Table 1 Common Anterior Cervical Tender Points



Download 0.56 Mb.
Date08.02.2017
Size0.56 Mb.


Table 9.1 Common Anterior Cervical Tender Points

Tender Point

Location

Classic Treatment Position

Acronym

AC1, rotation, uncoupled dysfunction (p136)

Posterior surface of ascending ramus of mandible between earlobe and angle of mandible (gonion)

Rotate head away; fine-tuning with side bending, usually away

RA

AC2–AC6, type II dysfunction (p138)

Anterior aspect of transverse process of dysfunctional cervical vertebra

Flex to level of dysfunctional segment; side bend away, rotate away

F SA RA

AC7, type I dysfunction of C7 or sternocleidomastoid (p139)

Anterior at origin of clavicular division of sternocleidomastoid muscle, approximately 2 cm lateral to sternoclavicular joint

Flex to level of C7; side-bend toward, rotate away

F ST RA

AC8, type II dysfunction of C7 (p140)

Origin of sternal division of sternocleidomastoid muscle at medial head of clavicle at sternal notch

Flex, but less than AC7; side-bend away, rotate away

F SA RA

http://pt.wkhealth.com/pt/pt-core/images/ftup.gif




http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff1.gif?geom=200x200

View Figure


Figure 9.1. Anterior cervical counterstrain tender points (5).

http://pt.wkhealth.com/pt/pt-core/images/ftup.gif


Table 9.2 Common Posterior Cervical Tender Points

Tender Point

Location

Classic Treatment Position

Acronym

PC1 Inion (p142)

2 cm below inion, pushing laterally into muscle mass

Flexion of occipitoatlantal articulation; additional cervical flexion may be necessary

F

PC1 lateral

(p143)


Halfway between PC2 and mastoid process associated with splenius capitis muscle

Extension of occipitoatlantal articulation with mild compression on head to reduce myofascial tension of suboccipital tissues; slight side bending and rotation away as needed

E Sa Ra

PC2 lateral (p143)

Within semispinalis capitis muscle associated with greater occipital nerve

Extension of occipitoatlantal articulation with mild compression on head to reduce myofascial tension of suboccipital tissues; slight side bending and rotation away as needed

E Sa Ra

PC2 midline (p141)

Superior lateral surface of spinous process of C2

Extension of occipitoatlantal articulation with mild compression on head to reduce myofascial tension of suboccipital tissues; slight side bending and rotation away as needed

E Ra

PC3–PC8 midline (p144)

Inferior surfaces of spinous processes of C2–C7 (named for spinal nerve exiting this level)

Extend to level of dysfunctional segment with minimal to moderate side bending directed at segment and minimal to moderate rotation away

E Sa Ra

PC3–PC7 lateral (p145)

Posterior at lateral surface of articular process associated with dysfunctional segment

Extend to level of dysfunctional segment with minimal to moderate side bending directed at segment and minimal to moderate rotation away

E SA RA

. http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff21.gif
Figure 9.21. Posterior cervical counterstrain tender points (5).

Table 9.3 Common Anterior Thoracic Tender Points

Tender Point

Location

Classic Treatment Position

Acronym

AT1 (p147-8)

Midline episternal notch

Flexion to dysfunctional level

F

AT2 (p147-8)

Midline, junction of manubrium and sternum (angle of Louis)

Flexion to dysfunctional level

F

AT3-AT5 (p148-9)
AT6 (p148)

Midline at level of corresponding rib;
Midline xiphoid–sternal junction

Flexion to dysfunctional level

F

AT7–AT9

(p150-1)


AT7: Midline or inferolateral to tip of xiphoid;
AT8: 3 cm below xiphoid at level of T12, midline or lateral
AT9: 1–2 cm above umbilicus at level of L2, midline or 2–3 cm lateral

Flexion to dysfunctional level, side bending toward and rotation away

F St RA

AT10–AT12 (p151)

AT10: 1–2 cm below umbilicus at level of L4, midline or 2–3 cm lateral
AT11: 5–6 cm below umbilicus below level of iliac crests at superior L5 level, midline or 2–3 cm lateral
AT12: Superior, inner surface of iliac crest at mid-axillary line

Hip flexion 90–135 degrees, slight side bending, rotation toward (type I) or side bending toward, rotation away (type II)

F St RT
F St RA

http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff41.gif
Figure 9.41. Anterior thoracic counterstrain tender points (5).

