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Jones InstituteOriginators of the Strain Counterstrain
Technique
Strain Counterstrain IFor the Spine
Course Syllabus
Developed and compiled by Randall S. Kusunose, P.T., O.C.S. from the work and concepts of Lawrence Jones, D.O., F.A.A.O.
Copyright 1995Artwork by Shanti Del Maestro
7937 Corte Domingo Carlsbad, CA 92009 Phone: (760) 942-0647 Fax: (760) 942-0645
w w w . j i s c s . c o m
Strain Counterstrain I for the Spine
Table of Contents
Introduction....................................................................................3
Technique.......................................................................................5
General Rules..................................................................................6
Anterior Cervicals............................................................................8
Posterior Cervicals..........................................................................12
Anterior Thoracics...........................................................................16
Posterior Thoracics..........................................................................20
Anterior Ribs – Depressed................................................................24
Posterior Ribs – Elevated.................................................................26
Anterior Lumbars............................................................................28
Posterior Lumbars...........................................................................32
Anterior Pelvis and Hip....................................................................36
Posterior Pelvis and Hip...................................................................40
Posterior Sacrals.............................................................................44
Evaluation.......................................................................................47
Home Program................................................................................51
Reference Articles...........................................................................55
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Strain Counterstrain Definitions:
1. A passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain and dysfunction by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction.
2. A mild overstretching applied in a direction opposite to the false and continuing message of strain, which the body is suffering.
Origin of Strain Counterstrain1. First observation:
2. Second observation:
Rational for Strain Counterstrain:Based on Proprioceptors and Somatic Dysfunction” by Irvin Korr, Ph. D. Proposed neural basis for joint dysfunction incriminating the muscle spindle.
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Tender Point Definitions:1. Small zones of tense, tender, edematous muscle and fascial tissue about 1
cm in diameter.2. Sensory manifestations of a neuromuscular or musculoskeletal dysfunction.
Use tender points to make diagnosis and monitor the effectiveness of the treatment technique.
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Jump sign & grimace.
Documenting the diagnosis.
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Similarities & differences to other systems that use points
Tender points are at least four times more tender than the patient’s normal tissue to palpation. Push with enough pressure to elicit a mild response from the patient’s normal tissue.
FINDING THE POSITION OF COMFORT
Two ways of finding the position of comfort:1. Patient feedback.2. Palpating for the mobile point.
Mobile Point Definition:Point of maximum tissue relaxation beneath your monitoring finger where joint movement in any direction will increase tissue sensation.
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How Strain Counterstrain fits into your armamentarium:1. Acute
2. Fragile (Osteoporotic)
3. Pregnant
4. Pediatrics
5. Chronic
6. Post-Op
7. Neurologic
8. In conjunction with:
a. articular techniques
b. muscle energy
c. Myofascial Release
d. exercise
e. modalities
TECHNIQUE1. Locate tender point2. Find position of comfort or mobile point.3. Monitor point response but take pressure off tissue.4. Hold 90 seconds.5. Return to neutral slowly.6. Recheck tender point-70% improved.
GENERAL RULES1. Hold position of comfort for no less than 90seconds.2. Return to neutral very slowly.3. Anterior tender points are usually treated in flexion.4. Posterior tender points are usually treated in extension.5. Tender points on or near midline are treated with more flexion and
extension.6. Tender points lateral from midline are treated with more rotation and side
bending.7. With multiple tender points, treat the most severe first.8. If tender points are in rows, try treating the one in the middle first.9. Tender points in the extremities can be found on the opposite side of pain.10. Warn patient that they may get sore following a Strain Counterstrain
treatment.11. No contraindications.
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ANTERIOR CERVICALS
LC 1 (p. 46)Tender Point: Find by palpating the position of the transverse process of C1.
The mastoid process and the transverse process of C1 are approximated on the involved side. Tender on lateral tip of TP. Push medially.
Treatment: Patient supine.Side-bend - slightly toward the side of the tender point to exaggerate deformity.
AC 1 (Regular) (p. 43)Tender Point: Posterior surface of ascending ramus of mandible 3 cm superior
to mandibular angle. Approach tender point posteriorly. Push anteriorly.
Treatment: Patient supine.Flexion - or extension-noneSide-bend - away slightlyRotate - away markedlyDirect the motion of treatment with pressure on top of the
head.
AC 1R (Rare exception)Tender Point: 2 cm anterior to the angle of the mandible along the inferior
surface. Push superiorly and laterally along its’ inner edge.
Treatment: Patient supineFlexion - markedSide-bend - toward slightlyRotate - away
AC 2 (p. 44)Tender Point: Anterior surface of tip of C 2 transverse process. Push posteriomedial.
Treatment: Patient supine. Same as AC 1Flexion - little if anySide-bend - away slightRotate - away
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AC 3 (p.44)Tender Point: Anterior surface of tip of C 3 transverse process. Push posteriomedial.
Treatment: Patient supine Flexion - markedSide-bend – away, sometimes towardRotate - away
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AC 4 (p.44)Tender Point: Anterior surface of tip of C 4 transverse process. Push posteriomedial.
