Table 9.

1 Common Anterior Cervical Tender Points Classic Treatment Tender Point Location Position Acronym AC1, rotation, uncoupled Posterior surface of ascending ramus Rotate head away; RA dysfunction (p136) of mandible between earlobe and fine-tuning with side angle of mandible (gonion) bending, usually away AC2AC6, type II Anterior aspect of transverse process Flex to level of F SA RA dysfunction (p138) of dysfunctional cervical vertebra dysfunctional segment; side bend away, rotate away AC7, type I dysfunction of Anterior at origin of clavicular Flex to level of C7; F ST RA C7 or sternocleidomastoid division of sternocleidomastoid side-bend toward, (p139) muscle, approximately 2 cm lateral rotate away to sternoclavicular joint AC8, type II dysfunction Origin of sternal division of Flex, but less than F SA RA of C7 (p140) sternocleidomastoid muscle at AC7; side-bend away, medial head of clavicle at sternal rotate away notch

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

View Figure

Table 9.2 Common Posterior Cervical Tender Points Tender Point Location Classic Treatment Position PC1 Inion 2 cm below inion, pushing Flexion of occipitoatlantal articulation; (p142) laterally into muscle mass additional cervical flexion may be necessary PC1 lateral Halfway between PC2 and Extension of occipitoatlantal articulation with (p143) mastoid process associated mild compression on head to reduce with splenius capitis myofascial tension of suboccipital tissues; muscle slight side bending and rotation away as needed PC2 lateral Within semispinalis capitis Extension of occipitoatlantal articulation with (p143) muscle associated with mild compression on head to reduce greater occipital nerve myofascial tension of suboccipital tissues; slight side bending and rotation away as needed PC2 midline Superior lateral surface of Extension of occipitoatlantal articulation with (p141) spinous process of C2 mild compression on head to reduce myofascial tension of suboccipital tissues; slight side bending and rotation away as needed PC3PC8 Inferior surfaces of Extend to level of dysfunctional segment with midline spinous processes of C2 minimal to moderate side bending directed at (p144) C7 (named for spinal segment and minimal to moderate rotation nerve exiting this level) away PC3PC7 Posterior at lateral surface Extend to level of dysfunctional segment with lateral of articular process minimal to moderate side bending directed at (p145) associated with segment and minimal to moderate rotation dysfunctional segment away

Acronym F E Sa Ra

E Sa Ra

E Ra

E Sa Ra

E SA RA

. 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 Flexion to dysfunctional level F and sternum (angle of Louis) AT3-AT5 (p148-9) Midline at level of Flexion to dysfunctional level F corresponding rib; AT6 (p148) Midline xiphoidsternal junction AT7AT9 AT7: Midline or inferolateral to Flexion to dysfunctional level, F St RA (p150-1) tip of xiphoid; side bending toward and rotation AT8: 3 cm below xiphoid at away level of T12, midline or lateral AT9: 12 cm above umbilicus at level of L2, midline or 23 cm lateral AT10AT12 AT10: 12 cm below umbilicus Hip flexion 90135 degrees, slight F St RT (p151) at level of L4, midline or 23 side bending, rotation toward F St RA cm lateral (type I) or side bending toward, AT11: 56 cm below umbilicus rotation away (type II) 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

Figure 9.41. Anterior thoracic counterstrain tender points (5).

Table 9.4 Common Posterior Thoracic Tender Points Tender Point Location Classic Treatment Position PT1PT3 Midline, or inferolateral Prone with arms hanging over sides of (p152-4) tip of spinous process table. Support patient's head by cupping (side opposite rotational point of chin; gently extend head and neck component) or over to engage dysfunctional segment. Avoid transverse process (on prefoverextending. Rotation and side side of rotational bending minimal. component)

PT4PT9 Same as above (p153-158)

PT10PT12 Same as above (p158)

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. Patient prone with arms at side, physician controlling pelvis.

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

Same as above

Figure 9.58. Posterior thoracic counterstrain tender points (5).

Table 9.5 Common Anterior Costal Tender Points Jones's Tender Point Term Location AR1 (p160) Depressed Below clavicle at first chondrosternal rib articulation AR2 (p160) Depressed On second rib at midclavicular line rib AR3-AR6 Depressed Anterior axillary line on dysfunctional (p161) ribs rib

Treatment Position, Acronym Patient supine f-F St RT Same as above Patient seated f ST RT

Figure 9.76. Anterior costal counterstrain tender points (5).

