Counterstrain tenderpoints

Question 1

Counterstrain technique

Answer 1

1. Locate a TP associated with the diagnosis
2. Establish a pain scale by informing the patient that the TP discomfort is now a 10/10
3. After establishing discomfort, keep your finger on the TP and continue to monitor throughout the treatment
4. Find a position (found by attempting to approximate the distal and proximal ends of the muscle) that reduces the discomfort by at least 70% (3/10 or less). The patient remains passive throughout the positioning.
5. Hold the final position for 90 seconds, while monitoring. Only light pressure over the TP is required (enough to slightly blanch the finger nail)
6. Slowly and *passively* return the patient to neutral.
7. reassess the TP and somatic dysfunction.

Question 2

Anterior cervicals

Answer 2

1-5 are on competency. C1- posterior edge of ascending ramus of mandible C2-6- anterior aspect of transverse processes C7- 2-3 cm lateral to clavicular head on superior aspect of clavicle C8- medial aspect of clavicular head

Patient position: supine initial position: flexion, rotation away, sidebending towards. Involved muscles: rectus capitis anterior (AC1), longus colli and capitis (AC2-6), Scalenes (AC2-7), Sternocleidomastoid (AC7-8)

Question 3

Iliacus/ Psoas

Answer 3

1 inch medial to ASIS pt posn: supine initial position: legs flexed to 90 degrees, sidebend and internally rotate toward

TP Involved muscles: iliacus, psoas

Question 4

Piriformis

Answer 4

location: 8-9 cm medial and slightly superior to greater trochanter pt psn: prone initial position: flex affected leg to 135 degrees, add abduction, and internal/ external rotation as needed involved muscles: piriformis

Question 5

Medial ankle (on competency)

Answer 5

location: 2 cm inferior to medial malleolus patient position: supine, seated or prone initial
position: inversion of ankle, slight dorsi or plantar flexion as needed involved muscls: adductor halllucis

Question 6

Lateral ankle (on competency)

Answer 6

location: 2 cm anterior and inferior to lateral malleolus

patient position: supine, seated or prone initial position: eversion of ankle, slight supination of forefoot involved muscles: fibularis longus and brevis, superior and/or peroneal retinaculum

Question 7

Posterior Thoracic (1-5 on competency)

Answer 7

location: over the spinous process centrally or paracntrally and on the transverse processes.

pt posn: prone or seated initial position: extension, slight sidebending and rotation away involved muscles: multifidus, rotatores

Question 8

Posterior Sacrum (PS1-5)

Answer 8

median crest centrally or bilaterally

pt posn: prone Initial position: gentle anterior pressure on opposite part of sacrum from TP, or attempt to bring base and apex together by cupping the secrum and flexing your fingers involved muscles: multifidus

Question 9

Lateral trochanter

Answer 9

location: lateral aspect of greater trochanter pt position: supine or prone initial
position: abduction and slight flexion of the thigh Involved muscles: iliotibial band

Question 10

upper anterior thoracic (AT 1-7)

Answer 10

location: centrally along sternum pt position: supine or seated initial position: flexion, slight sidebending and rotation as needed involved muscles: pectoralis major, sternal fascia

Question 11

lower anterior thoracic (AT7-12)

Answer 11

loation: T7-8 bilaterally between xiphoid process and umbilicus T9- bilaterally 1 cm above umbilicus T10- bilaterally 1-2 cm below umbilicus T11- bilaterally between umbilicus and pubis T12- bilterally inner surface of iliac crest on the midaxillary line patient position: supine or seated initial position: flexion, sidebending towards, rotation away involved muscles: rectus abdominis