Treatment: Patient supineFlexion - slight to moderate, sometimes likes slight extensionSide-bend - awayRotate - away
AC 5 (p.44)Tender Point: Anterior surface of tip of transverse process of C 5. Push posteriomedial.
Treatment: Patient supineFlexion - moderateSide-bend - awayRotate - away
AC 6 (p.44)Tender Point: Anterior surface of tip of C 6. Push posteriomedial.
Treatment: Patient supineFlexion - moderateSide-bend - awayRotate - away
AC 7 (p. 45)Tender Point: Posteriorsuperior surface of proximal clavicle. 3 cm lateral to
the medial end. Push inferiorly and anteriorly on the posterosuperior edge of the clavicle.
Treatment: Patient supineFlexion - marked; support lower posterior neck.Side-bend - toward markedlyRotate - away slightly
AC 8 (p. 45)Tender Point: Medial end of clavicle. Push laterally.
Treatment: Patient supineFlexion - slightlySide-bend - away slightlyRotate - away markedly
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TR Trachea (p. 48)Tender Point: Along the sides of the trachea as high as hyoid bone and as low
as suprasternal notch. Push medially. Used to treat chronic unproductive coughs.
Treatment: Patient supineFlexion - marked, support lower neckSide-bend - toward slightlyRotate - away slightly
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POSTERIOR CERVICALS
PC 1 Inion (Exception) (p. 39)Tender Point: On medial border of main posterior muscle mass of neck
(semispinalis capitis), 3 cm below inion (posterior occipital protuberance). Push anteriorly.
Treatment: Patient supineFlexion - marked (tuck chin)Side-bend - toward slightlyRotate - away slightly
PC 1 (Regular) (p. 40)Tender Point: On occiput below nuchal line, lateral to main muscle mass. 3.5
cm from midline. Push anteriomedial.
Treatment: Patient supine.Extension - at level of C 1. Lift head to flex lower cervicals, allowing marked extension of C 1Side-bend - away slightlyRotate - away slightlyNOTE: Augment extension of C 1 by hand pressure on top
of head.
PC 2 (p. 40)Tender Point: 1. On occiput, below nuchal line, in lateral belly of the main
muscle mass of neck, 1/5 cm lateral to midline. Push anteriorly.2. Also found on either side of the superior surface of the spinous process of C 2. Push inferiomedial.
Treatment: Patient supineExtension - same as PC 1Side-bend - away slightlyRotate - away usually
PC 3 (Exception) (p. 40)Tender Point: On either side of the inferior surface of the spinous process of C
2. Push superiomedial.
Treatment: Patient supineFlexion - markedSide-bend – away, sometimes towardRotate - away
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PC 4 (p. 41)Tender Point: 1. On either side of the spinous process of C 3 in the depression
below the spinous process of 2 C.2. In muscle mass between C 4 spinous process and C 4
transverse process.NOTE: Sometimes need to forward bend the neck to find this
point.
Treatment: Patient supine. In the supine position suspend the head over the end of the table.ExtensionSide-bend - awayRotate - away usually
PC 5,6,7 (p. 42)Tender Point: On either side of spinous processes of the corresponding vertebrae above.
Treatment: Patient supineExtension - markedSide-bend - away usuallyRotate - awayNOTE: The more posterior the head is placed the lower the action from PC 4 through PT 2.
PC 8 (p. 42)Tender Point: Posterior surface of the tip of transverse process of C 7.
Approach anterior to the trapezius at the base of the neck by palpating posteromedial toward transverse process. Push anterioinferior on the posterior surface of transverse process.
Treatment: Patient supineExtension - slightSide-bend - away markedlyRotate - away
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ANTERIOR THORACICS
AT 1 – AT 6 Midline Points AT 7 – AT 12 Bilateral Points
AT 1 (p. 57)Tender Point: Midline in suprasternal notch. Push inferiorly.
Treatment: Patient seated with hands on top of head. Operator places arms around patient and locks hands over the manubrium.Patient slides down operator’s torso producing thoracic flexion.
AT 2 (p. 57)Tender Point: Middle of manubrium. Push posteriorly.
Treatment: Patient seated, same as AT 1 but lock hands lower at junction of manubrium and sternum.
AT 3 (p. 57)Tender Point: On sternum just below sternal angle. Push posteriorly.
Treatment: Patient seated with arms dropped back and off edge of table. Operator pulls backwards on patients arms creating a fulcrum at the desired level. Operator uses his chest and abdomen to force patient’s thoracic spine into flexion. Augment thoracic flexion by internally rotating arms.Flexion
AT 4 (p. 57)Tender Point: On the body of the sternum at the level of 4th interspace.
Push posteriorly.
Treatment: Patient seated same as AT 3.Flexion
AT 5 (p. 58)Tender Point: On the body of the sternum at the level of 5th interspace.
Approximately nipple line. Push posteriorly.
Treatment: Patient seated with arms at side. Operator locks his fingers anteriorly over the tender point. Flexion is created by pulling the patient backwards using medial edges of hands as the fulcrum. Operator leans against patient’s upper thoracic area.Flexion
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AT 6 (p. 58)Tender Point: Xiphisternal junction. Push posteriorly.