Table 9.6 Common Posterior Costal Tender Points Jones's Tender Point Term Location PR1 (p163) Elevated rib Cervicothoracic angle just anterior to trapezius PR2 (p164) Elevated rib Superior surface PR3PR6 Elevated (p164) ribs PR, posterior rib. Superior surface of rib angles

Classic Treatment Position and Acronym Patient seated e SA Rt Patient seated e SA Rt or f SA RA Patient seated f SA RA

Figure 9.84. Posterior costal counterstrain tender points (5).

Table 9.7 Common Anterior Lumbar Tender Points Tender Point Classic Treatment Location Position Patient supine with hip and knee flexion Medial to ASIS Type II: F SA Ra Type I: F ST RA or F SA RT Medial to AIIS Type II: f-F SA RA Type I: f-F SA RT Lateral to AIIS Same as AL2 Inferior to AIIS Same as AL2 Anterior aspect of pubic bone 1 cm lateral to pubic Type II: F SA Ra symphysis just inferior to prominence Type I: F SA Rt

AL1 (p166)

AL2 (p167) AL3 (p168) AL4 (p168) AL5 (p169)

Figure 9.92. Anterior lumbar counterstrain tender points (5)

Table 9.8 Common Posterior Lumbar Tender Points Tender Point Location Classic Treatment Position PL1PL5 Inferolateral aspect of spinous process Patient prone with leg (hip) extension and (p171-2) or laterally on transverse process of slight external rotation, causing lumbar dysfunctional segment rotation to that side; adduction or abduction as needed e SA Ra-A (spinous process) e SA RA (transverse process) PL3 lateral Halfway between UPL5 and PL4 at Patient prone gluteus (iliac inferior aspect of posterior iliac crest E er add crest) (p173) near gluteus medius/maximus PL4 lateral Posterolateral pelvic edge halfway Patient prone gluteus (iliac between greater trochanter and iliac E er add crest) (p173) crest at gluteus maximus 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

Figure 9.104. Posterior lumbar counterstrain tender points (5).

Miscellaneous Muscle Iliacus Location 2-3 cm inferior to point halway between ASIS and midline, deep on dysfunctional side 7-10 cm medial to and slightly cephalad to greater trochanter on side of dysfunction, near to sciatic notch) mid supraspinatus muscle just superior to spine of scapula 2 cm medial to tendinous portion at lateral shoulder joint insertion or 2-4 cm inferior to spin of scapula superior angle of scapula Position patient supine F ER of hips, abduction of knees-->frog legs patient lies prone flex hip to 135 degrees, abducted, externally rotated F abd-ADD er-ER flex shoulder to 45 degrees, abduct 45 degrees, externally rotate flex shoulder 150 degrees, internally rotate, abduct head rotated away, internally rotate shoulder, mild to moderate traction, minimal abduction patient supine side bend neck towards, flex shoulder 150-170, apply traction cephalad patient supine, jaw relaxed move jaw posteriorly, inferiorly, and towards tenderpoint patient supine, jaw relaxed move jaw posteriorly, inferiorly, and away from tenderpoint abduct shoulder, extend slightly elevate shoulder using humerus or axilla, slight internal rotation Flex/extend as needed; Reference N&N p175

PIR (Pelvic/Piriformis Dysfunction)

N&N p176

Supraspinatus

N&N p177

Infraspinatus

N&N p178

Levator Scapulae

N&N p179

Trapezius

Masseter

midway between point of shoulder and base of neck be sure to differentiate from supraspinatus tenderpoint 1.5-2 cm superior to angle of mandible, press posteriorly towards anterior border ascending ramus 1 cm anterior to neck of condyle or lower edge greater wing of sphenoid, press medially and posterior (on inferior aspect zygomatic arch) medial border scapula, press medial to lateral

lab 1 autonomics in action 8/6/10 p2

lab 1 autonomics in action 8/6/10 p2

Lateral Pterygoid

lab 1 autonomics in action 8/6/10 p2

Rhomboid Scalene

lab 1 autonomics in action 8/6/10 p2 lab 1 autonomics in action 8/6/10 p2 Osteopathic

Flexors/extensors of

In the flexor or extensor

hand and wrist

compartment from hand to humerus Inferior to coracoid process

fine tune with rotation

Pectoralis Minor

Teres minor

Pronator teres

Latissimus dorsi

Inferior to inferior angle of scapula Anterolateral surface proximal head of radius Inferior and lateral to medial epicondyle

