Rib, Anterior Cervical, Anterior Thoracic Counterstrain

Question 1

counterstrain steps

Answer 1

1. Structural exam to locate somatic dysfunction
2. Find a significant tender point
3. Establish pain/tenderness scale
4. Wrap the patient around the tender point while monitoring
5. Reduce pain by at least 70% (ptin position of comfort)
6. Maintain position for 90 seconds
7. Passively return to neutral
8. Recheck/reassess

Question 2

if you have similar tenderness points, which do you treat first?

Answer 2

treat most central/and or proximal

if thoracic and rib TP, treat thoracic 1st

Question 3

What tender point is and where should you press down:

Posterior surface of ramus of mandible

Answer 3

AC1 mandible

push posterior to anterior

Question 4

What tender point is and What tender point is and where should you press down:

Midway between ramus and mastoid process on the transverse process of C1

Answer 4

AC 1 TP

push lateral to medial (Rennie)

Question 5

What tender point is:

Anterior surface of transverse processes

Answer 5

AC 2-6

Question 6

What tender point is and where should you press down:

2cm lateral to the medial end of the clavicle

Answer 6

AC 7

clavicular head of SCM

Question 7

What tender point is and where should you press down:

Medial end of clavicle

Answer 7

AC 8

sternal head of SCM at sternal notch

Question 8

AC1 TP and mandible are put in to what tx positions?

Answer 8

cervical SaRa

Question 9

AC 2-6 are put in to what tx positions?

Answer 9

Cervical FSaRa

Question 10

AC7 is put in to what tx positions?

Answer 10

cervical FStRa

Question 11

AC8 is put in to what tx positions?

Answer 11

cervical FSaRa

Question 12

an anterior rib tenderpoint indicates what?

Answer 12

DEPRESSED ribs

ribs depress w exhalation

Question 13

an posterior rib tenderpoint indicates what?

Answer 13

ELEVATED ribs

ribs elevate w inhalation

Question 14

Anterior Ribs are put in to what tx positions?

Answer 14

FStRt

AR 1-2: supine

AR 3-10: use your knee opposite to the tender point, and prop his arm up on your knee

Question 15

What tender point is:

below clavicle on rib 1, lateral to maubrium

Answer 15

AR 1

Question 16

What tender point is:

superior aspect of the rib, midclavicular line

Answer 16

AR 2

Question 17

What tender point is:

anterior axillary line on 3-6th ribs

Answer 17

AR 3-6

Question 18

when are ribs more prominent? less prominent?

Answer 18

less when elevated

more when depressed

Question 19

What tender point is:

On PosteroSuperior aspect of Rib 1 just lateral to the costotransverse articulation

Answer 19

PR 1

Question 20

What tender point is:

On the PosteroSuperior angle of the corresponding rib at medial border of scapula, about 2 1/2 inches lateral to midline

Answer 20

PR 2-10

Question 21

tx for PR 1-10?

Answer 21

Rib 1 E SART*** Maverick
pt is supine

Ribs 2-10 F SARA
pt is sitting

Question 22

What tender point is:

suprasternal notch

Answer 22

AT1

Question 23

What tender point is:

angle of the manubrium (Louis)

Answer 23

AT2

Question 24

What tender point is:

on the sternum at the same numbered costal level.

Answer 24

AT3-6

Question 25

TX position for anterior T1-6

Answer 25

cervical and thoracic flexion to level of TP AT1-2: supine AT3-6: seated, with arms holding the edge of the table in the back

Question 26

TX position for anterior T7-12?

Answer 26

F StRa AT7-9: seated, using opposite knee to St, flexion with head, rotate away AT10-12: stand on ipsi side, bring knees toward which rotates away to return to neutral, he takes a deep breath while he does that flex his knees and bring them back down

Question 27

What tender point is: | inferior tip of xiphoid and/or 1/4 distance from tip of xiphoid and umbilicus

Answer 27

AT7

Question 28

What tender point is: | halfway between tip of xiphoid and umbilicus

Answer 28

AT8

Question 29

What tender point is: | 3/4 distance from tip of xiphoid and umbilicus

Answer 29

AT9

Question 30

What tender point is: | 1/4 distance from the umbilicus to the pubic symphysis

Answer 30

AT10

Question 31

What tender point is: | halfway between the umbilicus and pubic symphysis

Answer 31

AT11

Question 32

What tender point is: | on the anterior superior surface of the iliac crest at the mid-axillary line

Answer 32

AT12

Question 33

What does rotation refer to?

Answer 33

movement of lumbar vertebrae in relation to tender point ie moving LE towards tenderpoint, torso and lumbar vertebrae rotates away

Question 34

To diagnosis for posterior ribs what should you do first?

Answer 34

have the pt should cross arms so you can pull the scapula away

Question 35

for posterior, rib 3-10 how do you set up for the tx?

Answer 35

you use your opposite knee to SB, and pull his oppo shoulder to turn away

Question 36

how should you return to neutral?

Answer 36

have the pt take a deep breath and as they exhale, slowly move them to neutral