Treatment: Patient seated with arms at side. Same as AT 5 but lower.Flexion
AT 7 (p. 58)Tender Point: 1. Under the costochondral margin of 7th rib. Push
superiolateral.2. 1 cm below the xyphoid. 1 cm lateral to midline.
Treatment: Patient seated. Operator has his foot on the table opposite of the tender point. Patient has opposite arm resting on pillow on the operator’s thigh, who stands behind him. Patient’s feet on table on side of tender point. (Side sitting)Flexion - created by sittingSide-bend - toward by translating trunk to opposite side.Rotate away by placing patient’s tender point side arm across
front of body.Operator tunes with hip movement.
AT 8 (p. 58)Tender Point: 2 cm below AT 7. 1.5 cm lateral to midline. Push posterior.
Treatment: Same as AT 7
AT 9 (p. 60)Tender Point: Just above umbilicus. 1.5 cm lateral to midline. Push posterior.
Treatment: Same as AT 7
AT 10 (p. 60)Tender Point: Just below the umbilicus. 1.5 cm lateral to midline. Push posterior.
Treatment: 1. Patient supine. Raise the head of the table. Rest patient’s flexed legs on operator’s thigh. Operator stands on side of the tender point. Produce marked flexion at the level of dysfunction.Side-bend - towardRotate - toward2. Straight table technique. Patient supine if needed. Place pillows under hips of patient to obtain flexion of pelvis and lumbar spine. Then proceed as above.
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AT 11 (p. 60)Tender Point: Suprapubic region at the level of the ASIS. 2 cm lateral to
midline.
Treatment: Same as AT 10. Fine tune.
AT 12 (p. 60)Tender Point: Crest of ilium at mid-axillary line. On inner table of iliac crest.
Roll palpating finger over the top and push inferiorly.
Treatment: Same as AT 10. Fine tune.
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POSTERIOR THORACICS
Thoracics 1-5 often have the most sensitive points on the sides of the spinous processes. The lower thoracic tender points are usually most sensitive paravertebrally or just lateral to spinous processes. At the thoracolumbar junction the most sensitive tender points are found on the posterior tips of the transverse processes or spinous process tender points will be the most tender.
With posterior thoracics, the closer the tender point is to the midline the more force in extension is needed. The farther the tender point is from the midline, the more side bending is needed.
PT 1-2 (p. 51)Tender Point: On the sides of the spinous processes of T 1 and T 2.
Sometimes PT 1 also has a tender point at the elbow 5 cm above lateral epicondyle.
Treatment: Patient prone with the arms along side body. May also be treated supine with the head hanging off the end of the table.Extension - if prone, cradle side of face in flat of hand, extend to
level.Side-bend - awayRotate - away
PT 3,4,5 (p. 51 & 52)
Tender Point: On the sides of the spinous processes of T 3,4,5. Sometimes PT 4 also has a tender point at the elbow 5 cm above medial epicondyle.
Treatment: Patient prone with the arms resting along side of head, in diving position.
Extension- Cradle side of face in flat of your hand. Extend to level
Side-bend - awayRotate - away
PT 6,7,8,9 (p. 52)Tender Point: Lateral to spinous processes in paravertebral area is most
common.
Treatment: Patient prone with arms resting along side of head.Extension- Cradle side of face in the flat of you hand, extend head to level. Use pillow under patient’s chest to assist the thoracic extension to level.
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Side-bend - awayRotate - away
Alternate TechniqueTreatment: Patient prone. Arm of tender point side along side of head.
Operator stands adjacent to patients’ head and grasps tender point side axilla. Axilla is pulled up in a cephalad direction.Extension – moderateSide-bend – is major force awayRotate - toward
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PT 10,11,12 PL 1-5(p. 53 & 72)
Tender Point: Lateral to spinous processes or on posterior aspect of transverse processes is most common.
Treatment: Patient is prone. Raise cephalic end of table to extend to level. Pull back on anterior pelvis on tender point side to side-bend and rotate.Extension- primarily motion with midline tender points.Side-bend - away, slight with midline points. More side-bending required with lateral points.
Rotate - toward, 30-45 degrees
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ANTERIOR RIBS – DEPRESSED
AR 1 Anterior First Rib – depressed (p. 65)
Tender Point: On the first costal cartilage beneath the clavicle adjacent to the manubrium.
Treatment: Patient supineFlexion - mild cervicalRotate - toward markedlySide-bend - toward. This is the greatest force applied. Point patients’ chin toward the tenderpoint.
AR 2 Anterior Second Rib – depressed (p. 65)
Tender Point: 1. On second rib, in the mid clavicular line.2. High in medial axilla.
Treatment: Same as first rib depressed
AR 3-AR 6 Anterior Third through Sixth Ribs – depressed(p. 64)
Tender Point: On anterior axillary line inferior rib margins at corresponding levels. Push medially.
Treatment: Patient sittingFlexion - sitting is enoughSide-bend - toward tender point. Support patient’s opposite axilla on the knee of the operator who stands behind him. Side-bend toward by gently translating patients’ trunk away from tender point side. Can increase side-bending toward by asking patient to place feet on the plinth on the tender point side. (side sitting)Rotate - toward. Let involved side arm hang behind patient to augment rotation.
