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OPP 11/28/12
Midterm positions and contraindications
| Question | Answer |
|---|---|
| Piriformis Counterstrain Contraindidcations | Severe hip arthritis, deep venous thrombosis in involved leg, hip replacement, or history of hip dislocation |
| Piriformis Counterstrain Location | Mid-Buttock, halfway between top of greater trochanter and mid-line of sacrum |
| Piriformis Counterstrain Technique | Label 10/10, Prone, Bend knee off table on tender point side, Flex hip 90° and aBDuct and externally rotate hip, hold for 90 seconds, Retest (Piriformis position of ease and Piriformis stretch for stretching) |
| Lateral Trochanter Counterstrain Contraindications | Deep venous Thrombosis |
| Lateral Trochanter Counterstrain Location | Hold the ankle with one hand and locate point on lateral thigh between greater trochanter and knee |
| Lateral Trochanter Counterstrain Technique | Label 10/10, Supine, aBDuct and slightly externally rotate the leg, hold for 90 seconds, Retest |
| Hip myofascial release Contraindications | Acute hip fracture or dislocation, deep venous thrombosis, severe hip or knee osteoarthritis |
| Hip myofascial release Location | Flex the hip and knee to 90° and test internal rotation and external rotation to determine direction of laxity and restriction (TEST BOTH SIDES AND COMPARE) |
| Hip myofascial release technique (Indirect) | Indirect: Move the hip to its positions of laxity, apply compression or traction along the femur to facilitate laxity and follow release, Retest |
| Hip myofascial release technique (Direct) | Move the hip into its restriction and apply gentle force until tissue give is completed, retest |
| Hip Muscle energy contraindications | Acute hip fracture or dislocation, acute hip sprain, hip join inflammation, or femoral head avascular necrosis |
| Hip Muscle energy location | Test hip flexion-extension, abduction-adduction, and internal-external rotation to identify barriers (test both sides and compare) |
| Hip Muscle energy technique | Move the hip to its restrictive barrier and ask the patient to gently push the leg away from the restriction against resistance for 3-5 seconds, allow full relaxation, move to new barrier and repeat 3-5 times, RETEST |
| Hip dysfunction treatments | Piriformis counterstrain, Lateral Trochanter counterstrain, hip mysfascial release, hip muscle energy |
| Medial/Lateral meniscus counterstrain Contraindications | Acute knee sprain with internal derangement or deep venous thrombosis |
| Hip Muscle energy technique | Move the hip to its restrictive barrier and ask the patient to gently push the leg away from the restriction against resistance for 3-5 seconds, allow full relaxation, move to new barrier and repeat 3-5 times, RETEST |
| Medial/Lateral meniscus counterstrain Contraindications | Acute kneww sprain with internal derangement or deep venous thrombosis |
| Medial/lateral meniscus counterstrain technique | Label 10/10, Supine, Hold ankle, flex the knee about 60° by dropping the leg off the table, fine tune with slight tibia rotation and add/abduction, hold for 90 seconds, RETEST |
| Patella Tendon counterstrain contraindications | Acute knee sprain with internal derangement, acute patella fracture, or deep venous thrombosis |
| Patella tendon counterstrain location | Place your knee under the foot and locate the tender point in the patella tendon |
| Knee Myofascial release technique (direct) | Slowly move the tibia into its restrictions and maintain constant force until tissue give is completed, RETEST |
| Patella tendon counterstrain technique | Label 10/10, Supine, Push the distal femur posterior to extend the knee, fine tune with slight tibia internal or external rotation, hold for 90 seconds, RETEST |
| Fibular head muscle energy contraindications | Acute ankle sprain, acute fibular fracture, deep venous thrombosis, or ankle join laxity |
| Knee myofascial release contraindications | Acute fracture or deep venous thrombosis |
| Fibular head muscle energy location | Supine, knee bent, place thumb and index finger on anterior and posterior sides of the proximal fibular head, |
| Knee myofascial release location | Supine or seated, Grasp leg on tibial plataeu and hold the foot between your knees, Move the tibia into anterior-posterior glide,medial-lateral glide, and internal-external rotation to determine directions of laxity/restriction |
| Knee Myofascial release technique (indirect) | Slowly move the tivia to its positions of laxity and follow any tissue relase until completed, RETEST |
| Knee Myofascial release technique (direct) | Slowly move the tibia into its restrictions and maintain constant force until tissue give is completed, RETEST |
| Fibular head muscle energy contraindications | Acute ankle sprain, acute fibular fracture, deep venous thrombosis, or ankle join laxity |
| Fibular head muscle energy location | Supine, knee bent, place thumb and index finger on anterior and posterior sides of the proximal fibular head, |
