Counterstrain Points 3l722h

Tender Point

Location On posterior aspect of ascending ramus of mandible at the level of earlobe AC2-6 On anterolateral aspect of corresponding anterior tubercle of transverse process AC7 On posterior-superior surface of clavicle at the clavicular attachment of SCM AC8 On medial head of clavicle at sternal attachment of SCM Anterior Cervical Region AC1

Treatment RA F SA RA F ST RA F SA RA

Posterior Cervical Region Tender Point Location PC1 Inion On inferior nuchal line, just lateral to inion PC1 lateral (occiput) Just below nuchal line midway between inion & mastoid, associated with semispinalis capitis and obliquus capitis superior PC2 lateral (occiput) On inferior nuchal line within the semispinalis capitis muscle associated with greater occipital nerve PC2 midline Superior lateral surface of C2 spinous process PC3 midline Inferior/inferolateral aspect/tip of C2 spinous process PC4-8 midline Inferior/inferolateral aspect of spinous process (ie. PC4 inferior to C3 spinous process) PC3-7 lateral On posterior lateral aspect of articular process

Anterior Thoracic Region Tender Point

Location

Treatment F E Sa Ra E Sa Ra E Sa Ra F Sa Ra E Sa Ra E Sa Ra

Treatment

AT1 midline AT2-6 midline AT7-9 B/L AT10-12 B/L

On episternal notch, midline or just lateral On sternum at level of corresponding rib AT7: ¼ distance tip of xiphoid and umbilicus AT8: ½ between tip of xiphoid and umbilicus AT9: ¾ distance tip of xiphoid and umbilicus AT10: ¼ distance umbilicus and pubic symphysis AT11: ½ between umbilicus and pubic symphysis AT12: top of iliac crest at midaxillary line

Posterior Thoracic Region Tender Point Location PT1-12 midline Midline, on inferior aspect of spinous process PT1-12 posterior On inferolateral aspect of deviated spinous process PT1-12 TP On lateral aspect of transverse process

Anterior Costal Region Tender Point

Location

F F F St RA F St Ra

Treatment e-E e-E SA RA e-E SA RT

Treatment

AR1 AR2 AR3-6

Below clavicle at first chondrosternal articulation On superior aspect of 2nd rib at MCL On dysfunctional rib at anterior axillary line

Posterior Costal Region Tender Point PR1 PR2-6

Location

On posterior-superior aspect of rib 1 just lateral to costotransverse articulation On posterior-superior angle of corresponding rib

Anterior Lumbar Region Tender Point Location AL1 Medial to ASIS AL2 Medial to AIIS AL3 Lateral to AIIS AL4 Inferior to AIIS AL5 Anterior, superior aspect of pubic ramus just lateral to symphysis

Anterior Pelvic Region Tender Point

Location

f-F St RT f-F St RT f-F ST RT

Treatment E SA Rt f SA RA

Treatment F ST RA F SA RT F SA RT F SA RT F SA RA

Treatment

Psoas Iliacus Low ilium Inguinal

2/3 distance from ASIS to midline, pressing deep in posterior direction ½ distance from ASIS to midline, pressing deep in posterior-lateral direction Superior surface of iliopubic eminence associated with attachment of psoas minor Medial aspect of inguinal ligament near pubic tubercle in association with attachment of pectineus

Posterior Lumbar Region Tender Point Location PL1-5 SP On inferolateral aspect/tip of deviated spinous process PL1-3 TP On lateral aspect of transverse process Quadratus Lumborum On inferior aspect of 12th rib On lateral tips of lumbar transverse process On superior aspect of iliac crest

Posterior Pelvic Region Tender Point

Location

F ST F ER F F ADD IR

Treatment e-E St Ra e-E ST RA E Abd ER

Treatment

Upper Pole L5 High ilium sacroiliac Lower Pole L5 High ilium flare out Gluteus medius PL3, PL4 Piriformis