RIBS INTERSPACE
INT 4 – INT 6 Interspace Rib Dysfunctions (p. 59)
(also called anterior lateral thoracics) Fourth through Sixth
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Tender Point: On or between the costal cartilage just lateral to sternum at the corresponding level.
Treatment: Patient seated with opposite side axilla supported on operator’s knee, who stands behind patient. Patient’s feet on table on side of tender point.Flexion - trunkSide-bend - toward by translating trunk to opposite side.Rotate away by placing patient’s involved side arm across front
of body.
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POSTERIOR RIBS ELEVATED
PR 1 Posterior First Rib – elevatedTender Point: Superior aspect of posterolateral arch of first rib. Push inferiorly
in front of trapezius at base of neck.
Treatment: Patient sitting. Opposite axilla over operator’s thigh. Lean patient mildly toward opposite side. Position head and neck.Extension - slightSide-bend - away slightRotate - toward moderately
PR 2 – PR 6 Posterior Second through Sixth Ribs – elevated (p. 66 & 67)
Tender Point: Posteriorly at angle of ribs on superior surface. Move scapula laterally to allow palpation of rib angles by crossing arm over chest.
Treatment: Patient sitting. Rest axilla of affected side over operator’s thigh, who stands behind patient. Hand of opposite arm behind body. Patient’s feet on table on the opposite side of tender point. (side sitting)Side-bend - away by translating trunk toward tender point side.Rotate trunk away. Operator tunes using his hip. For second rib rotate neck away also.
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ANTERIOR LUMBARS
AL 1 (p. 60)Tender Point: Medial surface of anterior superior iliac spine. Push
laterally, ¾ inch deep.
Treatment: Patient supine. Raise the head of the table if possible. Rest patient’s flexed legs on operator’s thigh. Operator stands on side of the tender point. Produce marked flexion at the level of dysfunction.Flexion -Side-bend - toward usuallyRotate - toward tender point side.
AL 2 (p. 73)Tender Point: Inferior-medial surface of anterior inferior iliac spine. Push
superiolateral.
Treatment: Patient supine. Operator stands on opposite side of tender point.
Flexion - patient’s legs flexed 90 degreesRotate knees away from tender side 60 degrees (markedly).Side-bend away slightly by pushing feet toward floor.
AbL 2 Abdominal (p. 74)Tender Point: 5 cm lateral to umbilicus. Push posteriorly.
Treatment: Patient supine. Operator stands on same side as tender point.Flexion - more than regular AL 2.Rotate knees toward tender side 60 degreesSide-bend - away by elevating feet upwards
AL 3 (p. 75)Tender Point: Lateral surface of anterior inferior iliac spine. Push
medially.
Treatment: Patient supine. Operator stands on opposite side as tender point.
Flexion - flex thighs 50-90 degrees over operator’s thigh.Side-bend - away markedly by pulling feet toward operator.Rotate - slightly to fine tune
AL 4 (p. 75)
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Tender Point: Inferior surface of anterior inferior iliac spine. Push superiorly.
Treatment: Same as AL 3 with fine tuning.
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AL 5 (p. 70)Tender Point: Anterior surface of pubic bone, 1.5 cm lateral to pubic
symphysis. Push posteriorly on tender point.
Treatment: Patient supine. Operator stands on same side as tender point.Flexion - flex thighs 60-90 degrees.Side-bend - away slightlyRotate knees toward side of tender point.
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POSTERIOR LUMBARS
PL 3 Iliac (p. 71)Tender Point: 3 cm below margin of ilium and about 7 cm lateral to posterior
superior iliac spine. Push anteriorly.
Treatment: Patient prone. Operator on opposite side of tender point.Extension – lift leg of affected side, support on thigh of
operator.Adduct – slightlyRotate – marked external rotation. The operator’s lifting hand placement will determine the amount of rotation. The higher the hand the greater the rotation.
PL 4 Iliac (p. 71)Tender Point: 4 cm below margin of ilium and just posterior to the border of
the tensor fascia lata. Push anteriomedial.
Treatment: Patient prone. Operator on opposite side of tender point.Extension – lift leg of affected side, support on thigh of
operator.Adduct – slightlyRotate – moderate external rotation
UPL 5 Upper Pole (p. 71)
Tender Point: Superior medial surface of the posterior superior iliac spine. Push inferiolateral on posterior superior iliac spine.
Treatment: Patient prone. Operator on opposite side of tender point.Extension – lift leg of affected side, support on thigh of operatorAdduct – slightRotate – mild external rotation
LPL 5 Lower Pole (p. 72)
Tender Point: 1. 2 cm below posterior superior iliac spine in small saddle between posterior superior iliac spine and posterior inferior iliac spine. 2. Found on the sacral promontory (first sacral spine) in midline.
Treatment: Patient prone. Operator seated on side of dysfunction. Leg on tender point side is dropped off of table, resting on operator’s thigh. Patient’s hip flexed 90 degrees. Patient’s hip is adducted slightly.
