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Jones Institute

Originators of the Strain Counterstrain


Technique

Strain Counterstrain I
For 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 1995
Artwork 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

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 Counterstrain
1. 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.

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.

Jump sign & grimace.

Documenting the diagnosis.


5

Similarities & differences to other systems that use points

Tender points are at least four times more tender than the patients normal tissue
to palpation. Push with enough pressure to elicit a mild response from the
patients 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.

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
TECHNIQUE
1. Locate tender point
2. 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 RULES
1. 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.
7

10

ANTERIOR CERVICALS
LC 1
Tender Point:

(p. 46)
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)
Tender Point:

(p. 43)
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-none
Side-bend - away slightly
Rotate - away markedly
Direct 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:

AC 2
Tender Point:
posteriomedial.
Treatment:

AC 3
Tender Point:
posteriomedial.

Patient supine
Flexion - marked
Side-bend - toward slightly
Rotate - away
(p. 44)
Anterior surface of tip of C 2 transverse process. Push
Patient supine. Same as AC 1
Flexion - little if any
Side-bend - away slight
Rotate - away
(p.44)
Anterior surface of tip of C 3 transverse process. Push

11

Treatment:

Patient supine
Flexion - marked
Side-bend away, sometimes toward
Rotate - away

12

AC 4
Tender Point:
posteriomedial.
Treatment:

AC 5
Tender Point:
posteriomedial.
Treatment:

AC 6
Tender Point:

(p.44)
Anterior surface of tip of C 4 transverse process. Push
Patient supine
Flexion - slight to moderate, sometimes likes slight extension
Side-bend - away
Rotate - away
(p.44)
Anterior surface of tip of transverse process of C 5. Push
Patient supine
Flexion - moderate
Side-bend - away
Rotate - away
(p.44)
Anterior surface of tip of C 6. Push posteriomedial.

Treatment:

Patient supine
Flexion - moderate
Side-bend - away
Rotate - away

AC 7
Tender Point:

(p. 45)
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 supine
Flexion - marked; support lower posterior neck.
Side-bend - toward markedly
Rotate - away slightly

AC 8
Tender Point:
Treatment:

(p. 45)
Medial end of clavicle. Push laterally.
Patient supine
Flexion - slightly
Side-bend - away slightly
Rotate - away markedly

13

TR Trachea
Tender Point:

(p. 48)
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 supine
Flexion - marked, support lower neck
Side-bend - toward slightly
Rotate - away slightly

SECTION NOTES:
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15

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 supine
Flexion - marked (tuck chin)
Side-bend - toward slightly
Rotate - away slightly

PC 1 (Regular)
Tender Point:

(p. 40)
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 1
Side-bend - away slightly
Rotate - away slightly
NOTE:
Augment extension of C 1 by hand pressure on top
of head.

PC 2
Tender Point:

(p. 40)
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 supine
Extension - same as PC 1
Side-bend - away slightly
Rotate - 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 supine
Flexion - marked
Side-bend away, sometimes toward
Rotate - away

16

PC 4
Tender Point:

(p. 41)
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:

PC 5,6,7
Tender Point:
vertebrae above.

Patient supine. In the supine position suspend the head over the
end of the table.
Extension
Side-bend - away
Rotate - away usually
(p. 42)
On either side of spinous processes of the corresponding

Treatment:

Patient supine
Extension - marked
Side-bend - away usually
Rotate - away
NOTE:
The more posterior the head is placed the lower the
action from PC 4 through PT 2.

PC 8
Tender Point:

(p. 42)
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 supine
Extension - slight
Side-bend - away markedly
Rotate - away

SECTION NOTES:
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19

20

21

ANTERIOR THORACICS
AT 1 AT 6 Midline Points
Points
AT 1
Tender Point:
Treatment:

AT 2
Tender Point:
Treatment:

AT 3
Tender Point:
Treatment:

AT 7 AT 12 Bilateral
(p. 57)

Midline in suprasternal notch. Push inferiorly.


Patient seated with hands on top of head. Operator places arms
around patient and locks hands over the manubrium.
Patient slides down operators torso producing thoracic flexion.
(p. 57)
Middle of manubrium. Push posteriorly.
Patient seated, same as AT 1 but lock hands lower at junction of
manubrium and sternum.
(p. 57)
On sternum just below sternal angle. Push posteriorly.
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 patients 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
Tender Point:

(p. 58)
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 patients upper thoracic area.
Flexion

22

23

AT 6
Tender Point:
Treatment:

(p. 58)
Xiphisternal junction. Push posteriorly.
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 operators thigh, who stands behind him. Patients feet on
table on side of tender point. (Side sitting)
Flexion - created by sitting
Side-bend - toward by translating trunk to opposite side.
Rotate away by placing patients tender point side arm across
front of body.
Operator tunes with hip movement.

