Cervical Counterstrain

Question 1

Which vertebrae has the transverse foramina for the vertebral artery

Answer 1

C1 atlas

• all cervical vertebrae has it but it originates here
• the exception is C7. The vertebral arteries DONT pass through here

Question 2

What muscles are AC1 associated with?

What is the treatment and location of tenderpoint as well

Answer 2

Rectus capitis anterior

Rectus capitis lateralis

Point located at posterior aspect aspect of ascending Ramus of the mandible at the level of the earlobe

Treatment = marked rotation away (with minor sidebending to help)

Question 3

What muscles are AC1 lateral associated with?

What is the location and treatment position

Answer 3

Same as AC1

Location = lateral aspect of the C1 transverse process midway between Ramus of mandible and the mastoid process
- have patient jut jaw forward and feel for knob

Treatment = marked rotation away (with minor flexion and sidebending to help)

Question 4

What muscles are AC2-AC6 associated with?

What is the location and treatment position also

Answer 4

The scalenes
- **note that AC2 is associated specifically w/ the middle scalene

Location = Anteriolateral aspect of the anterior tubercle of the respective transverse process

Treatment = FSARA

Question 5

What muscles are AC7 and AC8 associated with?

Location and treatment positions

Answer 5

The SCM

Tender points for each are pressed differently

• AC7 = superior -> inferior on the clavicular attachment
• AC8 = posterior inferior and lateral on the sternal attachment

Treatment for C7 = FSTRA

Treatment for C8 = FSARA

Question 6

What muscles are PC1 and PC1 occiput associated with?

Location and treatment of tenderpoint also

Answer 6

Splenius capitis

Location for PC1 = just lateral to the external occipital protuberance (inion) along the inferior nuchal line (just 1cm inferior to the inion)

Treatment for PC1 = marked flexion

Location for PC1 occiput = on the inferior nuchal line midway between inion and mastoid

Treatment for PC1 occiput = marked extension

Question 7

What muscles are PC2 occiput associated with?

Location and treatment position also

Answer 7

Semispinalis Capitis muscles

Location = on the inferior nuchal line just lateral to PC1 (2-3 cm from Inion)

Treatment = marked extension

Question 8

What special symptom is PC3 sometimes associated w/?

Answer 8

Patients that have vertigo

Question 9

What two PC tender points are the only flexion ones?

Answer 9

PC1 = flexion

PC3 = FSARA

all the others are extension or ESARA

Question 10

How do you adjust treatment position of AC1?

Answer 10

Fine tuning revolves around

• very minor flexion
• very minor sidebending away

Question 11

How to fine tune AC1 lateral?

Answer 11

Fine tuning revolves Around

- slight sidebending either way

Question 12

What are the atypical cervical vertebrae and why are they atypical?

Answer 12

C1 (atlas)

• has no body
• has no spinous process

C2 (axis)

• has a bifid spinous process
• has dens processes

Question 13

anterior scalenes

Answer 13

Origin = Anterior tubercles of C3-C6

Insertion = scalene tubercle of first rib

Innervation = C4-7

**Function to elevate rib 1

Question 14

middle scalene

Answer 14

Origin = Transverse process of vertebrae C2-7

Insertion = groove of subclavian artery on rib 1

Innervation = C3-7

Function to elevate rib 1

Question 15

rectus capitis anterior

Answer 15

Origin = C1 and its transverse process

Insertion = inferior surface of basilar occipital bone

Innervation = C1-2

Functions to flex the head at the Atlanta-occipital joint

Question 16

Rectus capitis lateralis

Answer 16

Origin = Superior surface of the transverse process of the atlas vertebrae

Insertion = inferior surface of the jugular process of the occipital bone

Innervation = C1-2

Functions to flex the head laterally to the same side

Question 17

longus capitis

Answer 17

Origin = Transverse processes of C3-6

Insertion = inferior the basilar occipital bone

Innervation = C1-3

Functions to flex the head

Question 18

Longus coli muscles

Answer 18

Superior:

• originate = anterior tubercles of C3-5
• Insert = anterior tubercles of atlas
• functions to flex the neck anterior and laterally w/ rotation opposite

Inferior:

• originate = anterior surface of T1-3
• insert = anterior tubercles of C5-6
• functions to do the same

Lateral:

• originate = anterior surfaces of C5-7
• inserts = anterior surface of C2-4
• same function as above

all innervated by C2-6

Question 19

how do atlas (C1) and axis (C2) vertebrae differ from each other

Answer 19

Atlas:

• no body present
• no spinous process present
• has anterior arch and tubercle
• has the inital transverse foramina for vertebral artery
• C2-6 also have transverse foramina BUT NOT C7*

Axis

• smallbody compared to other cervical vertebra
• bifid spinous process is present (C3-6 also have bifid processes, BUT NOT C7)
• has dens (odontoblasts processes

Question 20

PC2 tenderpoint

Answer 20

Location = superiolateral aspect of C2 spinous process

Treatment = ESARA

Question 21

PC 3 tenderpoint

Answer 21

Location = inferiolateral aspects of spinous process of C2

Treatment = FSARA

Question 22

PC4-PC8 tenderpoints

Answer 22

Location = inferiorlateral aspects of the tip of the spinous process of (PC#-1) vertebrae

I.e = PC4 = inferolateral aspect of C3 spinous process

Treatment = ESARA