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Flexion – hip to 90 degrees.Adduct – hip slightly
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QL Quadratus Lumborum (Not in book)
Tender Point: 1. On the lateral tips of the transverse processes of L2-L4. Push medially.
2. In the angle between the transverse process of L1 and the 12th rib. Push anteriorly.
Treatment: Patient prone. Side-bend trunk toward tender point. Side-bend legs toward tender point. Abduct and extend hip and fine tune with hip rotation.Extension – hip mildly, if patient lacks hip extension treat in
neutral.Abduction – hip moderatelyRotate – Play with external rotation to fine tune.
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ANTERIOR PELVIS AND HIP
LISI Low Ilium – Sacroiliac (p. 81)
Tender Point: Lateral ramus of pubic bone on superior surface. 2 cm lateral to pubic symphysis. Push inferiorly.
Treatment: Patient supine. Flex hip markedly on the tender point side.Flexion – 90-110 degreesSide-bend – noneRotate – none
LIFO Low Ilium – Flareout (p. 82)
Tender Point: Inferior medial surface of the descending ramus of the pubic bone. Push superiolateral.
Treatment: Patient supine. Flex patient’s thigh.Abduct femur moderately to accentuate the low flare out.Rotate femur externally – marked by keeping the foot on
midline.
AMT Anterior Medial Trochanter or Sartorius (p. 88)
Tender Point: 1 cm lateral to the anterior inferior iliac spine (AIIS). Push posteriorly.
Treatment: Patient supineFlex hip – 130 degreesAbduct – 0 degreesRotate – 0 degrees
ALT Anterior Lateral TrochanterTender Point: Flex the hip to find this trigger. 2 cm lateral to the AIIS.
Push posteriorly.
Treatment: Patient supineFlex hip – 90 degreesAbduct – moderateRotate – external, little or none
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IL Iliacus (p. 87)Tender Point: 4 cm medial and caudad to ASIS (Anterior Superior Iliac Spine)
in iliac fossa. Push in all directions to check fossa area.
Treatment: Patient supine. Patient’s ankles supported on operator’s thigh.Extreme flexion of hips, abduction and external rotation of femurs of both legs.
Ing Inguinal Ligament (p. 89)Tender Point: Lateral surface of pubic bone just below the inguinal ligament
attachment. Push medially.
Treatment: Patient supine. Operator stands on same side.Flexion – Flex both legs 90 degrees and rest on operator’s thigh. Move the unaffected leg over the top of the affected leg crossing knees. Adduction – of femurRotate – internal of femur
Add Adductors (p. 89)Tender Point: Origin of adductors to pubic bone and along the length of the
belly of muscle.
Treatment: Patient supineAdduction – marked. Cross leg of affected side over top of
opposite leg.Flexion – slight
Gmi Gluteus Minimus (p. 88)Tender Point: Anterior border of gluteus minimus muscle. Superior and
posterior to the greater trochanter. Push posteriorly.
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Treatment: Patient supineFlexion – hip to 90 degreesAbduction – slightRotate – marked internal
TFL Tensor Fascia Lata (p. 88)
Tender Point: Belly of the tensor fascia lata muscle. Superior and anterior to the greater trochanter.
Treatment: Same as gluteus minimus
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POSTERIOR PELVIS AND HIP
HISI High Ilium Sacroilliac (p. 79)
Tender Point: 3 cm lateral to the posterior superior iliac spine. Direct palpating finger medially.
Treatment: Patient proneExtension – hip supported on operator’s thighAbduction – slight
HFO-SI High Flare-out Sacroiliac (p. 80)
Note: May be associated with coccygodynia.
Tender Point: 1. Is found 4-7 cm below and slightly lateral to the posterior superior iliac spine. Pushing medially on to the lateral borders of the sacrum.2. Occasionally on the ischial tuberosity. Push superiorly.
Treatment: Patient prone. Operator on opposite side. Extend leg on the tender point side high enough to clear opposite leg and adduct across, scissoring the legs. Occasionally the opposite leg is extended and adducted.
MPSI Mid-Pole Sacroiliac (also called Flare-In SI) (p. 83)
Tender Point: Middle of the buttocks in a slight depression. Direct palpating finger medially with superficial pressure. Buttocks should accordion up the middle.
Treatment: Patient proneFlexion – slight or possible slight extensionAbduction – of hip, is the major component
PIR Piriformis (p. 92)
Tender Point: In belly of piriformis muscle, on a line between the lateral border of sacrum and greater trochanter. Push anteriorly.
Treatment: 1. Similar to LP 5 (Lower Pole 5th)Patient prone. Operator is seated on tender point side. Leg on the tender point side suspended off table, with patient’s foreleg resting on operator’s thigh.Flexion – hip approximately 90 degrees
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Abduct – hip horizontallyRotate – slight internal if flexion is above 90 degrees. Slight external if below 90 degrees.
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PLT Posterior Lateral Trochanter (Not in book)
Tender Point: Posterosuperior lateral surface of the greater trochanter. Push anterior & inferior. This indicates a dysfunction of the external rotators of the hip.