AT 8
Tender Point:
Treatment:
AT 9
Tender Point:
posterior.
Treatment:
AT 10
60)
Tender Point:
posterior.
Treatment:

(p. 58)
2 cm below AT 7. 1.5 cm lateral to midline. Push posterior.
Same as AT 7
(p. 60)
Just above umbilicus. 1.5 cm lateral to midline. Push
Same as AT 7
(p.
Just below the umbilicus. 1.5 cm lateral to midline. Push
1. Patient supine. Raise the head of the table. Rest patients
flexed legs on operators thigh. Operator stands on side of the
tender point. Produce marked flexion at the level of dysfunction.
Side-bend - toward
Rotate - toward
2. 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.
24

AT 11
Tender Point:
midline.

(p. 60)
Suprapubic region at the level of the ASIS. 2 cm lateral to

Treatment:

Same as AT 10. Fine tune.

AT 12
Tender Point:

(p. 60)
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
51)
Tender Point:

Treatment:

(p.
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.
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 - away
Rotate - away
PT 3,4,5

(p. 51 &

52)
Tender Point:

Treatment:

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.

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 - away
Rotate - away

PT 6,7,8,9
Tender Point:
common.
Treatment:

(p. 52)
Lateral to spinous processes in paravertebral area is most

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 patients chest to assist the
thoracic extension to level.
28

Side-bend - away
Rotate - away
Alternate Technique
Treatment:
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 moderate
Side-bend is major force away
Rotate - toward

29

PT 10,11,12
Tender Point:
Treatment:

PL 1-5
(p. 53 & 72)
Lateral to spinous processes or on posterior aspect of
transverse processes is most common.
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 supine
Flexion - mild cervical
Rotate - toward markedly
Side-bend - toward. This is the greatest force applied. Point
patients chin toward the tenderpoint.

AR 2 Anterior Second Rib depressed


65)
Tender Point:
1. On second rib, in the mid clavicular line.
2. High in medial axilla.
Treatment:

(p.

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 sitting
Flexion - sitting is enough
Side-bend - toward tender point. Support patients opposite
axilla on the knee of the operator who stands behind him. Sidebend 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
Tender Point:

On or between the costal cartilage just lateral to sternum at the


corresponding level.
34

Treatment:

Patient seated with opposite side axilla supported on operators


knee, who stands behind patient. Patients feet on table on side
of tender point.
Flexion - trunk
Side-bend - toward by translating trunk to opposite side.
Rotate away by placing patients involved side arm across front
of body.

35

36

POSTERIOR RIBS ELEVATED


PR 1 Posterior First Rib elevated
Tender 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 operators thigh. Lean


patient mildly toward opposite side. Position head and neck.
Extension - slight
Side-bend - away slight
Rotate - 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 operators thigh,


who stands behind patient. Hand of opposite arm behind body.
Patients 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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39

ANTERIOR LUMBARS
AL 1
(p. 60)
Tender Point:
Medial surface of anterior superior iliac spine. Push
laterally, inch deep.
Treatment:

Patient supine. Raise the head of the table if possible. Rest


patients flexed legs on operators thigh. Operator stands on
side of the tender point. Produce marked flexion at the level of
dysfunction.
Flexion Side-bend - toward usually
Rotate - 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 - patients legs flexed 90 degrees
Rotate knees away from tender side 60 degrees (markedly).
Side-bend away slightly by pushing feet toward floor.

AbL 2 Abdominal
Tender Point:
Treatment:

(p. 74)
5 cm lateral to umbilicus. Push posteriorly.
Patient supine. Operator stands on same side as tender point.
Flexion - more than regular AL 2.
Rotate knees toward tender side 60 degrees
Side-bend - away by elevating feet upwards

AL 3
Tender Point:
medially.
Treatment:

(p. 75)
Lateral surface of anterior inferior iliac spine. Push

Patient supine. Operator stands on opposite side as tender


point.
Flexion - flex thighs 50-90 degrees over operators thigh.
Side-bend - away markedly by pulling feet toward operator.
Rotate - slightly to fine tune

AL 4

(p. 75)
40

Tender Point:
Inferior surface of anterior inferior iliac spine. Push
superiorly.
Treatment:

Same as AL 3 with fine tuning.

41

AL 5
Tender Point:

(p. 70)
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 slightly
Rotate knees toward side of tender point.

