Osteopathic Treatment of the Upper Extremities: Counterstrain Points

by Tyler Cymet, DO, FACOFP

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    00:01 We're gonna talk about some osteopathic manipulative interventions for the upper extremity We're gonna start with some counterstrain points which are easy ways to treat dysfunction of the upper extremity.

    00:11 A common one is the biceps and we're gonna look at the counterstrain point for the long head of the biceps which comes up to the area of bicipital groove.

    00:21 So if you can identify the bicipital groove in the long head of the biceps, you find out that there's an area of tenderness or discomfort.

    00:29 Does that hurt? (it's okay) It's okay? but we're gonna act out like it hurts and treat this with a counterstrain point.

    00:37 So what I'm gonna do is take the point where it should be, I'm gonna flex the elbow, supinate the hand and then flex the shoulder as well.

    00:48 Find where the pain goes away using some internal rotation or external rotation where the pain is gone, we'll hold it for 90 seconds.

    00:57 Wait for the easing and then we'll go ahead relax it and see is it 70% better, have we been effective.

    01:04 That's the bicipital groove and it's the long head of the biceps.

    01:10 The next one is going to be the superspinatous.

    01:14 Just at the lateral aspect of the scapula is the superspinatous and the tender point is right over here, sitting at the top groove.

    01:23 And you find an area of tenderness of laxity in the muscle.

    01:29 And once you find that, you can flex, ABduct and externally rotate in order to alleviate that counterstrain point.

    01:44 And again, once you have the point of comfort, you have the pain going away, the patient is much more comfortable, you hold it for 90 seconds and allow it to relax.

    01:56 And the next counterstrain point is going to be the radial head, funny bone area.

    02:02 So you wanna localize the area and once you find the tender point of the radial head, this is a hard once because you want to supinate and extend it past baseline if you can.

    02:15 Maybe somewhat tender but you wanna get rid of the pain and that's gonna be hard.

    02:20 So rotate, supinate and extend and maybe even ABduct a little bit.

    02:28 So that's gonna be over the radial head, the lateral epicondyle.

    02:33 Hold it for 90 seconds, allow the pain to dissipate and you're good.

    02:43 If we're gonna look at counterstrain points on the hand, you're gonna have counterstrain points on both the palmar and the dorsal aspect.

    02:50 When you them on the palmar aspect, you look at the wrist area, you'll have four tender points along the wrist, you'll have three right over here, three on the thenar eminence and then three along the area along the hand.

    03:08 You've got points along the base of the digits and then two on each of the digits as well.

    03:18 If you find a tender point and you wanna treat it, you go ahead and when it's on the palmar aspect of the hand, you're going to flex and you can do some internal and external deviation to get to point of comfort and again you're gonna hold it for 90 seconds, waiting for the pain to ease and the tender point to go away.

    03:41 When you're dealing with the dorsum of the hand, again, four on the wrist area, four at the base of the digits.

    03:49 You're gonna go ahead and extend, again with ulnar or radial deviation until you get rid of the tender points, holding it for 90 seconds, waiting for the tender points to dissipate.

    04:03 It's not uncommon to have radial or ulnar deviation and those can be treated with muscle energy.

    04:10 Whereas if there is a radial deviation, you're gonna go ahead and push it in the area it wants to go and then have the patient push towards my hand.

    04:20 Push for 3 seconds, relax and then let it go a little bit further.

    04:25 Push again and relax until you get enhanced motion and it does better Those are some simple treatments of the upper extremity.

    About the Lecture

    The lecture Osteopathic Treatment of the Upper Extremities: Counterstrain Points by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Osteopathic Treatment of the Upper Extremities: Counterstrain Points

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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