Treatment: Patient prone. Operator on same side.Extension – hip, operator places knee under patient’s thigh to support extension. Abduction – slightRotate – marked external
PMT Posterior Medial Trochanter (also called Gemelli) (p. 93)
Tender Point: On a line from the ischial tuberosity to the lesser trochanter, along the bottom of the gluteal fold. Push anteriosuperior.
Treatment: Patient prone. Operator on opposite side. Patient flexes knee. Operator bends over to pin patient’s ankle in his axilla then stands up.Extension – hip, moderateAdduction – markedRotate – marked external
LT Lateral Trochanter (p. 93)Tender Point: 12 cm below trochanter on lateral side of the shaft of the femur.
Push medially.Treatment: Patient prone
Abduction – hipRotate – hip, internal or external rotation, slight.
GM Gluteus Medius (p. 91)
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Tender Point: On a line 1 cm below the iliac crest. Push anteriorly.
Treatment: Patient prone. Operator on same side.Extension – hip, operator places knee under patient’s thigh to
support.Abduction – moderateRotate – marked, internal
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POSTERIOR SACRALS
PS 1 (p. 85)Tender Point: 1.5 cm medial to the inferior aspect of the PSIS bilaterally.
Treatment: Patient prone. Apply a downward pressure with heel of hand on the opposite corner of the sacrum (sacral apex) from which the tender point is found. Produces a backward torsion around an oblique axis.
PS 2 (p. 85)Tender Point: Midline on sacrum between the first and second sacral
spines.
Treatment: Patient prone. Scoop the sacrum into extension by applying downward pressure to the apex of the sacrum in midline. Produces sacral extension around a tranverse axis.
PS 3 (p. 85)Tender Point: Midline on sacrum between the second and third sacral
spines.
Treatment: Patient prone same as PS 2. Apply a downward pressure to the apex of the sacrum in midline.
PS 4 (p. 85) Tender Point: Midline on sacrum just above the sacral hiatus.
Treatment: Patient prone. Apply a downward pressure to the sacral base in midline.
PS 5 (p. 85)Tender Point: 1 cm medial and 1 cm superior to the inferior lateral
angles bilaterally.
Treatment: Patient prone. Apply downward pressure on the opposite corner of the sacrum from which the tender point is found, (sacral base) Produces forward sacral torsion around an oblique axis.
Cyx Coccyx Point (p. 85)
Tender Point: Either side of tip of coccyx.
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Treatment: Patient prone. Extend sacrum by applying a downward pressure to the apex of sacrum toward side of tender point by twisting your hand in a clockwise or counter-clockwise direction.
Strain Counterstrain
Evaluation
63
64
NAME:____________________________________DATE:_________________
1 2 3 4 5 6POS CERV ANT RIBS POS RIBS KNEE SHLDR CRANIALIN AR1 PR1 MM AAC OM
PC1 AR2 PR2 MH BUR SBPC2 AR3 PR3 PCL LH SP
PC2 AR4 PR4 ACL SHLAM
PC3 AR5 PR5 PTE MCCO
RPC4 AR6 PR6 LM LC NAS
PC5INT
4 POS LUM LH SUB SO
PC6INT
5 PL1 PAT LD IO
PC7INT
6 PL2 PES ADDMA
SPC8 ANT LUM PL3 ANKLE PAC STY
ANT CERV AL1 PL4 LAN SUP FRO
AC1 AL2UP
5 EXA MTS2 LCAC1
RABL
2 LP5 MAN LTS2 ZYAC2 AL3 QL FAN POS SQ
AC3 AL4POS
PELVIS TAL TS3 PAAC4 AL5 HISI FMC TMJ POAC5 ANT PELVIS HFO FOOT TMIAC6 LISI MPSI MCA TRP
AC7LIF
O POS SAC LCA ELBOWAC8 IL PS1 FCA RADLC1 ING PS2 DCU CNDTRA POS THOR PS3 NAV MOL
ANT THOR PT1 PS4 CUB LOL
AT1 PT2 PS5H.NA
V WRISTAT2 PT3 CYX M1 PWRAT3 PT4 ANT HIP M2 DWRAT4 PT5 AMT M3 HANDAT5 PT6 ALT M4 CM1AT6 PT7 ADD M5 INTAT7 PT8 GMI DM1 ECM
65
AT8 PT9 POS HIP DM2AT9 PT11 PIR DM3AT1
0 PT12 PLT DM4AT1
1 PMT DM5AT1
2 LT BUNGME