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43

44

POSTERIOR LUMBARS
PL 3 Iliac
Tender Point:

(p. 71)
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 slightly
Rotate marked external rotation. The operators lifting hand
placement will determine the amount of rotation. The higher the
hand the greater the rotation.

PL 4 Iliac
Tender Point:

(p. 71)
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 slightly
Rotate 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 operator
Adduct slight
Rotate 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 operators
thigh. Patients hip flexed 90 degrees. Patients hip is adducted
slightly.
Flexion hip to 90 degrees.
Adduct hip slightly
45

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 moderately
Rotate Play with external rotation to fine tune.

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48

49

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 degrees
Side-bend none
Rotate 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 patients 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 supine
Flex hip 130 degrees
Abduct 0 degrees
Rotate 0 degrees

ALT Anterior Lateral Trochanter


Tender Point:
Flex the hip to find this trigger. 2 cm lateral to the AIIS.
Push posteriorly.
Treatment:

Patient supine
Flex hip 90 degrees
Abduct moderate
Rotate external, little or none

50

IL Iliacus
Tender Point:

(p. 87)
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. Patients ankles supported on operators 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 operators thigh.
Move the unaffected leg over the top of the affected leg
crossing knees.
Adduction of femur
Rotate internal of femur

Add Adductors
Tender Point:

(p. 89)
Origin of adductors to pubic bone and along the length of the
belly of muscle.

Treatment:

Patient supine
Adduction 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.
51

Treatment:

Patient supine
Flexion hip to 90 degrees
Abduction slight
Rotate 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

52

53

54

POSTERIOR PELVIS AND HIP


HISI High Ilium Sacroilliac
79)
Tender Point:
3 cm lateral to the posterior superior iliac spine. Direct
palpating finger medially.
Treatment:

(p.

Patient prone
Extension hip supported on operators thigh
Abduction slight

HFO-SI High Flare-out Sacroiliac


80)
Note: May be associated with coccygodynia.

(p.

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:

PIR Piriformis
92)
Tender Point:
Treatment:

Patient prone
Flexion slight or possible slight extension
Abduction of hip, is the major component
(p.
In belly of piriformis muscle, on a line between the lateral
border of sacrum and greater trochanter. Push anteriorly.
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 patients foreleg
resting on operators thigh.
Flexion hip approximately 90 degrees
Abduct hip horizontally
55

Rotate slight internal if flexion is above 90 degrees. Slight


external if below 90 degrees.

56

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 patients thigh to
support extension.
Abduction slight
Rotate 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 patients ankle in his axilla then
stands up.
Extension hip, moderate
Adduction marked
Rotate 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 hip
Rotate hip, internal or external rotation, slight.
GM Gluteus Medius
91)

(p.
57

Tender Point:
Treatment:

On a line 1 cm below the iliac crest. Push anteriorly.

Patient prone. Operator on same side.


Extension hip, operator places knee under patients thigh to
support.
Abduction moderate
Rotate marked, internal

58

59

60

POSTERIOR SACRALS
PS 1
Tender Point:
Treatment:

(p. 85)
1.5 cm medial to the inferior aspect of the PSIS bilaterally.
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
Tender Point:
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
Tender Point:
spines.
Treatment:

(p. 85)
Midline on sacrum between the second and third sacral

Patient prone same as PS 2. Apply a downward pressure to the


apex of the sacrum in midline.

PS 4
Tender Point:
Treatment:

(p. 85)
Midline on sacrum between the first and second sacral

(p. 85)
Midline on sacrum just above the sacral hiatus.

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:

Cyx Coccyx Point


85)
Tender Point:

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.
(p.
Either side of tip of coccyx.

