Lumbar & Pelvis COUNTERSTRAIN

Question 1

Where are the anterior lumbar points?

Answer 1

AL1- medial ASIS
AL2- medial AIIS
AL3- lateral AIIS
AL4- inferior AIIS
AL5- anterior aspect of pubic bone (lateral to pubic symphysis)

Question 2

How do you treat an AL1?

Answer 2

• pt supine doc on same side as TP w/foot on table
• flex pts hip/knees to 90 and ankle and knees pulled to doc

F STRT

Question 3

How would you treat AL2?

Answer 3

• pt supine doc OPPOSITE side of TP with foot on table
• flex hip/knees to 90 and knees and ankles away from TP toward doc

F SARA

Question 4

How would you treat AL3-4?

Answer 4

• pt supine doc on SAME side as TP with foot on table
• flex knees/hips to 90 ankles away and knees toward TP and doc

Ankles= induce SB, Knees= induce rotation

F SART

Question 5

How would you treat AL5?

Answer 5

• pt supine, doc on SAME side of TP with foot on table
• flex hip to 90-130, push ankle away and knee toward TP/doc

*more central point so minor R/SBing

F SART

Question 6

Where are the posterior lumbar points?

Answer 6

PL 1-5 SP - midline on respective SP
PL 1-3 TP - bilateral on TP
UPL5 - superomedial PSIS
LPL5 - inferior PSIS 
PL3 lat - 2/3 way between PSIS and tensor fascia lata (TFL)
PL4 lat - posterior margin of TFL

Question 7

How would you treat PL 1-5 SP midline TP?

Answer 7

• pt prone doc on same side or opposite side
• extend pts hip ipsilateral to TP
• fine tune as needed

Question 8

How would you treat PL 1-3 TP OR UPL5?

Answer 8

• pt prone doc opposite or same side
• extend pts ipsilateral hip to TP and rotate leg toward TP
• fine tuning as needed

*same as UPL5 only difference is where hand monitoring TP

Question 9

How would you treat LPL5 TP?

Answer 9

• pt prone with thigh of dysfunction over side of the table
• doc on same side
• flex hip/knee to 90 then ADDUCT and IR the hip (push knee toward table)

Question 10

How would you treat PL3 lat and PL4 lat TP?

Answer 10

• pt prone doc on same or opposite side TP
• extend pts ipsilateral hip
• fine tune as needed (by ABDUCTING)

PL4 may need less extension than for PL3

Question 11

Where are the anterior pelvis points?

Answer 11

IL (iliacus) - 1-2 in medial to ASIS in iliac fossa (near AL1)
LI (low ilium) - lateral aspect of superior ramus where psoas crosses pelvic rim
Inlig (inguinal lig) - lateral surface of pubic bone near attachment of lig

Question 12

How do you treat IL (iliacus) TP?

Answer 12

• pt supine doc on same side as TP with foot on table
• flex knees/hips to 90 and CROSS ANKLES on docs knee to separate pts knees
• marked ER of both hips
• *frog legged**

Question 13

How do you treat a LI (low ilium) TP?

Answer 13

• pt supine doc on same side as TP
• flex hip/knee to 90
• slight ER hip and fine tune with Ab/Adduction (only 1 leg)

Question 14

How do you treat an inguinal lig TP?

Answer 14

• pt supine doc on same side as TP with foot on table
• flex hip/knee to 90 and rest on doc knee
• cross opposite ankle over leg on Side of doc
• ankle toward doc IR hip on side of TP

Question 15

Where are the sacrum TPs?

Answer 15

• PS 1 - bilateral on sacral sulci
• PS 2-4 - midline sacrum between sacral spines
• PS 5 - bilateral superomedial to ILA

Question 16

Where are the posterior pelvic TPs?

Answer 16

• HISI (high ilium sacroiliac) - lateral PSIS
• HIFO (high ilium flare out) - 2 inch inferior/medial to PSIS (near coccygeus m)
• piriformis - half way from ILA to greater trochanter (middle butt)
• FISI (flare in sacroiliac) - 4 inch below PSIS (near glut max attachment)

Question 17

How do you treat a high ilium sacroiliac TP?

Answer 17

• pt prone doc on same side monitoring TP
• press lateral to medial
• extend pts hip on side of TP and fine tune with ab/adduction

Question 18

How do you treat a HIFO (high ilium flare out) TP?

Answer 18

• pt prone doc on OPPOSITE side
• extend leg on side of TP
• induce ADDUCTION and ER by pulling leg toward doc

Question 19

How do you treat a piriformis TP?

Answer 19

• pt prone with dysfunctional side at edge of table
• doc seated on same side monitoring TP in piriformis muscle belly
• flex pts hip to 135 off table
• induce ABDUCTION and ER by lifting pts knee superolaterally

Question 20

How would you treat a FISI (flare in sacroiliac) TP?

Answer 20

• pt prone doc on same side
• ABDUCT hip and flex enough to allow knee to clear table
• fine tune with ER

Question 21

How would you treat PS 1 or PS 5 TP?

Answer 21

• pt prone doc on same side
• apply posterior pressure at location diagonally opposite to TP

Ex) PS1 on left, apply pressure at R ILA
Ex) PS5 on left, apply pressure at R Sacral sulcus

Question 22

How would you treat PS3-4 TP?

Answer 22

• pt prone doc on side or pt
• apply posterior pressure on APEX (PS2) or BASE (PS4)
• produced transverse axis rotation
• PS3 varies where force is applied

Question 23

IMPORTANT NOTES on TP TREATMENT:

Answer 23

• keep finger in place (dont push) just monitor
• treat most severe and midline TP first
• if thoracic and rib TP treat thoracic first
• must bring pt SLOWLY and PASSIVELY back to neutral for greatest effectiveness
• *midline TP rotation and SB occur in relation to dysfunction
• *treatment for MAVERICK points calls for lengthening of pt tissues around TP rather than shortening/wrapping around them