Table 9.4 Common Posterior Thoracic Tender Points

Tender Point

Location

Classic Treatment Position

Acronym

PT1–PT3 (p152-4)

Midline, or inferolateral tip of spinous process (side opposite rotational component) or over transverse process (on side of rotational component)

Prone with arms hanging over sides of table. Support patient's head by cupping point of chin; gently extend head and neck to engage dysfunctional segment. Avoid prefoverextending. Rotation and side bending minimal.

e-E Sa Rt (type I) or e-E St Rt (type II).
Depending on physician preference, may be opposite (SARA) coupling.

PT4–PT9 (p153-158)

Same as above

Same as above, except shoulders may be flexed fully to add extension or placed at the side to decrease extension with physician controlling shoulder from opposite side.

Same as above

PT10–PT12

(p158)


Same as above

Patient prone with arms at side, physician controlling pelvis.

Same as above

http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff58.gif
Figure 9.58. Posterior thoracic counterstrain tender points (5).

Table 9.5 Common Anterior Costal Tender Points

Tender Point

Jones's Term

Location

Treatment Position, Acronym

AR1 (p160)

Depressed rib

Below clavicle at first chondrosternal articulation

Patient supine
f-F St RT

AR2 (p160)

Depressed rib

On second rib at midclavicular line

Same as above

AR3-AR6 (p161)

Depressed ribs

Anterior axillary line on dysfunctional rib

Patient seated
f ST RT

http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff76.gif
Figure 9.76. Anterior costal counterstrain tender points (5).

Table 9.6 Common Posterior Costal Tender Points

Tender Point

Jones's Term

Location

Classic Treatment Position and Acronym

PR1 (p163)

Elevated rib

Cervicothoracic angle just anterior to trapezius

Patient seated
e SA Rt

PR2 (p164)

Elevated rib

Superior surface

Patient seated
e SA Rt or f SA RA

PR3–PR6 (p164)

Elevated ribs

Superior surface of rib angles

Patient seated
f SA RA

PR, posterior rib.

http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff84.gif
Figure 9.84. Posterior costal counterstrain tender points (5).

Table 9.7 Common Anterior Lumbar Tender Points

Tender Point

Location

Classic Treatment Position

 

 

Patient supine with hip and knee flexion

AL1 (p166)

Medial to ASIS

Type II: F SA Ra
Type I: F ST RA or F SA RT

AL2 (p167)

Medial to AIIS

Type II: f-F SA RA
Type I: f-F SA RT

AL3 (p168)

Lateral to AIIS

Same as AL2

AL4 (p168)

Inferior to AIIS

Same as AL2

AL5 (p169)

Anterior aspect of pubic bone 1 cm lateral to pubic symphysis just inferior to prominence

Type II: F SA Ra
Type I: F SA Rt

http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff92.gif
Figure 9.92. Anterior lumbar counterstrain tender points (5)

Table 9.8 Common Posterior Lumbar Tender Points

Tender Point

Location

Classic Treatment Position







PL1–PL5 (p171-2)

Inferolateral aspect of spinous process or laterally on transverse process of dysfunctional segment

Patient prone with leg (hip) extension and slight external rotation, causing lumbar rotation to that side; adduction or abduction as needed
e SA Ra-A (spinous process)
e SA RA (transverse process)







PL3 lateral gluteus (iliac crest) (p173)

Halfway between UPL5 and PL4 at inferior aspect of posterior iliac crest near gluteus medius/maximus