| Fibular head muscle energy technique | Supine, Flex the knee 90°, pull the fibular head anterolaterally while dorisflexiing the foot to its restrictive barrier, Ask the patient to plantarflex (3-5 seconds), relax, repeat 3-5 times, Retest |
| Knee Dysfunction treatments | Medial/lateral meniscus counterstrain, Patella tendon counterstrain, knee myofascial release, Fibular head muscle energy |
| Glenohumeral myofascial release contraindications | Acute shoulder sprain or fracture, glenohumeral joint inflammation, gelnohumeral dislocation |
| Glenohumeral myofasical release location | With patient seated, grasp one or both arms at the elbow and induce passive aBDuction, observe restriction |
| Glenohumeral myofascial release technique | Sit at the head of the table and hold AC join with one hand and proximal forearm with other hand, slowly abduct arm while maintaining internal rotation, slowly externally rotate the arm and move into additional aBDuction, return and retest |
| Supraspinatus counterstrain contraindications | Acute shoulder fracture or dislocation |
| Supraspinatus counterstrain location | Locate tenderpoint in the supraspinatus muscle or its insertion onto the greater tubersity of the humerous |
| Supraspinatus counterstrain technique | Label 10/10, Slowly aBDuct the arm 45°, fine tune with slight arm external rotation, hold for 90 seconds, RETEST |
| Acromioclavicular counterstrain contraindications | Acute shoulder sprain, dislocation, or fracture |
| Acromioclavicular counterstrain location | Locate the tender point at the anterior acromioclavicular joint |
| Acromioclavicular counterstrain technique | Label 10/10, Hold the wrist, flex and adduct the shoulder, apply slight traction down the arm, hold for 90 seconds, retest |
| Scapular myofascial release contraindications | Acute scapula fracture |
| Scapular myofascial release location | Stand facing the patiend and drape the involved arm over your hand, holding the inferior angle of the scapula, Hold acromion and superior scapula with other hand, Move to determine restrictions |
| Scapular myofascial release technique (indirect) | Slowly move the scapula into its positions of laxity and follow any tissue release until completed |
| Scapular myofascial release technique (direct) | Slowly move the scapula into its restrictions and apply steady force until tissue give is completed |
| Shoulder dysfuntion treatments | Glenohumeral myofascial relase, supraspinatus counterstrain, acromioclavicular counterstrain, scapular myofascial release |
| Extension ankle counterstrain contraindicaitons | Acute ankle sprain with join instability, acute fracture, deep venous thrombosis |
| Extension ankle counterstrain location | Locate tender point in the proximal gastrocnemius muscle near its medial or lateral origin |
| Extension ankle counterstrain technique | Label 10/10, Prone, Flex patient's knee, place your foot on the table and rest the patient's foot on your thigh, fine tune by pushing the patient's foot into your thigh, hold for 90 sec, RETEST |
| Lateral ankle counterstrain contraindications | Acute ankle sprain with join instability, acute fracture, or deep venous thrombosis |
| Lateral ankle counterstrain location | With the patient lying on the side of the problem, use one hand to hold the distal tibia and find tender point anterior and inferior to lateral malleolus |
| Lateral ankle counterstrain technique | Label 10/10, lateral, Hold the heel with your other hand,m evert the foot by pushing the heel toward the floor, fine tune with more or less eversion, hold for 90 seconds, RETEST |
| Medial ankle counterstrain contraindications | Acute ankle sprain with joint instability, acute fracture, deep venous thrombosis |
| Medial ankle counterstrain location | With patient lying on opposite side of the problem, use one hand to hold the distal tibia and find tender point inferior to the medial malleolus |
| Medial ankle counterstrain technique | Label 10/10, Lateral, Invert the foot with your other hand and fine tune with interal rotation and inversion, hold for 90 seconds, RETEST |
| Ankle myofascial release contraindications | Acute fracture or dislocation, calf deep venous thrombosis or acute sprain |
| Ankle myofascial release location | Hold the calcaneus and platar surface of the foot with one hand and the distal leg with the other, Test ankle dorsiflexion and plantear flexion and compare both sides |
| Ankle myofascial release technique (indirect) | Gently and slowly move the ankle to its position of laxity, apply compression or traction between your hands, follow any tissue release, RETEST |
| Ankle myofascial release technique (direct) | Slowly move the ankle into its restriction and apply steady force until tissue give is completed, RETEST |
| Ankle muscle energy contraindications | Acute fracture or dislocation, acute sprain, ankle join inflammation, or calf deep venous thrombosis |
