UE/LE COunterstrain Flashcards
Counter-strain Steps
Counter-strain Steps
- Structural exam to find SD
- Find a significant tenderpoint
- Establish pain scale
- Shorten the local tissues while monitoring
- Reduce pain by at least 70% by putting pt in comfortable position
- Maintain position for 90 seconds
- Passively return to neutral
- Recheck/reassess (tenderness, asymmetry, ROM, etc.)
3
Which TP do you treat in counterstrain?
- Most tender 1st
- If more than 1 that are similar in tenderness, tx the most central/proximal
Lateral Trochanter Counterstrain
- TP:
- Pt position
- Doc:
- Position:
- TP: inferior to the iliac crest in the body of the tensor fascia lata
- Pt position: supine or prone
- Doc: same side of TP
- Position: f ABD hip
IT Band Counterstrain
- TP:
- Pt position
- Doc:
- Position:
- TP: along IT band, below lateral trochanter
- Pt position: supine/prone (back)
- Doc: same side to TP
- Position: f ABD hip/thigh
Lateral hamstring Counterstrain
- TP:
- Pt position
- Doc:
- Position:
TP: distal aspect of the biceps femoris muscle, where it attaches to the fibular head (near the back of the knee)
Pt position: supine or prone
Doc: same side as TP
Position: F ER Abd & compress calcaneous to plantar flex ankle
- flex knee
- ER and abduct tibia
Medial hamstring Counterstrain
- TP:
- Pt position
- Doc:
- Position:
MEdial hamstring Counterstrain
TP: distal part of medial hamstring, near attachment of posterior medial part of tibial condyle
Pt position: supine of prone
Doc: ipsilateral to TP
Position: F IR Add
- Flex knee
- IR and adduct tibia by grabbing ankle
Lateral meniscus (lateral fibular) collateral ligament
TP:
Pt position
Doc:
Position: F Abd IR/ER
- TP: Lateral aspect of menicus on joint line
- Pt postion: supine (back)
- Doc: same side as TP, seated
- Position F Abd IE/ER
- Abduct the patients thigh so leg is off table
- Flex knee to 35-40%
- Abduct tibia and IR/ER until tenderness is less than 70% reduced
Medial meniscus (medial tibial) collateral ligament
- TP:
- Pt position
- Doc:
- Position:
- medial knee joint line
- supine (on back)
- ipsilateral seated
- Abduct the patients thigh so leg is off table
- Flex knee to 35-40%
- Adduct tibia and IR/ER until tenderness is less than 70% reduced
Anterior cruciate counterstrain
TP:
Pt position
Doc:
Position:
TP: superior aspect of popliteal fossa
Pt position: supine (back)
Doc: same side
Position:
- Fulcrum (pillow) on distal femur
- Push proximal tibia posterior on distal femur
*
Posterior cruciate counterstrain
TP:
Pt position
Doc:
Position:
TP: right below center of popliteal fossa
Pt position: supine (back)
Doc: supsilateral
Position:
- Fulcrum (pillow) under proximal tibia
- Push posterior on distal femur
- moves femur posterior on proximal tibia
Popliteus TP
- TP:
- Pt position
- Doc:
- Position:
- TP: Muscle belly inferior to popliteal space
- Pt position: prone (stomach)
- Doc: ipsi
- Position:
- flex knee and IR tibia
Extension Ankle (Gastrocnemius) TP
TP:
Pt position
Doc:
Position:
- TP: proximal gastroc muscle, distal to popliteal margin
- Pt: prone
- Doc: same side
- Position
- Flex knee
- Plantarflex ankle and rest on you
- Compress through calcaneus
Medial ankle (tibialis anterior) TP
- TP:
- Pt position
- Doc:
- Position:
- TP: Anterior and inferior to medial malleolus on deltoid L
Pt position: LR with pillow under affected leg
Doc:
Position:
* Inversion of foot and ankle + IR
Lateral ankle fibularis (longus, brevis tertius) TP
- TP:
- Pt position
- Doc:
- Position:
- TP: anterior and inferior to lateral malleolus in the sinus tarsi
- Pt position: LR with pillow under affected leg
- Doc:
- Position:
- Evert w slight ER
Flexion Calcaneus (Quadratus Plantae) TP
TP:
Pt position
Doc:
Position:
- TP: Plantar surface of calcaneus at, where it attaches to plantar fascia
Pt position: supine or pronse
Doc: ipsilateralt TP
Position:
* Flex knee * Put dorsum of foot on docs thigh * Move calcaneus toward forefoot
Navicular TP
TP:
Pt position
Doc:
Position:
Navicular TP
TP:
Pt position
Doc:
Position:
Shoulder TART
- Joints: GH, SC, AC
- Myofascial:
*
Supraspinatus TP
- TP: Middle of supraspinatus muscle; above spine of scapula
-
Postion:
- Lay supine
- F (45 deg) Abduct (45 deg) and ER
Infraspinatus TP
TP:
Pt position
Doc:
Position:
- TP:
- Upper: inferior and lateral to spine of scapula (posterior medial aspect of GH joint)
- Lower:
- Lower portion of muscle
- inferior to spine
- Lateral to medial morder
- Lower portion of muscle
- Position
- Upper: Supine (on back)
- Flex (90-120); abduct and adjust
- Upper (ER/IR)
- Flex (90-120); abduct and adjust
- Lower TP: LR with TP up; doc in front of
- Flex (135- 150) abduct and adjust
- ER
- Flex (135- 150) abduct and adjust
- Upper: Supine (on back)
Levator Scapulae TP
- TP: in levator at the superior angle of the scapula
- POSITION
- Lay prone and rotate head away
- IR arm by addiing traction with a little abduction
Rhomboid Minor/Major tP
- TP: Medial border of the scapular where rhomboids attach
- Position:
- seated or prone
- Pull on elbow and extend shoulder and adduct elbow
Arm undwind
- Place cephalad hand near patients shoulder
- Flex and abudcut patients arm and rest forearm in YOUR antecubital fossa so it wont hang
- Slide caudal hand UNDER scapula and grab medial scapular border
- Put cephalad hand on anterior shoulder
- Pull laterally and superior until fascia pull eases
- Slowly ER deep fascia all the way to the wrist and finish ST of thenar and hypothenar eminence and pull fingers;
DO NOT ER THE SHOUDER
Subscapularis TP
- Anterolateral border of scapula on subscapularis m (push posterior and medial) (deep in armpit)
- Pos (E IR)
- pt supine ( on back) with arm handing off
- Extend arm, IR wrist and add traction
Biceps Brachii (Long Head) TP
- TP: tendon of long head of bicep in bicipal grove
- Pt
- supine
-
oh me oh my position (
- Shoulder and elbow are flexed
- Arm is abducted and IR