Patient prone
E er add







PL4 lateral gluteus (iliac crest) (p173)

Posterolateral pelvic edge halfway between greater trochanter and iliac crest at gluteus maximus

Patient prone
E er add







UPL5

Superior surface of PSIS

Patient prone with hip extension E er add







LPL5 (p174)

2 cm below PSIS on the ilium

Patient prone with hip flexed off table and slight adduction
F IR add







http://pt.wkhealth.com/fulltextservice/ct%7b06b9ee1beed5941952098af76fa269cc28d32747b2d0e33bf296724538fd44dc9efaabf677079857ad6e5c55817abfbf%7d/da2c9ff104.gif
Figure 9.104. Posterior lumbar counterstrain tender points (5).

Miscellaneous

Muscle

Location

Position

Reference

Iliacus

2-3 cm inferior to point halway between ASIS and midline, deep on dysfunctional side

patient supine

F ER of hips, abduction of knees-->frog legs



N&N p175

PIR (Pelvic/Piriformis Dysfunction)

7-10 cm medial to and slightly cephalad to greater trochanter on side of dysfunction, near to sciatic notch)

patient lies prone

flex hip to 135 degrees, abducted, externally rotated

F abd-ADD er-ER


N&N p176

Supraspinatus

mid supraspinatus muscle just superior to spine of scapula

flex shoulder to 45 degrees, abduct 45 degrees, externally rotate

N&N p177

Infraspinatus

2 cm medial to tendinous portion at lateral shoulder joint insertion or 2-4 cm inferior to spin of scapula

flex shoulder 150 degrees, internally rotate, abduct

N&N p178

Levator Scapulae

superior angle of scapula

head rotated away, internally rotate shoulder, mild to moderate traction, minimal abduction

N&N p179

Trapezius

midway between point of shoulder and base of neck

be sure to differentiate from supraspinatus tenderpoint



patient supine

side bend neck towards, flex shoulder 150-170, apply traction cephalad



lab 1 autonomics in action 8/6/10 p2

Masseter

1.5-2 cm superior to angle of mandible, press posteriorly towards anterior border ascending ramus

patient supine, jaw relaxed

move jaw posteriorly, inferiorly, and towards tenderpoint



lab 1 autonomics in action 8/6/10 p2

Lateral Pterygoid

1 cm anterior to neck of condyle or lower edge greater wing of sphenoid, press medially and posterior (on inferior aspect zygomatic arch)

patient supine, jaw relaxed

move jaw posteriorly, inferiorly, and away from tenderpoint



lab 1 autonomics in action 8/6/10 p2

Rhomboid

medial border scapula, press medial to lateral

abduct shoulder, extend slightly

lab 1 autonomics in action 8/6/10 p2

Scalene




elevate shoulder using humerus or axilla, slight internal rotation

lab 1 autonomics in action 8/6/10 p2

Flexors/extensors of hand and wrist

In the flexor or extensor compartment from hand to humerus

Flex/extend as needed; fine tune with rotation

Osteopathic treatment for elbow, wrist, and hand 10/28/09 P15

Pectoralis Minor

Inferior to coracoid process

90o flex shoulder , internally rotate and adduct

10/29/10 Case Studies/FPR/Prep for RAM Clinic @1:11:50

Teres minor




30o extend shoulder, slightly adduct, markedly externally rotate

OMS II lab 14: shoulder, arm wrist 11/5/10 p7

Pronator teres




Markedly flex elbow and pronate forearm; externally rotate humerus; dorsal hand and wrist against lateral chest wall

