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OMM Question of the Day: Cervical Spine Counterstrain

Osmosis Team
Published on Aug 4, 2021. Updated on Aug 3, 2021.

Today's OMM question involves a 19-year-old woman with a left-sided neck pain. How would you position the patient to treat her tender point with counterstrain?

A 19-year-old woman presents to the office with one week of a left-sided neck pain near her clavicle. She remembers straining her neck last week when she turned her head too quickly while putting on her seatbelt, and the pain has not improved since. The pain does not radiate anywhere, and she has no other symptoms. She has no past medical history and takes no medications. Her temperature is 36.4 ºC (97.5 ºF), pulse is 66/min, respirations are 14/min, blood pressure is 102/58 mmHg. On physical exam, her OA joint, AA joint and cervical spine have full and symmetric motion. On her left side, you palpate a small area of hypertonic and tender musculature at the attachment of her sternocleidomastoid to her manubrium. How would you position the patient to treat her tender point with counterstrain?

A. Sidebend right, rotate right at the tender point

B. Flex, sidebend right, rotate right at the tender point

C. Sidebend left, rotate left at the tender point

D. Extend, sidebend right, rotate right at the tender point

E. Flex, sidebend left, rotate right at the tender point

Scroll down for the correct answer!


The correct answer to today's OMM Question is...

B. Flex, sidebend right, rotate right at the tender point

Before we get to the Main Explanation, let's look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!

Incorrect answer explanations

The incorrect answers to today's OMM Question are...

A. Sidebend right, rotate right at the tender point

While rotating away (to the right) brings the patient to her point of maximal ease, flexion should also be added for the anterior cervical AC2-AC8 tender points.

C. Sidebend left, rotate left at the tender point

For the AC2-AC8 tender points, the point of maximal ease is found by sidebending and rotating away (to this patient’s right), as well as including flexion.

D. Extend, sidebend right, rotate right at the tender point

While rotating away (to the right) brings the patient to her point of maximal ease, flexion rather than extension is used for treating the AC2-AC8 tender points.

E. Flex, sidebend left, rotate right at the tender point

This would correctly treat an AC7 tender point, which is located at the sternal attachment of the sternocleidomastoid. This patient has an AC8 tender pint.

Main Explanation

Treatment of the anterior cervical tender points 2-6 and 8 (AC2-AC6, AC8) follows the same positioning for finding the point of maximal ease. Treatment involves flexion, sidebending away and rotating away (you can remember this as “F SARA”). This patient’s tender point is AC8, which is found at the origin of the sternocleidomastoid at the manubrium. In contrast to these points, AC7 is treated by sidebending toward rather than away.

Counterstrain is an indirect technique that involves positioning a patient at their maximal ease which can be appreciated by continuously palpating the tender point and moving the patient around that point. By moving the patient slowly into their direction of ease, this helps reduce the over-sensitization and over-stimulation of the alpha-motor neurons so that they do not perceive a muscle as being continually stretched. This in turn helps reduce the hypertonicity and normalize this pathologic process.

Major Takeaway

The AC2-6 and AC8 tender points are all treated the same – flexion, sidebending away, rotating away (“F SARA”). When treating with counterstrain, always maintain palpation at the tender point as you move the patient to their point of maximal ease so you can feel the softening of the hypertonic musculature.

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