = anterior pressure wherever tenderness is reduced

If PS4 = anterior pressure on base

Question 20

Location and tx position for PS5 (b/l)

Answer 20

Superomedial ILA bilaterally

Pt prone; Dr standing on pts side. Apply posterior to anterior pressure at the location diagonally opposite the TP

Question 21

What should you do if there is more than one TP in a region of similar significance and intensity?

Answer 21

Treat the most proximal or midline TP first

Question 22

If you find both thoracic TP and rib TP, which one should you treat first?

Answer 22

Thoracic