Review: Lumbar and Pelvic Counterstrain Flashcards
Location and tx position for AL1
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)
Location and tx position for AL2
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»_space; SB
Location and tx position for AL3-4
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)
Location and tx position for AL5
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)
Location and tx position for PL 1-5 SP
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
Location and tx position for PL 1-3 TP
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
Location and tx position for UPL5
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
Location and tx position for LPL5
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
Location and tx position for PL3 Lat (glut.medius)
2/3 of way between PSIS and TFL
Pt prone, dr same side of TP (can stand opposite); EXTEND ipisilateral hip
Location and tx position for PL4 lat (glut med)
Posterior margin of TFL
Pt prone; Dr same side of TP. EXTEND ipsilateral hip (may be less extension than for PL3)
Location and tx position for iliacus (IL)
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”
Location and tx position for low ilium (LI)
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)
Location and tx position for inguinal ligament (Inlig)
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)
Location and tx position for psoas major
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
Location and tx position for HISI
Lateral aspect of PSIS
Pt prone, Dr same side, monitoring TP by pressing lateral to medial; extend hip and fine tune with ab/adduction
Location and tx position for HIFO
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
Location and tx position for piriformis
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
Location and tx position for PS1 (bilateral)
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
Location and tx position for PS 2-4
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
Location and tx position for PS5 (b/l)
Superomedial ILA bilaterally
Pt prone; Dr standing on pts side. Apply posterior to anterior pressure at the location diagonally opposite the TP
What should you do if there is more than one TP in a region of similar significance and intensity?
Treat the most proximal or midline TP first
If you find both thoracic TP and rib TP, which one should you treat first?
Thoracic
