Strain-Counterstrain Techniques - Sheet1 Flashcards
Algorithm for Counterstrain
- Locate tender point
- Palpate tender point
- Communicate pain scale (0-10)
- Establish pain scale - press firmly and say “this is a 10”
- Position the body towards the position of comfort while monitoring for relaxation
- Reasses the PT, looking for reduction in pain by 70%. Finetune if not.
- Hold patient in < 3 tender location for 90 seconds.
- Slowly return PT to neutral
- Recheck tender point
Supraspinatus
Associated with pain found at the deltoid region and the on lateral
side of the arm. There is usually pain in performing abduction of
the arm.
Tender point: In the belly or the distal tendon of the
supraspinatus muscle.
Treatment: Patient on their side with tender point side facing up.
Moderate flexion, abduction, and external rotation of the arm by
approximately 45° in each direction.
Levator Scapulae
Presents with stiffness at the base of the neck and upper shoulder
blade. When dysfunctional, the patient may present with an
elevated shoulder and difficulty in turning the head to the elevated
side.
Tender point: Inferior attachment of the levator scapulae muscle
at the superior-medial border of the scapula.
Treatment: Patient on their side with tender point facing up.
Patient’s head is on a pillow to assist in slight side bending of the
cervical spine toward the scapula. Pull the arm on the ipsilateral
side of the tender point across the back to rotate the scapula
medially. Operator places one hand on the inferior angle of the
scapula and applies a cephalad push to shorten the muscle.
Latissimus Dorsi
Associated with pain toward the mid to lower back, ipsilateral
restriction of arm abduction and excessive thoracolumbar side
bending.
Tender point: Near the insertion of muscle on the humerus or at
the iliac crest attachment.
Treatment: Patient on their side with tender point side facing up.
Extension, internal rotation, and slight abduction of the arm while
applying mild traction.
Subscapularis
The patient may prefer to keep their arm at their side. This
condition is related to “frozen shoulder”.
Tender point: On the anterior and lateral surface of the scapula.
Treatment: Patient is supine. Extend, internally rotate, and
slightly abduct the humerus on the same side of the tender point.
Biceps
Associated with pain at the front of the shoulder and may radiate
toward the antecubital region. Pain may increase with either passive
or active extension of the elbow.
Tender point: On the tendon of the long head of the biceps in the
bicipital groove of the humerus.
Treatment: Patient supine. Elbow flexed to shorten the biceps,
then flex, adduct, and internally rotate the humerus about the
glenohumeral joint.
Coracobrachialis
Associated with pain appreciated deeply at the anterior shoulder.
Can be confused with bicipital tendonitis but may also coexist with
it.
Tender point: Near the coracoid process.
Treatment: Patient supine. Forearm flexed and elbow grasped by
operator to flex, adduct, and internal rotate humerus about the
glenohumeral joint.
Brachialis
Can be associated with pain and/or numbness that radiates toward
the forearm and base of the thumb, accentuated by heavy/repetitive
flexion at the elbow. Tender point: At the proximal portion of the brachialis.
Treatment: Patient supine. Flexion of the elbow with the palm in
a supinated position. The forearm is placed immediately lateral to
the upper arm
Supinator
Associated with pain at the lateral epicondyle, especially with
supination and pronation activities. Pain may radiate toward the
forearm and base of the thumb.
Tender point: At the lateral aspect to the supinator muscle near the
radialhead.
Treatment: Extension, supination, and slight abduction of the
forearm.
Pronator
Pain is found from the anterior surface of the forearm and the
medial epicondyle and can radiate up to the wrist.
Tender point: At the proximal forearm on the pronator teres
attachment.
Treatment: Flexion, pronation, and slight adduction of the
forearm.
Carpi Radialis Longus and Brevis
Extensor Carpi Radialis Longus & Brevis (ECR) – Rennie pg 92
Pain associated with ECRL found over the radial dorsal wrist
Tender point: found in the muscle belly on the lateral aspect of the
posterior forearm, OR the tendinous insertion on the lateral aspect
of the posterior surface of the wrist.
Treatment: patient is seated/supine, with elbow stabilized.
Operator grasps patient’s hand, inducing extension at the wrist and
elbow with slight radial deviation.
Extensor Carpi Ulnaris
Pain associated with ECU found over the ulnar dorsal wrist
Tender point: found in the muscle belly on the medial aspect of
the posterior forearm, OR in the tendinous insertion on the medial
aspect of the posterior surface of the wrist.
Treatment: patient is seated/supine, with elbow stabilized.
Operator grasps patient’s hand, inducing extension at the wrist and
elbow with slight ulnar deviation.
Flexor Digitorum Superficialis & Profundus
Pain attributed to these muscles follows into the fingers along the
corresponding tendinous lines.
Tender point: Deep in the palm and/or up to the MCP joints.
Treatment: Flexion of the fingers, palm, and wrist.
Abductor Pollicis Brevis
Pain is found at the base of the thumb.
Tender point: On palmar surface, anterior base of the first
metacarpal.
Treatment: Flexion of the wrist and abduction of the thumb.
Flexor Pollicis Brevis
Pain is found at the base of the thumb.
Tender point: On palmar surface, medial to the head of the first
metacarpal.
Treatment: Flexion of the thumb over the palmar surface
