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
AC2–AC6, 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
PC3–PC8 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
PC3–PC7 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
.
Figure 9.21. Posterior cervical counterstrain tender points (5).
Acronym
F
E Sa Ra
E Sa Ra
E Ra
E Sa Ra
E SA RA
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 xiphoid–sternal
junction
AT7–AT9
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: 1–2 cm above umbilicus
at level of L2, midline or 2–3
cm lateral
AT10–AT12
AT10: 1–2 cm below umbilicus Hip flexion 90–135 degrees, slight F St RT
(p151)
at level of L4, midline or 2–3 side bending, rotation toward
F St RA
cm lateral
(type I) or side bending toward,
AT11: 5–6 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
PT1–PT3 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)
PT4–PT9 Same as above
(p153-158)
PT10–PT12 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.
Figure 9.58. Posterior thoracic counterstrain tender points (5).
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
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
Figure 9.76. Anterior costal counterstrain tender points (5).
Treatment Position,
Acronym
Patient supine
f-F St RT
Same as above
Patient seated
f ST RT
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
PR3–PR6
Elevated
(p164)
ribs
PR, posterior rib.
Superior surface of rib angles
Figure 9.84. Posterior costal counterstrain tender points (5).
Classic Treatment Position and
Acronym
Patient seated
e SA Rt
Patient seated
e SA Rt or f SA RA
Patient seated
f SA RA
Table 9.7 Common Anterior Lumbar Tender Points
Tender Point
AL1 (p166)
AL2 (p167)
AL3 (p168)
AL4 (p168)
AL5 (p169)
Classic Treatment
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
Location
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
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
PIR
(Pelvic/Piriformis
Dysfunction)
Supraspinatus
Infraspinatus
Levator Scapulae
Trapezius
Masseter
Lateral Pterygoid
Rhomboid
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
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
Scalene
Flexors/extensors of
hand and wrist
In the flexor or extensor
compartment from hand to
humerus
Position
patient supine
F ER of hips, abduction of
knees-->frog legs
Reference
N&N p175
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
N&N p176
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
N&N p179
abduct shoulder, extend
slightly
elevate shoulder using
humerus or axilla, slight
internal rotation
Flex/extend as needed;
fine tune with rotation
lab 1 autonomics in
action 8/6/10 p2
lab 1 autonomics in
action 8/6/10 p2
N&N p177
N&N p178
lab 1 autonomics in
action 8/6/10 p2
lab 1 autonomics in
action 8/6/10 p2
lab 1 autonomics in
action 8/6/10 p2
Osteopathic
treatment for elbow,
wrist, and hand
Pectoralis Minor
Inferior to coracoid process
Latissimus dorsi
Inferior to inferior angle of
scapula
Lateral epicondylitis
Anterolateral surface
proximal head of radius
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
Medial epicondylitis
Inferior and lateral to medial
epicondyle
Full flex and pronate
forearm, flex wrist
Teres minor
Pronator teres
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
Patient prone, flex knee,
dorsiflex foot
Lateral ankle
Inferior 3 cm anterior to
lateral malleolus
Evert foot
Talus
2 cm anterior to medial
malleolus
Invert foot, fine tune with
internal rotation
Plantar fasciitis
Attachment on inferior
lateral aspect calcaneus
Tensor Fascia Lata
Inferior to ASIS
Iliotibial band
Below trochanter on lateral
side of femur, anywhere
Plantar flex ankle, flex
toes, fine tune with
supination or pronation
Flex hip 60-90o, abduct
and internally rotate hip
Flex hip 30o, abduct hip,
fine tune with
Patient prone; plantar
flex foot
Invert foot, fine tune with
internal rotation
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
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
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
11/19/10 Hip and
Knee p12
Adductors
brevis/longus
Obturator internus
along band
Attachment below pubic
ramus
Medial to ischial tuberosities
Inguinal ligament
Lateral surface pubic bone,
pectinous muscle belly
Biceps femoris
Posterior thigh, lateral to
midline
Lateral meniscus
Lateral to patella on tibial
plateau
Medial meniscus
Medial to patella on tibial
plateau
Medial hamstring
tendon
Superior to medial
attachment on
posteromedial surface tibial
Lateral tendon, attachment
to posterior lateral surface
proximal fibula
Lateral hamstring
tendon
Vastus lateralis
Lateral thigh between
trochanter and lateral
aspect knee
Vastus medialis
Anterior medial lower thigh
Rectus femoris
Anterior surface thigh
Psoas
AL1, AL2
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 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