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NAME:___________________________________ DATE: 1. _________
DATE: 2. _________
DATE: 3. _________
DATE: 4. _________
ANTERIOR CERVICAL POSTERIOR CERVICALRIGHT LEFT RIGHT LEFT
L1C[] [] []
[]L1C
[] [] [] []
1N[] [] []
[]1N [] [] [] []
A1C[] [] []
[]A1C
[] [] [] []
P1C[] [] []
[]P1C [] [] [] []
A1CR[] [] []
[]A1C
R[] [] []
[]P2C
[] [] [] []
P2C [] [] [] []
A2C[] [] []
[]A2C
[] [] [] []
P3C[] [] []
[]P3C [] [] [] []
A3C[] [] []
[]A3C
[] [] [] []
P4C[] [] []
[]P4C [] [] [] []
A4C[] [] []
[]A4C
[] [] [] []
P5C[] [] []
[]P5C [] [] [] []
A5C[] [] []
[]A5C
[] [] [] []
P6C[] [] []
[]P6C [] [] [] []
A6C[] [] []
[]A6C
[] [] [] []
P7C[] [] []
[]P7C [] [] [] []
A7C[] [] []
[]A7C
[] [] [] []
P8C[] [] []
[]P8C [] [] [] []
A8C[] [] []
[]A8C
[] [] [] []
TRA[] [] []
[]TRA
[] [] [] []
ANTERIOR LATERAL COLUMNS POSTERIOR LATERAL COLUMNSRIGHT LEFT RIGHT LEFT
ACOL2
[] [] [] []
ACOL2
[] [] [] []
PCOL2[] [] []
[]PCOL
2[] [] []
[]ACOL
3[] [] []
[]ACOL
3[] [] []
[]PCOL3
[] [] [] []
PCOL3
[] [] [] []
ACOL4
[] [] [] []
ACOL4
[] [] [] []
PCOL4[] [] []
[]PCOL
4[] [] []
[]ACOL
5[] [] []
[]ACOL
5[] [] []
[]PCOL5
[] [] [] []
PCOL5
[] [] [] []
ACOL6
[] [] [] []
ACOL6
[] [] [] []
PCOL6[] [] []
[]PCOL
6[] [] []
[]ANTERIOR THORACIC POSTERIOR THORACIC
A1T[] [] []
[]A4T
[] [] [] [] RIGHT LEFT
A2T [] [] [] A5T [] [] [] P1T [] [] [] P1T [] [] []
67
[] [] [] []
A3T[] [] []
[]A6T
[] [] [] []
P2T[] [] []
[]P2T
[] [] [] []
RIGHT LEFTP3T
[] [] [] []
P3T[] [] []
[]
A7T[] [] []
[]A7T
[] [] [] []
P4T[] [] []
[]P4T
[] [] [] []
A8T[] [] []
[]A8T
[] [] [] []
P5T[] [] []
[]P5T
[] [] [] []
A9T[] [] []
[]A9T
[] [] [] []
P6T[] [] []
[]P6T
[] [] [] []
A10T[] [] []
[]A10T
[] [] [] []
P7T[] [] []
[]P7T
[] [] [] []
A11T[] [] []
[]A11T
[] [] [] []
P8T[] [] []
[]P8T
[] [] [] []
A12T[] [] []
[]A12T
[] [] [] []
P9T[] [] []
[]P9T
[] [] [] []
P10T[] [] []
[]P10T
[] [] [] []
P11T[] [] []
[]P11T
[] [] [] []
P12T[] [] []
[]P12T
[] [] [] []
SCALENESRIGHT LEFT RIGHT LEFT
SCA2[] [] []
[]SCA2
[] [] [] []
SCA5[] [] []
[]SCA5
[] [] [] []
SCA3[] [] []
[]SCA3
[] [] [] []
SCA6[] [] []
[]SCA6
[] [] [] []
SCA4[] [] []
[]SCA4
[] [] [] []
SCA7[] [] []
[]SCA7
[] [] [] []
68
NAME:___________________________________ DATE: 1. _________
DATE: 2. _________
DATE: 3. _________
DATE: 4. _________
THORACO-LUMBAR ERECTOR SPINAE
TRANSVERSOSPINALIS
RIGHT LEFT RIGHT LEFT
TLES6[] [] []
[]TLES6
[] [] [] []
TRAN1[] [] []
[]TRAN1
[] [] [] []
TLES7[] [] []
[]TLES7
[] [] [] []
TRAN2[] [] []
[]TRAN2
[] [] [] []
TLES8[] [] []
[]TLES8
[] [] [] []
TRAN3[] [] []
[]TRAN3
[] [] [] []
TLES9[] [] []
[]TLES9
[] [] [] []
TRAN4[] [] []
[]TRAN4
[] [] [] []
TLES10
[] [] [] []
TLES10
[] [] [] []
TRAN5[] [] []
[]TRAN5
[] [] [] []
TLES10
[] [] [] []
TLES10
[] [] [] []
TRAN6[] [] []
[]TRAN6
[] [] [] []
TLES11
[] [] [] []
TLES11
[] [] [] []
TRAN7[] [] []
[]TRAN7
[] [] [] []
TLES12
[] [] [] []
TLES12
[] [] [] []
TRAN8[] [] []
[]TRAN8
[] [] [] []
TRAN9[] [] []
[]TRAN9
[] [] [] []
ANTERIOR RIBS TRAN10
[] [] [] []
TRAN10
[] [] [] []
RIGHT LEFTTRAN1
1[] [] []
[]TRAN1
1[] [] []
[]
A1R[] [] []
[]A1R [] [] [] [] TRAN1
2[] [] []
[]TRAN1
2[] [] []
[]
A2R[] [] []
[]A2R [] [] [] []
A3R[] [] []
[]A3R [] [] [] [] POSTERIOR RIBS
A4R[] [] []
[]A4R [] [] [] []
RIGHT LEFT
A5R[] [] []
[]A5R [] [] [] [] P1R
[] [] [] []
P1R[] [] []
[]
A6R[] [] []
[]A6R [] [] [] [] P2R
[] [] [] []
P2R[] [] []
[]INT
4[] [] []
[]INT4 [] [] [] [] P3R
[] [] [] []
P3R[] [] []
[]INT [] [] [] INT5 [] [] [] [] P4R [] [] [] P4R [] [] []
69
5 [] [] []INT
6[] [] []
[]INT6 [] [] [] [] P5R
[] [] [] []
P5R[] [] []
[]
SA[] [] []
[]SA [] [] [] [] P6R
[] [] [] []
P6R[] [] []
[]FRI
B[] [] []
[]FRI
B[] [] []
[]
SPI[] [] []
[]SPI
[] [] [] []
ANTERIOR LUMBAR POSTERIOR LUMBARRIGHT LEFT RIGHT LEFT
