Counterstrain

Question 1

Short head biceps/Coracobrachialis counterstrain

Answer 1

1. Position: FAddIR (1/2 dab)
2. Muscle actions
   A. Shoulder flexion
   B. Elbow flexion
3. Nerve musculocutaneous (C5-C7)
4. Tenderpoint: inferolateral side coracoid process

Question 2

Long head biceps brachii counterstrain

Answer 2

1. Position: FAbdIr (Scarlet O’Hara)
2. Muscle actions: shoulder flexion and abd, elbow flexion, forearm supination
3. Nerve: musculocutaneous (C5-C7)
4. Tenderpoint: over tendon long head biceps over bicipital groove

Question 3

Supraspinatus counterstrain

Answer 3

1. Position: FAbdER (45/45/45)
2. Muscle actions: stabilize shoulder, shoulder abd (first 90)
3. Nerve: suprascapular
4. Tenderpoint: muscle belly above scapular spine

Question 4

Levator scapulae counterstrain

Answer 4

1. Position: prone, IrAbd+traction
2. Muscle action: stabilize shoulder, initiates shoulder abd
3. Nerve: dorsal scapular (C5)
4. Tenderpoint: attachment point on scapular angle

Question 5

Subscapularis counterstrain

Answer 5

1. Position: EIr, slight abduction, + or - traction (4 o’clock)
2. Muscle actions: internal rotation shoulder
3. Nerve: subscapular nerves (C5-C6)
4. Tenderpoint: between scapula and ribs

Question 6

Lateral epicondyle counterstrain

Answer 6

1. Position: EsupVal, arm over dr. Knee
2. Muscle actions: wrist extension and abd, forearm sup
3. Nerve: radial (C5-C6)
4. Tenderpoint: anterolateral radial head on flexor surface

Question 7

Medial epicondyle (Pronator)

Answer 7

1. Position: FProADD + or - wrist flexion (pronator teres Rex)
2. Muscle action: forearm pronation
3. Nerve: median (C6-T1)
4. Tenderpoint: anteromedial elbow, distal medial epicondyle

Question 8

Dorsal wrist extensor carpi radialis counterstrain

Answer 8

1. Position: EAbd(Radial deviation)
2. Muscle action: wrist extension and abduction
3. Nerve: Radial (C5-C6)
4. Tenderpoint: dorsal base MC2

Question 9

Dorsal wrist extension extensor carpi ulnaris counterstrain

Answer 9

1. Position: EAdd (ulnar deviation)
2. Muscle action: wrist extension and adduction
3. Nerve: radial (C5-C6)
4. Tenderpoint: dorsal base MC 5

Question 10

Palmar wrist flexor carpi ulnaris counterstrain

Answer 10

1. Position: FAd (ulnar deviation)
2. Muscle action: wrist flexion and adduction
3. Nerve: ulnar (C8-T1)
4. Tenderpoint: palmar base MC5

Question 11

Palmer wrist flexor carpi radialis counterstrain

Answer 11

1. Position: FAb (radial deviation)
2. Muscle action: wrist flexion and abduction
3. Nerve: medial (C6-T1)
4. Tenderpoint: palmar base MC2 or 3

Question 12

First MC abductor pollicis brevis counterstrain

Answer 12

1. Position: FAbd thumb
2. Muscle action: abduct thumb
3. Nerve: median (C6-T1)
4. Tenderpoint: palmar base MC1 in APB muscle

Question 13

Medial meniscus/MCL counterstrain

Answer 13

1. Position: FIrAd, F=60 knee off table
2. MCL connection: medial epicondyle femur to medial epicondyle tibia
3. Tenderpoint: anteromedial aspect of meniscus on joint line

Question 14

Lateral meniscus/LCL counterstrain

Answer 14

1. Position: FAbd Ir/Er, F= 35-40 and off table
2. LCL connection: lateral epicondyle of femur to fibular head
3. Tenderpoint: anterolateral aspect of meniscus on joint line

Question 15

Medial hamstring (semimembranosus) counterstrain

Answer 15

1. Position: FIrAdd, pt prone, plantarflex by heel compression
2. Muscle actions: hip extension, knee flexion
3. Nerve: Tibial n. (L4-S3)
4. Tenderpoint:
   A. In front of attachment at knee
   B. Posterior thigh medial to midline halfway down femur shaft

Question 16

Lateral hamstring (biceps femoris) counterstrain

Answer 16

1. Position: FErAbd, pt prone, plantarflex by heel compression
2. Muscle action: hip extension, knee flexion
3. Nerve: long head - tibial (L4-S3), short head - common fibular (L4-S2)
4. Tenderpoint:
   A. Distal attachment biceps femoris
   B. Posterior thigh lateral to midline halfway down femur shaft

Question 17

Iliotibial (IT) band/lateral trochanter counterstrain

Answer 17

1. Position: FAbd + or - rotation
2. IT connection: anterolateral iliac crest to lateral tibial condyle
3. Tenderpoint: along IT band, distal to lateral trochanter

Question 18

Tensor fascia latae/lateral trochanter counterstrain

Answer 18

1. Position: FAbd + or - rotation, pt prone
2. Muscle action:
   A. Hip flexion, internal rotation, abduction
   B. Knee external rotation
3. Nerve: superior gluteal (L4-S1)
4. Tenderpoint: inferior to iliac crest in TFL body

Question 19

Flexion calcaneus (quadratus plantae) counterstrain

Answer 19

1. Position: knee flex, foot plantarflexion, foot on dr thigh, forefoot flexes toward heel
2. Muscle actions: DIP joint flexion
3. Nerve: lateral plantar (L4-S3_
4. Tenderpoint: ant calcaneus on plantar surface

Question 20

Plantar navicular counterstrain

Answer 20

1. Position: FSupInv, pt prone

2. Tenderpoint: plantar surface navicular bone

Question 21

Medial ankle (tibialis ant) counterstrain

Answer 21

1. Position: InvShr, pt lat recumbent (tenderpoint faces floor)
2. Deltoid ligaments: ant and post tibiotalar, tibionavicular, tibiocalcaneal
3. Muscle actions: foot dorsiflexion
4. Nerve: deep fibular (L4-S2)
5. Tenderpoint: inferior medial malleolus along 2cm arc

Question 22

Lateral ankle (fibularis brevis and longus) counterstrain

Answer 22

1. Position: EvShr, pt lat recumbent, tenderpoint toward floor
2. Ligaments: ant talofibular, post inferior talofibular, calcaneofibular
3. Muscle actions: flexion, eversion, foot plantar
4. Nerve: superficial fibular (L4-S2)
5. Tenderpoint: sinus tarsi (talocalcaneal sinus) 2 cm ant and inferior from lateral malleolus

Question 23

Extension ankle (gastrocnemius and soleus)

Answer 23

1. Position: knee flex, foo on dr thigh, ankle plantarflexed, heel pushed to popliteal, pt prone
2. Muscle action:
   A. Knee flex (gastrocnemius only)
   B. Foot plantarflexion
3. Nerve: tibial (L4-S3)
4. Tenderpoint
   A. Medial and lateral distal to popliteal
   B. Medial and lateral distal musculotendinous junction of soleus
   C. Medial and lateral Achilles