Lower limb counterstrain
Page created: March 04, 2021
Notes
Lower limbs
Lower limb counterstrain
THIGH AND KNEE | ||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION |
| Medial meniscus / Medial collateral ligament | Anteromedial aspect of meniscus on joint line | Flex knee, internally rotate and adduct tibia (varus stress) (F IR Add) |
| Lateral meniscus / Lateral collateral ligament | Anterolateral aspect of meniscus on joint line | Flex knee, internally or externally rotate tibia, abduct tibia (valgus stress) (F Abd IR / ER) |
| Medial hamstring (Semimembranosus, Semitendinosus) | Posterior thigh medial to midline, about halfway down femur shaft at attachment of medial hamstring | Flex knee, internally rotate and adduct tibia, plantar flex ankle (F IR Add) |
| Lateral hamstring (Biceps femoris) | Posterior thigh lateral to midline, approximately halfway down femur shaft at attachment of biceps femoris | Flex knee, externally rotate and abduct tibia, plantar flex ankle (F ER Abd) |
| Iliotibial (IT) band | Along IT band, distal to lateral trochanter | Flex and abduct hip (F Abd) |
| Tensor fasciae latae (TFL) | Inferior to iliac crest in body of TFL | Flex and abduct hip (F Abd) |
| Popliteus | Within the muscle belly of popliteus | Flex and internally rotate knee and tibia (F IR) |
Figure 1. Locations of the counterstrain tender points of the thigh and knee. The points on the medial and lateral sides of the knee represent the secondary points for the medial and lateral hamstrings, respectively.
LEG, ANKLE, AND FOOT | ||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION |
| Flexion calcaneus (Quadratus plantae) | Plantar surface, anterior aspect of calcaneus | Flex forefoot |
| Medial ankle (Tibialis anterior) | Inferior to medial malleolus along deltoid ligament | Place fulcrum on medial ankle, apply inversion force |
| Lateral ankle (Fibularis muscles) | Anterior and inferior to lateral malleolus at talocalcaneal sulcus | Place fulcrum on lateral ankle, apply eversion force |
| Extension ankle (Gastrocnemius) | Proximal gastrocnemius muscles distal to popliteal fossa, inferior musculotendinous regions of soleus muscle medial or lateral to Achilles tendon | Flex knee, plantar flex ankle |
Figure 2. Locations of the counterstrain tender points of the leg, ankle, and foot.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Jillian Dunbar
Editor: Robyn Hughes, MScBMC
Key Takeaways
Counterstrain is a manual therapy technique used to treat lower limb musculoskeletal pain, using gentle, passive movements to relocate the lower limb joints to their "normal" or "resting" position.
One of the benefits of counterstrain is that it can be used on people of all ages and it doesn't require any special equipment. However, it's important to note that this technique should only be performed by a certified practitioner.