A1L[] [] []
[]A1L [] [] [] [] P1L
[] [] [] []
P1L[] [] []
[]
A2L[] [] []
[]A2L [] [] [] [] P2L
[] [] [] []
P2L[] [] []
[]
AB2L[] [] []
[]AB2
L[] [] [] [] P3L
[] [] [] []
P3L[] [] []
[]
A3L[] [] []
[]A3L [] [] [] [] P4L
[] [] [] []
P4L[] [] []
[]
A4L[] [] []
[]A4L [] [] [] [] UP5
L[] [] []
[]UP5
L[] [] []
[]
A5L[] [] []
[]A5L [] [] [] [] LP5
L[] [] []
[]LP5
L[] [] []
[]PRL
2[] [] []
[]PRL
2[] [] []
[]ANTERIOR PELVIS POSTERIOR PELVIS
RIGHT LEFT RIGHT LEFT
LISI[] [] []
[]LISI [] [] [] [] HI-IL-
SI[] [] []
[]HI-IL-
SI[] [] []
[]
LIFO[] [] []
[]LIFO [] [] [] [] HFO-
SI[] [] []
[]HFO-
SI[] [] []
[]
IL[] [] []
[]IL [] [] [] [] MPSI
[] [] [] []
MPSI[] [] []
[]
ING[] [] []
[]ING [] [] [] [] OI
[] [] [] []
OI[] [] []
[]
FLS[] [] []
[]FLS [] [] [] [] GMX
[] [] [] []
GMX[] [] []
[]
PD[] [] []
[]PD [] [] [] []
[] [] [] []
70
Strain Counterstrain
Home Program
71
Strain Counterstrain Home Program
General Rules:1. Monitor tender point if possible2. Find most comfortable position that reduces tenderness and feels good.3. Hold that position for two to three minutes.4. Return to neutral very slowly.5. Repeat twice daily.
UPPER ANTERIOR CERVICALLying: Palpate point behind jaw just below the lobe of the ear. Turn head away from painful side until tenderness diminishes.
MIDDLE ANTERIOR CERVICALSLying: Head supported on a pillow against a headboard in moderate flexion. Palpate point on side of the neck. Turn head away from the painful side until tenderness diminishes.
POSTERIOR CERVICALSLying: Palpate point on posterior spine. Slide your head slowly off the edge of the bed allowing the neck to gently extend. Turn head away from the painful side until tenderness diminishes. Remember: This position must feel comfortable.
UPPER ANTERIOR THORACICSSitting: Palpate point midline on the sternum. Slowly slump in the chair, gently folding your body over the point until the tenderness diminishes.
MIDDLE ANTERIOR THORACICSSitting: Palpate point in the upper abdomen just off midline. Lean the non-painful side up against the armrest of the sofa using pillows. Bring your feet up by your side. Rest opposite hand on pillows. Accentuate gentle side bending toward the point until the tenderness diminishes.
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POSTERIOR THORACICSLying: Prop pillows under your chest to create increased extension in the upper to middle back. Raise arms up over pillows. Turn head away from the side of the point until you find a comfortable position.
ELEVATED AND DEPRESSED RIBSSitting: Lean you side up against the armrest of sofa using pillows to support your arm. Bring your feet up by your side. Rest opposite arm behind back. Accentuate gentle side bending toward your feet until you find a comfortable position.
ILIACUSLying: Palpate point in the lower abdomen. Lie in front of a sofa with a pillow beneath your buttock. Place your feet on the sofa with the bottoms together. Allow your knees to fall gently out to the sides until the tenderness diminishes and you feel relaxed.
ANTERIOR LUMBARSLying: Palpate point on the lateral pelvic bones. Lie in front of a sofa with a pillow beneath your buttocks. Place your feet on the sofa. Allow your knees to fall slowly away from the side of the point until the tenderness diminishes.
PIRIFORMISLying: Lie on your stomach so that the affected side is nearest to the edge of the bed. Draw the affected hip up until you have close to a 90-degree angle at the hip. Adjust the hip out to the side while supported on the bed until you find a comfortable position.
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ReferenceArticles
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