Lower limb counterstrain
Lower limb counterstrain
Chronic Week 1
Chronic Week 1
Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
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.