Board prep for Counterstrain points of the upper and lower extremity

Flashcards covering location and classic treatment positions for documented Upper and Lower Extremity Counterstrain points based on the Atlas of Osteopathic Techniques.

What is the location and classic treatment for the Levator scapulae counterstrain point?

Located on the superior medial border of the scapula; treated by gliding the scapula superiorly and medially (Scap Sup Med) or alternatively by marked internal rotation of the shoulder with traction and slight abduction (IR Abd traction).

Where is the Supraspinatus counterstrain point located, and what is the treatment acronym?

Located in the belly of the supraspinatus muscle; treatment is Flexion of shoulder, abduction, with marked external rotation (F Abd ER).

Describe the location and treatment for the Upper Infraspinatus counterstrain point.

Located inferior and lateral to the spine of the scapula at the posterior medial aspect of the glenohumeral joint; treatment is Flexion of shoulder to $90-120$ degrees and abduction, with optional external or internal rotation (F Abd er/ir).

Describe the location and treatment for the Lower Infraspinatus counterstrain point.

Located in the lower portion of the muscle inferior to the spine and lateral to the medial border of the scapula; treatment is Flexion of shoulder to $135$ degrees with slight abduction and external or internal rotation (F Abd er/ir).

What is the classic treatment position for the Rhomboid minor and major counterstrain points?

With the patient seated or prone: Shoulder extension with adduction by pulling the arm posterior and medial (E Add).

How is the Subscapularis counterstrain point treated?

Shoulder extension and internal rotation (E IR).

What is the location and treatment for the Long head of biceps counterstrain point?

Located over the tendon in the bicipital groove; treatment is Flexion of elbow, shoulder flexion, abduction, and internal rotation (F Abd ir).

What is the location and treatment for the Short head of biceps/coracobrachialis counterstrain point?

Located at the inferolateral aspect of the coracoid process; treatment is Flexion of elbow, shoulder flexion, adduction, and internal rotation (F Add ir).

Where is the Pectoralis minor counterstrain point located and how is it treated?

Located inferior and medial to the coracoid process; treatment is Adduction of the arm and protraction of the scapula medial and caudad (f-F Add).

What is the location and treatment for the Radial head lateral (supinator point)?

Located on the anterolateral aspect of the radial head; treatment is Elbow in full extension, forearm in marked supination, and slight valgus force (E SUP Val).

What is the classic treatment for the Medial epicondyle (pronator teres) counterstrain point?

Flexion, marked pronation, and slight adduction of the forearm with slight flexion of the wrist (F PRO Add).

What are the locations and treatments for the Dorsal wrist counterstrain points?

At the 2nd metacarpal (extensor carpi radialis): Wrist extension with slight abduction (E Abd). At the 5th metacarpal (extensor carpi ulnaris): Wrist extension with slight adduction (E Add).

How are the Palmar wrist counterstrain points for Flexor carpi radialis and Flexor carpi ulnaris treated?

Flexor carpi radialis (2nd or 3rd metacarpal): Wrist flexion with slight abduction (F Abd). Flexor carpi ulnaris (5th metacarpal): Wrist flexion with adduction/Ulnar Deviation (F Add).

What is the treatment for the First carpometacarpal (abductor pollicis brevis) counterstrain point?

Wrist flexion with abduction of the thumb (F Abd), though some notes also indicate F ADD.

What is the treatment for the Tensor fascia latae and Lateral trochanter (IT band) counterstrain points?

Both are treated with abduction of the hip/thigh and slight flexion (f ABD).

Where is the Lateral hamstring (Biceps femoris) point located and how is it treated?

Located in the posterior thigh lateral to the midline halfway down the femur; treatment is Flexion of the knee, external rotation, and slight abduction of the tibia, with plantar flexion of the ankle via calcaneal compression (F ER Abd).

Where is the Medial hamstring (Semimembranosus/Semitendinosus) point located and how is it treated?

Located in the posterior thigh medial to the midline halfway down the femur; treatment is Flexion of the knee, internal rotation, and slight adduction of the tibia, with plantar flexion of the ankle via calcaneal compression (F IR Add).

How is the Lateral meniscus counterstrain point treated?

Moderate knee flexion, slight abduction, and internal or external rotation of the tibia (F Abd ir/er).

How is the Medial meniscus counterstrain point treated?

Moderate knee flexion, internal rotation, and slight adduction of the tibia (F IR Add).

What is the classic Jones treatment for an Anterior cruciate ligament (ACL) counterstrain point?

Place a pillow under the distal femur as a fulcrum and apply a shearing force by moving the proximal tibia posteriorly on the femur.

What is the classic Jones treatment for a Posterior cruciate ligament (PCL) counterstrain point?

Place a pillow under the distal femur as a fulcrum and apply a shearing force by moving the distal femur posteriorly on the proximal tibia.

What are the treatment positions for the Popliteus and Gastrocnemius points?

Popliteus: Slight flexion of the knee with internal rotation of the tibia (F IR). Gastrocnemius: Marked plantar flexion of the ankle with knee flexion.

How are the Medial and Lateral ankle counterstrain points treated?

Medial ankle (Tibialis anterior): Inversion force with slight internal rotation (INV ir). Lateral ankle (Fibularis): Eversion force with slight external rotation (EV er).

What is the location and treatment for the Flexion calcaneus (Quadratus plantae) point?

Located on the anterior aspect of the calcaneus on the plantar surface; treated by marked flexion of the forefoot approximating it to the calcaneus (F).