61

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

62

63

NAME:____________________________________
DATE:_________________
1
POS
CERV
IN
PC1
PC2

2
ANT RIBS
AR1
AR2
AR3

POS RIBS
PR1
PR2
PR3

KNEE
MM
MH
PCL

PC2

AR4

PR4

ACL

SH

PC3
PC4

AR5
AR6
INT
4
INT
5
INT
6
ANT LUM

PR5
PR6

PTE
LM

MC
LC

LH

SUB

SO

PL1

PAT

LD

PL2
PL3

PES
ANKLE

ADD
PAC

IO
MA
S
STY

PL4
UP
5

LAN

SUP

FRO

EXA

MTS2

LC

LP5
QL
POS
PELVIS
HISI
HFO
MPSI

MAN
FAN

LTS2
POS

ZY
SQ

TS3
TMJ
TMI
TRP

PA
PO

PC5
PC6
PC7
PC8
ANT
C
E
R
V

AL1

AC1
AC1
R
AC2

AL2

AC3
AC4
AC5
AC6

AL4
AL5
ANT PELVIS
LISI
LIF
O
IL
ING
POS THOR

ABL
2

AL3

AC7
AC8
LC1
TRA
ANT
T
H
O
R
AT1

POS LUM

TAL
FMC
FOOT
MCA

POS SAC
PS1
PS2
PS3

LCA
FCA
DCU
NAV

PT1

PS4

CUB

PT2

PS5

H.NA
V

SHLDR
AAC
BUR
LH

6
CRANIAL
OM
SB
SP
LA
M
CO
R
NAS

ELBOW
RAD
CND
MOL

LOL
WRIST
64

AT2
AT3
AT4
AT5
AT6
AT7
AT8
AT9
AT10
AT11
AT12

PT3
PT4
PT5
PT6
PT7
PT8
PT9
PT11
PT12

CYX
ANT HIP
AMT
ALT
ADD
GMI
POS HIP
PIR
PLT
PMT
LT
GME

M1
M2
M3
M4
M5
DM1
DM2
DM3
DM4
DM5
BUN

PWR
DWR
HAND
CM1
INT
ECM

65

NAME:___________________________________
_________

DATE: 1.
DATE: 2.

_________
DATE: 3.
_________
DATE: 4.
_________

ANTERIOR CERVICAL
L1C
A1C
A1CR
A2C
A3C
A4C
A5C
A6C
A7C
A8C
TRA

RIGHT
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

L1C
A1C
A1C
R
A2C
A3C
A4C
A5C
A6C
A7C
A8C
TRA

POSTERIOR CERVICAL

LEFT
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]

ACOL
2
ACOL
3
ACOL
4
ACOL
5
ACOL
6

[]
[]
[]
[]
[]

LEFT
ACOL [] []
2
[]
ACOL [] []
3
[]
ACOL [] []
4
[]
ACOL [] []
5
[]
ACOL [] []
6
[]

A2T

[]
[]

[]
[]
[]

[]
[]

A4T
A5T

[]
[]

P2C
P3C
P4C
P5C
P6C
P7C
P8C

[]
[]
[]
[]
[]
[]
[]
[]
[]

1N []

[]

[]

[]

P1C []

[]

[]

[]

P2C []

[]

[]

[]

P3C []

[]

[]

[]

P4C []

[]

[]

[]

P5C []

[]

[]

[]

P6C []

[]

[]

[]

P7C []

[]

[]

[]

P8C []

[]

[]

[]

[]

[]
[]
[]
[]
[]

ANTERIOR THORACIC
A1T

P1C

LEFT

[]

ANTERIOR LATERAL COLUMNS


RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

1N

RIGHT
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

POSTERIOR LATERAL COLUMNS


RIGHT
[] []
PCOL2
[]
[] []
PCOL3
[]
[] []
PCOL4
[]
[] []
PCOL5
[]
[] []
PCOL6
[]

[]
[]
[]
[]
[]

PCOL
2
PCOL
3
PCOL
4
PCOL
5
PCOL
6

LEFT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]

POSTERIOR THORACIC
[]
[]
[]

[]
[]

P1T

RIGHT
[] []

[]

P1T

LEFT
[] []

[]
66

A3T

A7T
A8T
A9T
A10T
A11T
A12T

[]

[]
[]
[]

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]

[]
[]
[]
[]
[]
[]

A6T

A7T
A8T
A9T
A10T
A11T
A12T

[]

[]
[]
[]

LEFT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]

P2T
P3T

[]
[]
[]
[]
[]
[]

P4T
P5T
P6T
P7T
P8T
P9T
P10T
P11T
P12T

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

P2T
P3T
P4T
P5T
P6T
P7T
P8T
P9T
P10T
P11T
P12T

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

SCALENES
RIGHT
[] []
SCA2
[]
[] []
SCA3
[]
[] []
SCA4
[]

[]
[]
[]

LEFT
[] []
SCA2
[]
[] []
SCA3
[]
[] []
SCA4
[]

[]
[]
[]

RIGHT
[] []
SCA5
[]
[] []
SCA6
[]
[] []
SCA7
[]

[]
[]
[]

SCA5
SCA6
SCA7

LEFT
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]

67

NAME:___________________________________
_________

DATE: 1.
DATE: 2.