Lateral epicondylitis

90o flex shoulder , internally rotate and adduct 30o extend shoulder, slightly adduct, markedly externally rotate Markedly flex elbow and pronate forearm; externally rotate humerus; dorsal hand and wrist against lateral chest wall 30o extension shoulder, internal rotate, slightly adduct, traction humerus Fully extend, supinate, abduct forearm Full flex and pronate forearm, flex wrist Patient prone, flex knee, dorsiflex foot Patient prone; plantar flex foot

treatment for elbow, wrist, and hand 10/28/09 P15 10/29/10 Case Studies/FPR/Prep for RAM Clinic @1:11:50 OMS II lab 14: shoulder, arm wrist 11/5/10 p7 OMS II lab 14: shoulder, arm wrist 11/5/10 p7

Medial epicondylitis

Flexed ankle/dorsiflexors

Medial to tendon of extensor digitorum longus as it crosses ankle joint Extended Medial and lateral heads of Ankle/plantarflexors gastrocnemius, inferolateral popliteal fossa; medial and lateral aspects Achilles tendon at attachment to calcaneus Medial ankle 2 cm inferior to medial malleolus Lateral ankle Inferior 3 cm anterior to lateral malleolus 2 cm anterior to medial malleolus Attachment on inferior lateral aspect calcaneus Inferior to ASIS

OMS II lab 14: shoulder, arm wrist 11/5/10 p7 OMS II lab 14: shoulder, arm wrist 11/5/10 p8 OMS II lab 14: shoulder, arm wrist 11/5/10 p8 11/12/10 Common Foot and Ankle Sports Injuries p3 11/12/10 Common Foot and Ankle Sports Injuries p3

Invert foot, fine tune with internal rotation Evert foot

Talus

Invert foot, fine tune with internal rotation Plantar flex ankle, flex toes, fine tune with supination or pronation Flex hip 60-90o, abduct and internally rotate hip

Plantar fasciitis

Tensor Fascia Lata

11/12/10 Common Foot and Ankle Sports Injuries p4 11/12/10 Common Foot and Ankle Sports Injuries p4 11/12/10 Common Foot and Ankle Sports Injuries p5 11/12/10 Common Foot and Ankle Sports Injuries p5 11/19/10 Hip and Knee p12

Iliotibial band

Adductors brevis/longus Obturator internus Inguinal ligament

Below trochanter on lateral side of femur, anywhere along band Attachment below pubic ramus Medial to ischial tuberosities Lateral surface pubic bone, pectinous muscle belly

Biceps femoris

Posterior thigh, lateral to midline Lateral to patella on tibial plateau

Lateral meniscus

Medial meniscus

Medial to patella on tibial plateau

Medial hamstring tendon Lateral hamstring tendon

Superior to medial attachment on posteromedial surface tibial Lateral tendon, attachment to posterior lateral surface proximal fibula Lateral thigh between trochanter and lateral aspect knee Anterior medial lower thigh

Vastus lateralis

Vastus medialis

Rectus femoris Psoas

Anterior surface thigh AL1, AL2

Flex hip 30o, abduct hip, fine tune with internal/external rotation Patient supine, flex and adduct hip Flex knee 90, externally rotate hip Patient supine, flex hip and knee 90o, internal rotation and adduction of hip Patient prone, flex knees 90o, extend and internally rotate hip Patient sitting, elevate knee, push inferior and medial , abduction ankle, make knee valgus Elevate knee, push inferiorly and laterally, adduction ankle, make knee varus Patient supine, flex hip and knee 90o, internally rotate tibia Patient supine; extends hip, flex knee, fine tune with abduction and external rotation Patient supine; abduct hip [handout says: hyperextend knee, externally rotate thigh] Patient supine; flex hip, hyperextend knee, internally rotate Patient supine, flex hip, hyperextend knee Flexion, internal rotation hip

11/19/10 Hip and Knee p12 11/19/10 Hip and Knee p13 11/19/10 Hip and Knee p13 11/19/10 Hip and Knee p13

11/19/10 Hip and Knee p14 11/19/10 Hip and Knee p14

11/19/10 Hip and Knee p14

11/19/10 Hip and Knee p14 12/3/10 Catch Up Lab p3

12/3/10 Catch Up Lab p3

12/3/10 Catch Up Lab p3 12/3/10 Catch Up Lab p3 2/17/11 OMT in Pregnancy