Anterior Pelvic Counterstrain.
So what we're going to go over today,
are the tender points in the pelvis
that could be treated with counterstrain.
So remember with counterstrain,
we're gonna follow the principles,
we're gonna find these tender points,
establish a pain scale with the patients
find the mobile point by usually positioning
the muscle into a position of ease,
holding that for 90 seconds and then
returning the patient without their help
and then the point should
no longer be tender
So there are four basic points in the
anterior pelvis that we're gonna cover
If you find the ASIS and
midline along the umbilicus
and so if you come one-third of the way medial
to the ASIS, you'll find your iliacus point
If you come in a little more two-thirds of the way
in, then that's gonna give you your psoas point
so the iliacus point and psoas point are gonna
be one thirds of the way towards midline
and then two thirds of the
way towards the midline.
Low ilium which is associated
with the psoas minor,
what we're gonna do is we're gonna find the pubic
tubercle and come out a little bit lateral to it
and so that the attachment of the psoas
minor is the low ilium point.
And then finally, on the pubic tubercle,
we have the inguinal tender point.
So iliacus, psoas, low ilium and inguinal.
We're gonna go over the treatment
positions but remember when you're
practicing and performing the techniques,
to go through all the steps.
So we're gonna demonstrate
first the iliacus positioning,
so for iliacus if we find that tender point here, what
we're going to is to perform the action of the muscles,
Remember the iliopsoas muscle does primarily
flexion and external rotation of the hip,
so what we're going to do is we're
gonna move the leg into that position.
So go ahead and bend your knee up for me.
I'm monitoring the point with my thumb
here, we're going to flex the legs up,
We're gonna cross the far ankle over
the near and this allows the patient
to kinda let their knees fall out to the side
and that causes external rotation of the hip.
We're gonna flex up, until
we feel the softening here
and this would be the final
position for iliacus tender point.
Of course if you're patient's still in pain then
you may need to fine tune it a little bit more.
For the psoas point, which is just two-thirds
of the way a little bit more medial,
poisitioning initially is the same - so you're gonna
cross the legs over, flex up, externally rotate the hip
It may require a little more flexion and it may
require some side bending to the ipsilateral sides
So what I'm gonna do is I'm gonna
bring the ankles towards me
and when I bring the ankles towards
me, that's gonna sidebend the patient
to that side and shorten the muscle more.
So that is the positioning for
psoas - flexion, external rotation,
then maybe a little bit of fine tuning and
sidebending the pelvis towards me.
I'm gonna bring you back now, relax.
For the low ilium point, what we're going to do
is pure flexion on the same side as the points,
so for low ilium, we're gonna
take the leg, flex the knee up,
and try to maximally flex the hip and then this
should be the final positioning for the low ilium.
For the inguinal points on the pubic tubercle, what we're
going to do is we're gonna flex both legs up again,
and then again I put my leg up so I can support
the weight of the legs for 90 seconds,
we're gonna cross the
far knee over the near.
and now we're going to flex up and then we're
gonna induce a little bit of rotation.
So rotation is taking the knees
and bringing it towards me
and then we're gonna induce a little bit of side
bending which is bringing the ankles towards me,
so we're gonna rotate and
sidebend towards the point
and this should be the final positioning for
the inguinal canal, inguinal tender point.
So we're gonna bring you back.
So that is the location and the positioning
for the four anterior pelvic tender points
Counterstrain for the Posterior
Pelvis Tender Points.
So in the posterior pelvis there are several
points that could be treated with counterstrain
We wanna find the PSIS - they
come a little bit above it
and that's the upper pole L5 just below
the PSIS but still pushing superiorly
That's the lower pole L5 from the PSIS we could
come out lateral to the Tensor Fasciae Latae
and that is the posterior aspect of
that is gonna be upper pole of L4
and two-thirds of way between PSIS and
that point, it's gonna be upper pole L3
So these are the upper and lower pole lumbar
points and the posterior aspect of the pelvis.
You also have the piriformis tender
point, so here is the sacrum.
In the middle of the sacrum,
you could have a tender point
connecting from this piriformis muscle to the greater
trochanter so usually in between this region,
you might be able to find a piriformis
tender point and then on the sacrum itself,
by the ileus and the sacrococcygeal junction, you
could find a high ilium flare up tender point.
So again applying the principles of counterstrain,
we're gonna go through all the steps,
let's establsh a pain scale,
hold the point for 90 seconds
and then turn them slowly, we're gonna focus
more on the final positioning for these points.
So for upper pole L5, what you're gonna
do is you're gonna stand opposite to the side
of the tender point cause final positioning for
the upper pole L5 is hip extension and ADduction
so it's easy to ADduct the leg when
you're standing on the opposite side.
So I'm gonna have you pick up your knee a
little bit, I'm just gonna hold on to the leg
and once I have control of the leg I'm
going to extend and ADduct the hip
You might have to fine tune with a
little bit of internal external rotation
but this would be the general final
positioning for upper pole L5.
For upper pole L4 and L3, they both
have the same starting position
where we're going to stand on the same
side because upper pole L3 and L4
both involve extension and ADduction so I'm gonna
stand on the same side of the tender point,
I'm going to extend the ipsilateral
leg and I'm gonna ABduct - great.
L4 might require a little
less ABduction than L3
and then you could fine tune with
external and internal rotation
so positioning for L3-L4, upper
pole L3-L4 is extension, ABduction
and fine tuning with the external
rotation or internal rotation.
In this position, external rotation
is when the toes kinda point out,
and internal rotation is when the
toes kinda point more medially
so external rotation and internal rotation.
So the piriformis muscle attaches from the sacrum,
the middle of the sacrum to the greater trochanter
So the tender point usually wll rise
somewhere between its atachments,
usually within the muscle belly.
So to treat the piriformis counterstrain point, what
we're going to do is start in an inital position
where you're taking it through
its action on the muscles.
Remember the piriformis muscle will
flex and externally rotate the hip
so what we're going to do is flex
the hip up and externally rotate
and usually the final position here will
give you a shape of the P with the legs
so it helps you remember the piriformis points,
you're gonna make a letter P with the legs
and so this usually is the
initial starting position.
Sometimes you could fine tune with a little bit of internal
or external rotation to treat it but most of the time
you might have to just add more flexion if the patient
still doesn't reach a mobile point with the treatments.
Counterstrain to treat the high ilium
flare out or better known as HIFO
So the point is gonna be close to the
sacroileus or between the sacrum and the coccyx
And so when we're treating the points,
what we're gonna do is we're gonna stand
opposite from the point because the
treatment is to extend and ADduct the hip
so w'ere going to find a point, we're
going to stand opposite from it
so here I'm treating a point
more by the right ILA
I'm gonna bring the hip up into extension
and then gently ADduct the hip
and so this will be the final
positioning for a high ilium flare out
Counterstrain for Lower Pole L5.
So for lower pole L5 the motion is gona be flexion,
ADduction and external rotation for positioning
so what we're going do is that we're going to
take the leg, I want to bring it down into flexion
and then we're going to ADduct
the knee towards the table
and then we're going to internally rotate by
bringing the ankle a little bit more lateral
and so this would be the final
positioning for lower pole L5.
of course having the position in a seated position will
help you with holding the position for 90 seconds.