_________
DATE: 3.
_________
DATE: 4.
_________

THORACO-LUMBAR ERECTOR
SPINAE
TLES6
TLES7
TLES8
TLES9
TLES1
0
TLES1
0
TLES1
1
TLES1
2

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]
[]
[]
[]

TLES6
TLES7
TLES8
TLES9
TLES1
0
TLES1
0
TLES1
1
TLES1
2

LEFT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

TRANSVERSOSPINALIS

[]
[]
[]
[]
[]
[]
[]
[]

ANTERIOR RIBS

A1R
A2R
A3R
A4R
A5R
A6R
INT
4
INT

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []

LEFT
[]
[]
[]
[]
[]
[]
[]
[]

RIGHT
[] []
TRAN1
[]
[] []
TRAN2
[]
[] []
TRAN3
[]
[] []
TRAN4
[]
[] []
TRAN5
[]
[] []
TRAN6
[]
[] []
TRAN7
[]
[] []
TRAN8
[]
[] []
TRAN9
[]
TRAN1 [] []
0
[]
TRAN1 [] []
1
[]
TRAN1 [] []
2
[]

A1R []

[]

[]

[]

A2R []

[]

[]

[]

A3R []

[]

[]

[]

A4R []

[]

[]

[]

A5R []

[]

[]

[]

P1R

A6R []

[]

[]

[]

P2R

INT4 []

[]

[]

[]

P3R

INT5 []

[]

[]

[]

P4R

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

LEFT
[] []
TRAN1
[]
[] []
TRAN2
[]
[] []
TRAN3
[]
[] []
TRAN4
[]
[] []
TRAN5
[]
[] []
TRAN6
[]
[] []
TRAN7
[]
[] []
TRAN8
[]
[] []
TRAN9
[]
TRAN1 [] []
0
[]
TRAN1 [] []
1
[]
TRAN1 [] []
2
[]

[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]

POSTERIOR RIBS
RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []

[]
[]
[]
[]

P1R
P2R
P3R
P4R

LEFT
[] []
[]
[] []
[]
[] []
[]
[] []

[]
[]
[]
[]
68

5
INT
6
SA

[]
[]

[]
[]
[]
[]
[]

[]
[]

INT6 []

[]

[]

[]

P5R

SA []

[]

[]

[]

P6R
FRI
B
SPI

ANTERIOR LUMBAR
A1L
A2L
AB2L
A3L
A4L
A5L

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]

A1L []

[]

[]

[]

P1L

A2L []

[]

[]

[]

P2L

AB2
[]
L

[]

[]

[]

P3L

A3L []

[]

[]

[]

P4L

A4L []

[]

[]

[]

A5L []

[]

[]

[]

UP5
L
LP5
L
PRL
2

ANTERIOR PELVIS
LISI
LIFO
IL
ING
FLS
PD

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]

[]
[]

[]
[]
[]

P5R
P6R
FRI
B
SPI

[]
[]
[]
[]

[]
[]
[]
[]

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]
[]
[]

P1L
P2L
P3L
P4L
UP5
L
LP5
L
PRL
2

LEFT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]
[]
[]

POSTERIOR PELVIS

LEFT
[]

[]

[]

[]
[]
[]
[]
[]
[]
[]
[]
[]

POSTERIOR LUMBAR

LEFT
[]

[]

[]
[]
[]
[]
[]
[]
[]
[]
[]

HI-ILSI
HFOSI

LISI []

[]

[]

[]

LIFO []

[]

[]

[]

IL []

[]

[]

[]

MPSI

ING []

[]

[]

[]

OI

FLS []

[]

[]

[]

GMX

PD []

[]

[]

[]

RIGHT
[] []
[]
[] []
[]
[] []
[]
[] []
[]
[] []
[]

[]
[]
[]
[]
[]

LEFT
[] []
HI-ILSI
[]
[] []
HFOSI
[]
[] []
MPSI
[]
[] []
OI
[]
[] []
GMX
[]
[] []
[]

[]
[]
[]
[]
[]
[]

69

Strain
Counterstrain
Home Program

70

Strain Counterstrain Home Program


General Rules:
1. Monitor tender point if possible
2. 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 CERVICAL


Lying: Palpate point behind jaw just below the lobe of the
ear. Turn head away from painful side until tenderness
diminishes.

MIDDLE ANTERIOR CERVICALS


Lying: 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 CERVICALS
Lying: 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 THORACICS


Sitting: Palpate point midline on the sternum. Slowly slump
in the chair, gently folding your body over the point until
the tenderness diminishes.
MIDDLE ANTERIOR THORACICS
Sitting: 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.
71

POSTERIOR THORACICS
Lying: 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 RIBS


Sitting: 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.

ILIACUS
Lying: 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 LUMBARS
Lying: 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.

PIRIFORMIS
Lying: 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.

72

73

Reference
Articles

74

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77

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79

80

81

82

83

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