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Lower limb counterstrain

Notes

Notes

Lower limbs

Lower limb counterstrain

THIGH AND KNEE
TENDER POINTANATOMICAL POSITIONTREATMENT 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 hamstringFlex 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 POINTANATOMICAL POSITIONTREATMENT 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 tendonFlex knee, plantar flex ankle

Figure 2. Locations of the counterstrain tender points of the leg, ankle, and foot.