{"id":3141,"date":"2021-08-04T13:30:00","date_gmt":"2021-08-04T13:30:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3141"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"omm-question-of-the-day-cervical-spine-counterstrain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain","title":{"rendered":"OMM Question of the Day: Cervical Spine Counterstrain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#B_Flex_sidebend_right_rotate_right_at_the_tender_point\" >B. Flex, sidebend right, rotate right at the tender point<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#A_Sidebend_right_rotate_right_at_the_tender_point\" >A. Sidebend right, rotate right at the tender point<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#C_Sidebend_left_rotate_left_at_the_tender_point\" >C. Sidebend left, rotate left&nbsp;at the tender point<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#D_Extend_sidebend_right_rotate_right_at_the_tender_point\" >D. Extend, sidebend right, rotate right at the tender point<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#E_Flex_sidebend_left_rotate_right_at_the_tender_point\" >E. Flex, sidebend left, rotate right at the tender point<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today&#8217;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?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 \u00baC (97.5 \u00baF), pulse is 66\/min, respirations are 14\/min, blood pressure is 102\/58 mmHg. On physical exam, her OA joint, AA joint and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bones_of_the_neck?from=\/md\/foundational-sciences\/anatomy\/neck\/anatomy\" target=\"_blank\" rel=\"noreferrer noopener\">cervical spine&nbsp;<\/a>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?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Sidebend right, rotate right at the tender point<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Flex, sidebend right, rotate right at the tender point<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Sidebend left, rotate left&nbsp;at the tender point<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Extend, sidebend right, rotate right at the tender point<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Flex, sidebend left, rotate right at the tender point<\/strong>Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at Touro University Nevada\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/n_MWmp92vDA?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Flex_sidebend_right_rotate_right_at_the_tender_point\"><\/span>B. Flex, sidebend right, rotate right at the tender point<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s OMM Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Sidebend_right_rotate_right_at_the_tender_point\"><\/span>A. Sidebend right, rotate right at the tender point<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Sidebend_left_rotate_left_at_the_tender_point\"><\/span>C. Sidebend left, rotate left&nbsp;at the tender point<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">For the AC2-AC8 tender points, the point of maximal ease is found by sidebending and rotating away (to this patient\u2019s right), as well as including flexion.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Extend_sidebend_right_rotate_right_at_the_tender_point\"><\/span>D. Extend, sidebend right, rotate right at the tender point<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Flex_sidebend_left_rotate_right_at_the_tender_point\"><\/span>E. Flex, sidebend left, rotate right at the tender point<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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 \u201cF SARA\u201d). This patient\u2019s 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Motor_cortex\" target=\"_blank\" rel=\"noreferrer noopener\">alpha-motor neurons<\/a>&nbsp;so that they do not perceive a muscle as being continually stretched. This in turn helps reduce the hypertonicity and normalize this pathologic process.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The AC2-6 and AC8 tender points are all treated the same \u2013 flexion, sidebending away, rotating away (\u201cF SARA\u201d). 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_a9a2aa.png\" alt=\"Osmosis ad to create an account\" class=\"wp-image-3144\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_a9a2aa.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_a9a2aa.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><br><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>&nbsp;Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Today&#8217;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 [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3143,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,34,16],"tags":[],"class_list":["post-3141","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Cervical Spine Counterstrain - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-cervical-spine-counterstrain\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Cervical Spine Counterstrain - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Today&#8217;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. 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