Sacral Region Tender Point PS1 B/L

Superior medial surface of PSIS 2-3cm lateral to PSIS, pressing medially toward PSIS On ilium just inferior to PSIS, pressing superiorly Lateral aspect of ILA and/or lateral aspect of coccyx Upper outer portion of gluteus medius at level of PSIS PL3: 2/3 lateral from PSIS to TFL PL4: posterior margin of TFL Midpoint between lower half and lateral aspect of sacrum and ILA and greater trochanter

E add IR/ER E Ab ER F IR add E Add E er abd

Location Medial to PSIS at level of S1

Treatment Apply P-A pressure on opposite ILA 2: apply P-A pressure midline to apex of sacrum 3: F or E 4: apply P-A pressure midline to base of sacrum Apply P-A pressure on opposite sacral base

PS2, PS3, PS4 midline

Midline on sacrum at corresponding sacral level

PS5 B/L

Just medial and superior to ILA

Lower Extremities Tender Point

Location

F Abd IR/ER

Treatment

TFL Lateral trochanter IT band Lateral hamstring Biceps femoris Lateral meniscus LCL Medial hamstring Semimembranosus Semitendinosus Medial meniscus MCL ACL

Inferior to crest of ilium in body of TFL Along IT band distal to greater trochanter

f Abd F Abd

In posterior thigh lateral to midline, approximately halfway down shaft of femur Lateral aspect of meniscus on t line

F ER Abd

In posterior thigh medial to midline approximately halfway down shaft of femur

F IR Add

Anteromedial aspect of meniscus on t line

F IR Add

Superior aspect of popliteal fossa on hamstring tendon

PCL

In center/slightly below center of popliteal fossa

Popliteus

In belly of popliteus muscle, just inferior to popliteal space

Extension ankle gastrocnemius

Within proximal gastrocnemius muscles distal to popliteal margin

Medial ankle tibialis anterior

Inferior to medial malleolus along deltoid ligament

Lateral ankle fibularis or peroneus longus, brevus, tertius

Inferior and anterior to lateral malleolus in talocalcaneal sulcus

Flexion calcaneous Quadratus plantae

Anterior aspect of calcaneus on plantar surface of foot as attachment of plantar fascia

Place pillow under distal femur to create fulcrum, apply shearing force by moving proximal tibia posteriorly on femur Place pillow under distal femur to create fulcrum, apply shearing force by moving distal femur posteriorly on proximal tibia Slight flexion of knee with internal rotation of tibia Marked plantar flexion of ankle with knee flexion Place fulcrum on medial aspect of ankle, apply inversion force with slight shear Place fulcrum on lateral aspect of ankle, apply eversion force with slight shear Marked flexion of forefoot approximating the forefoot to the calcaneus

Upper Extremities Tender Point

Location

F Ab/ER

Treatment

Supraspinatus Infraspinatus

Levator scapulae

Subscapularis Long head of biceps Short head of biceps Corachobrachialis Pectoralis minor

In belly of supraspinatus muscle Upper: inferior and lateral to spine of scapula at posterior medial aspect of GH Lower: in lower portion of muscle inferior to spine and lateral to medial border of scapula On superior medial border of scapula at attachment of levator scapula

At anterolateral border of scapula on subscapularis muscle, pressing from anterior-lateral to posteromedial direction Over biceps tendon in bicipital groove At inferolateral aspect of coracoid process Inferior and medial to coracoid process

Radial head – lateral

On anterolateral aspect of radial head at attachment of supinator

Medial epicondyle

On medial epicondyle of humerus at common flexor tendon and attachment of pronator teres On dorsal surface of 2nd metacarpal in extensor carpi radialis On dorsal surface of 5th metacarpal in extensor carpi ulnaris At palmar base of 2nd/3rd metacarpal in flexor carpi radialis At palmar base of 5th metacarpal in flexor carpi ulnaris

Dorsal wrist

Palmar wrist

F Abd ER F IR Abd

Glide scapula superiorly and medially to shorten muscle; could also internally rotate shoulder with traction and slight abduction E IR F Abd IR F Add IR Adduction of arm; protract scapula Elbow in full extension, forearm marked supination and slight valgus force F Pronate Add E Ab E Add F Ab F Add