| Ankle muscle energy location | Test ankle dorsi and plantar flexion, compare both sides |
| Ankle muscle energy technique | Move ankle to restrictive barrier, ask patient to push (or pull) against restrictive barrier for 3-5 seconds, allow full relaxtion, move ankle to new barrier, repeat 3-5 times, RETEST |
| Ankle dysfuncation treatments | Extension ankle counterstrain, Lateral ankle counterstrain, medial ankle counterstrain, ankle myofascial release, ankle muscle energy |
| Posterior thoracic counterstrain tenderpoint locations (T1-T9) | T1-T9: Spinous process or 1/2" lateral |
| Posterior thoracic midline counterstrain contraindications | Acute fracture |
| Posterior thoracic midline counterstrain technique | Label 10/10, prone, have patient cross wrists and intertwine fingers, rest head on arms, extend the upper thoracic spine, hold for 90 seconds, RETEST |
| Posterior thoracic lateral counterstrain contraindications | Acute fracture, shoulder dislocation |
| Posterior thoracic lateral counterstrain technique | Label 10/10, prone, life the shoulder of the side of the tneder point posteriorly toward point, hold for 90 seconds, RETEST |
| Anterior Cervical Counterstrain (C1) contraindications | Acute fracture or dislocation, atlantoaxial instability, vertebrobasilar insufficiency |
| Anterior Cervical Counterstrain (C1) location | Locate the tender point at the C1 transverse processes located between the angle of the madibular and mastoid process |
| Anterior cervical counterstrain (C1) technique | Label 10/10, supine, Rotate the head away from the tender point, fine tune wiht more rotation and slight flexion, hold for 90 seconds, RETEST |
| Anterior cervical counterstrain (C2-C8)Contraindications | Acute cervical fracture or dislocation |
| Anterior cervical Counterstrain (C2-C8) location | Locate the tender points on the anterior aspect of the articular pillar (C7 is located on sternoclavicular joint) |
| Anterior cervical counterstrain (C2-C8) technique | Label 10/10, Supine, AC2-C6: flexion, sidebending and rotation away from tenderpoint AC7: Flexion, sidebending toward and roation away from tender point, Hold for 90 seconds, RETEST |
| Posterior Cervical counterstrain (C1) contraindications | Acute cervical fracture or dislocation, vertebrobasilar insufficiency |
| Posterior cervical counterstrain (C1) Location | Locate tenderpoint just inferior to the lateral nuchal line or on the posterior arch of the atlas |
| Posterior cervical counterstrain (C1) technique | Label 10/10, Supine, gently push the back of the head inferiorly to extend the occiput, fine tun eiwht extension, sidebending, or rotation, Hold for 90 seconds, RETEST |
| Posterior cervical counterstrain (C2-C7) contraindications | Acute fracture or dislocation, vertebrobasilar insufficiency |
| Posterior cervical counterstrain (C2-C7) location | Locate tender point on the spinous process or articular pillar |
| Posterior cervical counterstrain (C2-C7) technique | Label 10/10, Supine, Extend the head, fine tune with slight sidebeding and rotation away from the tenderpoint, hold for 90 seconds, RETEST |
| Posterior Lumbar counterstrain (T10-L5) location | Spinous processes or 1/2"-1" lateral |
| Posterior Lumbar counterstrain (T10-L5) contraindications | Acute fracture, hip dislocation, severe hip osteoarthritis |
| Posterior Lumbar counterstrain (T10-L5) technique | Label 10/10, Prone, Stand on the opposite side and lift the thigh on the side of the tender point to extend hip, fine tune with extention, abduction or adduction, Hold for 90 seconds, RETEST |
| Lower pole L5 counterstrain location | Inferior surface of the PSIS |
| Lower pole L5 counterstrain contraindication | Acute fracture, hip dislocation, severe hip osteoarthritis |
| Lower pole L5 counterstrain technique | Label 10/10, Prone, Flex the hip and knee 90°, fine tune with slight aDDuction, Hold for 90 seconds, RETEST |
| Anterior Lumbar Counterstrain: T9-L5 anterior counterstrain locations | AT9: 1/2"-1" superior to bellybutton; AT10: 1" below bellybutton; AT11: 2" below bellybutton; AT12: inner aspect of iliac crest in mid-ax line; AL1: 1/2" medial to ASIS, AL2: Medial surface of AIIS; AL3: Lateral AIIS; AL4: Inferior AIIS; AL5: Pubic ramus |
| T9-L5 counterstrain contraindications | Acute lumbar fracture, acute lumbar strain and sprain |
| T9-L5 counterstrain technique | Label 10/10, Supine, Flex the knees and hips 90°, fine tune with increased hip flexion or slight rotation/sidebending of the knees, hold for 90 seconds, RETEST |
| Iliopsoas counterstrain contraindications | Acute lumbar or hip fracture, hip dislocation |
| Iliopsoas counterstrain location | Stand beside the patient and locate the tender point 1" medial and slightly inferior to the ASIS |
| Iliopsoas counterstrain technique | Label 10/10, Supine, Cross the ankles and passively flex the knees and hips 90°, allowing the hips to externally rotate, hold for 90 seconds, RETEST |
Created by:
mcasto
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