Counterstrain CPA

Question 1

Lower Thoracic (Under the shoulder, lateral recumbent)

Answer 1

Pt lateral recumbent with side to be treated up, facing pt; - finger pads placed on paravertebral muscles lateral to SP - engage muscles with ventral force and move out laterally to give a perpendicular stretch

Question 2

AL1

Answer 2

Medial to ASIS

• pts supine, dr. On side of TP w foot on table
• flex hips/knees pulled toward Dr. And the TP

F STRT

Question 3

AL2

Answer 3

Medial to AIIS - pt supine, dr. Opposite to side of TP w/ foot on table - flex hips/knees 90 deg, knee and ankles AWAY from the TP and TOWARDS the doc Tx require sigfig rotation of flexed hip AWAY from tender point Rt>>> SB

F SARA

Question 4

AL3 & AL4

Answer 4

AL3- lateral to AIIS

AL4- inferior AIIS

• pt supine dr. Same side as TP w/ foot on table
• Flex knees/hips to 90 deg ankles away from the TP and dr. Induce SB, knees pulled TOWARD the TP and Dr.

F SART

Question 5

AL5

Answer 5

Anterior aspect of pubic bone about 1cm lateral to pubic symphysis (near pubic tubercle)

• pt supine; dr. Same side of TP w/ foot on table
• Flex hip 90-135 deg, push ankles away TP and Dr. And Rt. Knees slightly TOWARD the TP and Dr.

F SART

Question 6

PL 1-5 SP

Answer 6

Midline of respective SP

• pt prone, dr. Same side of tender point
• Extend pt IPSI hips to TP, fine tune as necessary

Question 7

PL 1-3 TrP

Answer 7

On respective TrP

• pt prone, dr. OPPOSITE of TP
• Extend IPSI hip to TP and rot. pts leg TOWARD TP
• fine tuning as necessary

Question 8

UPL5

Answer 8

Superomedial to PSIS

• pt prone dr OPPOSITE side of TP
• Extend pt IPSI hip to TP and rot pt leg toward the TP
• fine tuning as necessary

Question 9

LPL5

Answer 9

Inferior aspect of PSIS

• pt prone w/ thigh on dysfunctional side suspended over side of table
• dr. SAME side - Flex pt hips and knees to 90 deg + adduction and internal rot.

Question 10

PL3 Lat (Glut. Medius)

Answer 10

2/3 way b/n PSIS & tensor fascia lata

• pt prone, dr on whichever side more comfortable
• Extend pt IPSI hip
• fine tune as necessary

Question 11

PL4 Lat (Glut Medius)

Answer 11

Posterior margin of TFL

• pt prone, dr stands of whichever side more comfortable
• Extend pt IPSI hip
• fine tune as necessary

Question 12

Iliacus (IL)

Answer 12

Lower quadrant, 1-2” medial to ASIS deep in iliac fossa

• pt supine; dr SAME side as TP w/ foot on table
• Flex knees/hips 90 deg, ankles crossed on dr knees with knee separated (marked ER of both hips)

“FROG LEGS”

Question 13

Low Ilium (LI)

Answer 13

Lateral aspect of superior ramus, where psoas muscle crosses pelvic rim

• pt supine; dr same side of TP
• Flex IPSI knee/hip 90 deg, slight ER hip
• fine tube with AD/AB

Question 14

Inguinal Ligament (Inlig)

Answer 14

Lateral surface of the pubic bone near attachment of Inguinal ligament (associated with pectineus m. and/or inguinal ligament)

• pt supine; dr. SAME side of TP w/ foot on table
• Flex knee/hip 90 deg and rest on dr knees, cross opposite ankle over the leg on the side of the dr.

Question 15

High Ilium Sacroiliac (HISI)

Answer 15

Lateral aspect of PSIS (associated w/ gluteus maximus, quadratus lumborum, or iliolumbar ligament)

• pt prone; dr. SAME side monitor TP by pressing lateral => medial
• Extend pts IPSI hip and fine tune w/ AB/ AD

Question 16

High Ilium Flare Out (HIFO)

Answer 16

2” inferior and just medial to PSIS, related to coccygeus m.

• pt prone; dr. OPPOSITE side
• Extend dysfunctional leg to clear other leg
• induce marked AD and ext rot by pulling leg toward dr.

Question 17

Piriformis

Answer 17

Half-way from sacral ILA to greater trochanter

• pt prone; dysfunctional side at edge of the table
• dr seated on SAME side, monitor TP in piriformis m. belly
• Flex pt hip to 135 deg off the side of the table, induce AB+ ext rot by lifting the pts’ knee superolaterally

Question 18

Flare- IN Sacroiliac (FISI)

Answer 18

4” below PSIS, related to gluteus maximus attachment

• pt prone; dr. SAME side
• AB hip+ flex knee to clear table
• fine tune w/ ext rot.

Question 19

PS 1 (b/l)

Answer 19

Medial to inferior border of PSIS b/l

• pt prone; dr. SAME side
• apply posterior => anterior P, diagonally opposite the TP

Question 20

PS 2, 3, 4 (midline)

Answer 20

Midline on sacrum b/n sacral spines

• pt prone; dr standing on pt’s side - posterior => anterior P on apex (if PS2) or base (if PS4) of sacrum - PS3 may vary where force applied (ask where tenderness is reduced)

Question 21

PS5(b/l)

Answer 21

Superomedial ILA (b/l)

• pt prone; dr. SAME side
• apply posterior =>anterior P at location diagonally opposite to the TP

Question 22

AC1 or LC1 (C1TP)

Answer 22

On the posterior surface of ascending ramus of mandible

• pt supine; dr. @ HEAD of table

RA

Question 23

AC2-6

Answer 23

Anterolateral aspect of the TP of affected vertebra - pt supine; dr. @ head of table F SARA

Question 24

AC7

Answer 24

Posterosuperior surface of proximal clavicle where SCM inserts - pt supine; dr. @ head of table F STRA

Question 25

AC8

Answer 25

On the medial end of the clavicle at the sternal attachment of SCM - pt supine; dr. @ head of table F SARA

Question 26

AT1-8

Answer 26

AT1: Midline on suprasternal notch AT2: midline on the manubrium AT3: midline at the level of the costal cartilage related to the named vertebra AT4: midline at the level of the costal cartilage related to the names vertebra AT5: midline about 1” superior to xyphoid AT6: midline at sternal-xiphoid junction AT7: midline at the tip of xiphoid AT8: midline 1.5” inferior to xiphoid Pt supine w/ feet flat on table - dr at head of table, place knee under pts head/neck or trunk - Flex pt to involved vertebra - dr operating hand support upper back and fine tune Flexion (More Flexion needed for the lower TP)

Question 27

AT9-12

Answer 27

AT9: midline 1-2 cm superior to umbilicus AT10: midline 1-2 cm inferior to umbilicus AT11: midline 3-4 cm below umbilicus AT12: midaxillary line on the superomedial surface of iliac crest (b/l) - pt supine - dr. SAME side of TP w/ foot on table - use pt’s leg to cause Flexion at waist, - pts. Hip & knees bend to 90 deg w/ fine tuning by adding rot TOWARD dr.