OMS II lab 14: shoulder, arm wrist 11/5/10 p7

Latissimus dorsi

Inferior to inferior angle of scapula

30o extension shoulder, internal rotate, slightly adduct, traction humerus

OMS II lab 14: shoulder, arm wrist 11/5/10 p7

Lateral epicondylitis

Anterolateral surface proximal head of radius

Fully extend, supinate, abduct forearm

OMS II lab 14: shoulder, arm wrist 11/5/10 p8

Medial epicondylitis

Inferior and lateral to medial epicondyle

Full flex and pronate forearm, flex wrist

OMS II lab 14: shoulder, arm wrist 11/5/10 p8

Flexed ankle/dorsiflexors

Medial to tendon of extensor digitorum longus as it crosses ankle joint

Patient prone, flex knee, dorsiflex foot

11/12/10 Common Foot and Ankle Sports Injuries p3

Extended Ankle/plantarflexors

Medial and lateral heads of gastrocnemius, inferolateral popliteal fossa; medial and lateral aspects Achilles tendon at attachment to calcaneus

Patient prone; plantar flex foot

11/12/10 Common Foot and Ankle Sports Injuries p3

Medial ankle

2 cm inferior to medial malleolus

Invert foot, fine tune with internal rotation

11/12/10 Common Foot and Ankle Sports Injuries p4

Lateral ankle

Inferior 3 cm anterior to lateral malleolus

Evert foot

11/12/10 Common Foot and Ankle Sports Injuries p4

Talus

2 cm anterior to medial malleolus

Invert foot, fine tune with internal rotation

11/12/10 Common Foot and Ankle Sports Injuries p5

Plantar fasciitis

Attachment on inferior lateral aspect calcaneus

Plantar flex ankle, flex toes, fine tune with supination or pronation

11/12/10 Common Foot and Ankle Sports Injuries p5

Tensor Fascia Lata

Inferior to ASIS

Flex hip 60-90o, abduct and internally rotate hip

11/19/10 Hip and Knee p12

Iliotibial band

Below trochanter on lateral side of femur, anywhere along band

Flex hip 30o, abduct hip, fine tune with internal/external rotation

11/19/10 Hip and Knee p12

Adductors brevis/longus

Attachment below pubic ramus

Patient supine, flex and adduct hip

11/19/10 Hip and Knee p13

Obturator internus

Medial to ischial tuberosities

Flex knee 90, externally rotate hip

11/19/10 Hip and Knee p13

Inguinal ligament

Lateral surface pubic bone, pectinous muscle belly

Patient supine, flex hip and knee 90o, internal rotation and adduction of hip

11/19/10 Hip and Knee p13

Biceps femoris

Posterior thigh, lateral to midline

Patient prone, flex knees 90o, extend and internally rotate hip

11/19/10 Hip and Knee p14

Lateral meniscus

Lateral to patella on tibial plateau

Patient sitting, elevate knee, push inferior and medial , abduction ankle, make knee valgus

11/19/10 Hip and Knee p14

Medial meniscus

Medial to patella on tibial plateau

Elevate knee, push inferiorly and laterally, adduction ankle, make knee varus

11/19/10 Hip and Knee p14

Medial hamstring tendon

Superior to medial attachment on posteromedial surface tibial

Patient supine, flex hip and knee 90o, internally rotate tibia

11/19/10 Hip and Knee p14

Lateral hamstring tendon

Lateral tendon, attachment to posterior lateral surface proximal fibula

Patient supine; extends hip, flex knee, fine tune with abduction and external rotation

12/3/10 Catch Up Lab p3

Vastus lateralis

Lateral thigh between trochanter and lateral aspect knee

Patient supine; abduct hip

[handout says: hyperextend knee, externally rotate thigh]



12/3/10 Catch Up Lab p3

Vastus medialis

Anterior medial lower thigh

Patient supine; flex hip, hyperextend knee, internally rotate

12/3/10 Catch Up Lab p3

Rectus femoris

Anterior surface thigh

Patient supine, flex hip, hyperextend knee

12/3/10 Catch Up Lab p3

Psoas

AL1, AL2

Flexion, internal rotation hip

2/17/11 OMT in Pregnancy



Share with your friends:


The database is protected by copyright ©dentisty.org 2019
send message

    Main page