Counterstrain: Anterior Thoracic, Anterior Ribs, Posterior Ribs

intercostal nerves

– tendinous attachments
– belly of a muscle
– myofascial tissues
– dermatome
– sclerotome
– myotome
– motor points

nervous

muscles served by a single nerve root

place where an alpha motor neuron pierces investing fascia of a muscle to innervate a muscle

area of skin innervated by sensory fibers from single spinal nerve

mesodermic somite cells that migrate toward notochord forming the arch of the spinal cord and ultimately develop into vertebrae and ribs
–> some continue migrating

– agonist muscle overstretches–> fires an afferent message through Ia afferent neurons
– agonist muscle contracts
– antagonist muscle quickly lengthens and creates strain
– over-lengthening leads to reactive contraction in antagonist muscle
–> muscle stays hypershortened

– upper back pain
– whiplash
– precordial pain
– heartburn
– fatigue
– epigastric pain
– umbilical pain
– diarrhea or constipation
– cystitis
– shoulder pain
– elbow pain
– low back pain
– restriction of thoracic motion

– apex of sternal joint
– flex patient
– test vector: S–> I
– sternal fascia

– middle of manubrium
– flex patient
– test vector: A–> P
– sternal fascia

– on sternum at level of rib 3
– flex patient
– test vector: A–> P
– sternal fascia

– on sternum at level of rib 4
– flex patient
– test vector: A–> P
– sternal fascia

– on sternum at level of rib 5
– flex patient
– test vector: A–> P
– sternal fascia

– on sternum at level of rib 6
– flex patient
– test vector: A–> P
– sternal fascia

– under costochondral margin, lateral and inferior to xiphoid
– F St RA
– test vector: A–> P
– upper rectus abdominis (belly)

– halfway between xiphoid and umbilicus
– F St RA
– test vector: A–> P
– upper rectus abdominis (belly)

– 3/4 distance between xiphoid and umbilicus
– F St RA
– test vector: A–> P
– upper rectus abdominis (belly)

– same distance below umbilicus as AT9 is above
– F St RA
– test vector: A–> P
– lower rectus abdominis (belly)

– same distance below umbilicus as AT10 is from umbilicus
– F St RA
– test vector: A–> P
– lower rectus abdominis (belly)

– inner surface of iliac crest at mid-axillary line
– F St RA
– test vector: S–> I
– external oblique, internal oblique, transversus abdominis

exhalation SD
(problems with inhalation)

– on 1st rib where it articulates with manubrium
– F St RT
– A–> P
– anterior scalene

– on 2nd mid-clavicular line
– F St RT
– A–> P
– posterior scalene

– on rib in anterior axillary line
– f ST Ra/t
– AL–> PM
– serratus anterior

– on rib in anterior axillary line
– f ST Ra/t
– AL–> PM
– serratus anterior

– on rib in anterior axillary line
– f ST Ra/t
– AL–> PM
– serratus anterior

– on rib in anterior axillary line
– f ST Ra/t
– AL–> PM
– internal intercostal

– origin: rib 1-9 mid-clavicular line
– insertion: medial border of scapula
– long thoracic nerve from C5-7

– e Sa Rt
– S–> I
– middle scalene (angle of rib)

– f SA Rt
– P–> A
– iliocostalis, levatores costarum, longissimus thoracis (angle of rib)

flexion

extension

TRUE

middle point

– acute or chronic somatic dysfunction
– somatic dysfunctions with a neural component
– primary treatment

– patient who cannot voluntarily relax
– patients who speak a different language

1. identify significant tender point
2. establish tenderness scale
3. monitor and retest
4. position to eliminate tenderness
5. maintain for 90 seconds
6. slowly return to starting position
7. recheck

– didn’t treat most significant point
– patient doesn’t fully relax
– patient helped in returning to neutral
– return to neutral too quickly
– do not reassess
– inappropriate patient selection