Counter Strain

Question 1

What are the 7 Steps of Counter Strain?

Answer 1

1. Find the tender point
2. Establish tenderness scale on a scale of 0-100
3. Monitor the tender point through the treatment
4. Place patient in position of optimal comfort
5. Maintain position for 90 seconds
6. Slowly return to neutral
7. Recheck the tender point (looking for 70% reduction in pain)

Question 2

Where are you palpating for cervical tender points?

Answer 2

At the occiput:

• PC1 inion (medial)
• PC1 Occiput (lateral)
• PC2 Occiput (between PC1 Inion and PC1 Occiput)

Along Spinous Processes:

• PC2 - Most superior tip of C2 spinous process
• PC3 - Most inferior tip of C2 spinous process
• PC4 - inferior to C3 spinous process
• PC5 - Inferior to C4 spinous process
• PC6 - inferior to C5 spinous process
• PC7 - inferior to C6 spinous process
• PC8 - inferior to C7 spinous process

Question 3

Where are you palpating for thoracic tender points?

Answer 3

PT1 - Inferior aspect of T1 spinous process
PT2 - Inferior aspect of T2 spinous process
PT3 - Inferior aspect of T3 spinous process
PT4 - Inferior aspect of T4 spinous process
.
.
.
PT12 - Inferior aspect of T12 spinous process

PT1 - Inferolateral aspect of T1 transverse process
.
.
.
.
PT12 - inferolateral aspect of T1 transverse process

Question 4

Where are you palpating for lumbar tender points?

Answer 4

PL1 - Spinous Process of L1
PL1 - Transverse Process of L1
PL2 - Spinous Process of L2
PL2 - Transverse Process of L2
PL3 - Spinous Process of L3
PL3 - Transverse Process of L3
PL4 - Spinous Process of L4
PL5 - Spinous Process of L5

UPL5 - Upper Pole - Superior Medial surface of PSIS
LPL5 - Lower Pole - On ilium just inferior to PSIS
HISI - High Ilium Sacroiliac - 2-3 cm lateral to PSIS
PL3 Gluteus - 2/3 of way to IT Band from PSIS
PL4 Gluteus - Posterior margin of Tensor Fascia Lata

Question 5

How do you treat PC1 Inion?

Answer 5

Pt lies on back

Monitor PC1 inion

Have the head in the F St Ra

• Flexed
• Sidebent toward
• Rotated away

Hold for 90 sec

Return to neutral

Question 6

How do you treat PC1 and PC2 occiput?

Answer 6

Pt lies on back

Monitor the tender point

Put pt’s head in E Sa Ra

• Extension
• Sidebent away
• Rotated Away

Hold for 90

return to neutral

Question 7

How do you treat PC2, PC4 - PC8?

Answer 7

Pt lies on back

Monitor tender point

Put pt’s head in E Sa Ra

• Extension
• Sidebent Away
• Rotated Away

Question 8

How do you treat PC3?

Answer 8

Pt lies on back

Monitor tender point

Put pt’s head into F Sa Ra

• Flexed
• Sidebent away
• Rotated away

Question 9

How do you treat PT spinous processes?

Answer 9

• Pt lies on stomach with arms draped over sides of table
• Monitor tender point
• Lift end of table, putting pt into extension
• Hold for 90
• Return to neutral
• Recheck the tender point

Question 10

How do you treat PL1-5 spinous processes?

Answer 10

Pt lies on stomach

Stand on opposite side of tender point

Monitor tender point

Lift pt’s contralateral leg into a slight extension

Question 11

How do you treat PL1-3 transverse processes?

Answer 11

Pt lies on stomach

Stand on opposite side of tender point

Monitor tender point

Lift pt’s contralateral ASIS off the table

Question 12

What is the Rule of 3’s?

Answer 12

T1-3
- Spinous processes (SP) are in the same plane as the transverse processes (TP) and vertebral body

T4-6
- SP is in plane halfway between its own TP and the TP of the vertebrae below

T7-9
- SP is in the plane of the TP of the vertebrae one level below

T10

• Like T7-9
• One level below

T11

• Like T4-6
• Halfway

T12

• Like T1-3
• Same Plane