Counterstrain Techniques

Location Indication for Tender Point Acronym Treatment

Treatment

Cervical traction SD of cervical N/A Supine Hand cupping under chin

spine and the other under
occiput; may be done for
2-5 min

Cervical Rotation SD of cervical N/A Supine Hand placement is

spine temporomandibular
region; hold position at
elastic limit for 3-5
seconds

AC 1 SD of C1 Posterior aspect of ascending RA Rotate 90° away from

Frontal or ramus of mandible @ earlobe f RA (fine-tuning) tender point
migraine level
headaches;
Blurring of vision

AC 2-6 SD of C2-6 Anterolateral aspect of FSARA Flex to level of

Posterior or corresponding anterior tubercle dysfunction
lateral neck pain of transverse process
AC2 = middle scalene muscle
AC3-6 = anterior & middle
scalenes, longus capitis, and
longus colli
AC 7 SD of lower Posterior-superior surface of FSTRA Flex to level of C7, press
cervical spine clavicle at sternocleidomastoid inferior and posterior
region muscle attachment

AC 8 SD of lower Medial head of the clavicle at f-F SARA Flex to level <C7, press
cervical spine sternocleidomastoid muscle inferior and posterior,
region attachment medial to lateral

PC 3-7 lateral SD of cervical Posterior lateral aspect of e SARA Extend to level of

spine, neck pain articular processes; dysfunction
and headache transversospinalis muscle grp
PT 1-12 midline SD of thoracic Midline, on inferior aspect/tip of e-E Extend to level of
spine; tenderness the spinous process; may be dysfunction, patient
in center of back associated with supraspinous prone, arms extended to
and flattening of ligament, interspinales, spinalis, ears, avoid
thoracic kyphosis or semispinalis thoracic muscles hyperextension of
cervical region with
supine technique instead

PT 1-9 posterior SD of thoracic On inferolateral aspect of e-E SARA Extend to level of

spine deviated spinous process of dysfunction, rotate to
dysfunctional segment opposite side of spinous
deviation;
pt supine for T 1-4
pt Prone for T-5-9

PT 4-9 transverse/lateral SD of thoracic On lateral aspect of transverse e-E SART Forearm under axilla on
spine process; longissimus thoracis, same side as tender
levatores costarum, semispinalis, point, patient prone
multifidus, or rotatores
AT 1-2 midline SD of thoracic AT 1: On episternal notch, midline f-F Flex to level of
spine, anterior or just lateral dysfunction; patient
chest wall pain AT 2: Midline or just lateral to seated with hands behind
and upper back junction of manubrium and head
pain associated sternum (Angle of Louis)
w/ anterior head *Both associated with sternal
and neck carriage fascia and pectoralis major
and u. thoracic muscle
kyphosis

AT 3-6 midline SD of thoracic On sternum at level of f-F Flex to level of

spine, anterior corresponding rib, midline or dysfunction (concavity
chest wall pain slightly lateral under finger); patient
and upper back supine, arms over sides of
pain associated associated with sternal fascia and table
w/ anterior head pectoralis major muscle
and neck carriage
and u. thoracic
kyphosis

AT 7-9 bilateral SD of thoracic AT 7: ¼ from xiphoid to umbilicus F StRA Flex to level of

spine; AT 8: ½ from xiphoid to umbilicus dysfunction, patient
midthoracic pain, AT 9: ¾ from xiphoid to umbilicus seated, foot on table
epigastric or flank Rectus abdominis, obliques, opposite side of tender
pain, transversus abdominis, point
gastroesophageal intercostals
 reflux

AT 10-12 bilateral SD of lower AT 10: ¼ from umbilicus to pubis F StRa Flex to level of
thoracic and/or AT 11: ½ from umbilicus to pubis St: move ankles dysfunction, patient
upper lumbar AT 12:top of iliac crest at mid RA: moves torso supine, knee under flexed
region; pain in axillary line Hip flexion for fine-tuning knees of patient
those areas, lower Rectus abdominis, obliques,
abdominal pain, transversus abdominis,
or flank pain intercostals

PL 1-5 spinous process SD of lumbar On inferolateral aspect/tip of e-E StRa Patient prone, extend to
region; may deviated spinous process of SD (ADD for fine tuning) level of SD by lifting leg or
present with low segment ASIS on same side
back pain
PL 1-3 Transverse process SD of lumbar On lateral aspect of transverse e-E STRA Patient prone, extend to
region; may process of SD segment (ADD for fine tuning) level of SD by lifting leg or
present with low ASIS on same side
back pain

Upper Pole L5 SD of lumbar Superior medial surface of PSIS E IR/ER Patient prone, hip extend,
spine and/or between L5 spinous process and ADD for fine-tune fine tune with ADD and
pelvis; may PSIS (Multifidus, rotatores, and/or IR/ER
complain of low iliolumbar ligament)
back or pelvic
pain

High Ilium Sacroiliac SD of lumbar 2-3cm lateral to PSIS, press E AB ER Patient prone, hip extend,
spine and/or medially toward PSIS fine tune with ADD and
pelvis; may IR/ER
complain of pain
in buttock
associated with
strain of
quadratus
lumborum,
gluteus maximus,
or iliolumbar
ligament
Lower Pole L5 SD of lumbar On ilium, just inferior to PSIS, F IR ADD Patient prone, hip flexed
spine and/or press superiorly (post. SI to 90°, ADD and slight
pelvis; may ligaments, erector spinae, biceps IR/ER
 complain of low femoris, iliopsoas)
back or pelvic
pain

High Ilium Flare Out SD of pelvic Lateral aspect of ILA and/or E ADD Patient prone, hip extend,
region or sacrum; lateral aspect of coccyx fine tune with ADD
may complain of
pain in lower
medial portion of
gluteus maximus
or deep w/in
coccygeus muscle
and pelvic floor
Gluteus Medius Posterior; SD of lumbar Upper outer portion of gluteus E AB ER Patient prone, hip extend,
L3 & L4 and/or pelvic medius at level of PSIS fine tune with ADD and
region; may PL 3: 2/3 lateral from PSIS to ER
complain of pain tensor fasciae latae
below iliac crest PL 4: posterior border of tensor
in posterior fasciae latae
gluteal region
while walking or
standing up from
seated position

Piriformis SD of pelvic Midpoint between lower half of F AB Patient prone, hip flexed,
region; may lateral aspect of ILA and greater (IR/ER for fine-tuning) ADD; fine tune with IR/ER
complain of pain trochanter
in buttock and
posterior thigh
(sciatic neuritis)