Pelvis counterstrain
Notes
Pelvis
Pelvis counterstrain
ANTERIOR PELVIS | ||||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION | ||
| Psoas | ⅔ distance from ASIS to midline | Bilaterally flex and externally rotate hips, side bend lumbar spine toward you | ||
| Iliacus | ⅓ distance from ASIS to midline | Bilaterally flex knees, bilaterally flex and externally rotate hips | ||
| Low ilium | Superior surface of iliopubic eminence | Flex ipsilateral hip | ||
| Inguinal | Medial aspect of inguinal ligament near pubic tubercle | Bilaterally flex hips with contralateral thigh crossed over ipsilateral thigh, pull ipsilateral leg laterally to induce internal rotation of ipsilateral hip | ||
Figure 1. Locations of the anterior pelvis counterstrain tender points (green) and other relevant structures (red).
POSTERIOR PELVIS | ||||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION | ||
| Piriformis | Midway between lower half of lateral aspect of sacrum and inferior lateral angle (ILA) and greater trochanter | Flex and abduct ipsilateral hip, minimize internal or external rotation of hip | ||
| High ilium sacroiliac (HISI) | 2–3 cm lateral to PSIS | Extend ipsilateral hip, minimize hip abduction and external rotation | ||
| High ilium flare out (HIFO) | Lateral aspect of ILA | Extend and adduct ipsilateral hip | ||
| Upper pole 5th lumbar (UP5L) | Superomedial aspect of PSIS | Extend ipsilateral hip to level of tender point, adduct and externally rotate | ||
| Lower pole 5th lumbar (LP5L) | About 2 cm inferior to PSIS | Flex ipsilateral hip and knee, adduct and internally rotate | ||
| PL3 gluteus | ⅔ distance lateral from PSIS to posterior margin of tensor fasciae latae (halfway between UP5L and PL4-Lateral) | Extend ipsilateral hip to level of tender point, abduct and externally rotate | ||
| PL4 gluteus | Halfway between iliac crest in mid-axillary line and greater trochanter at posterior margin of tensor fasciae latae | Extend ipsilateral hip to level of tender point, abduct and externally rotate | ||
Figure 2. Locations of the posterior pelvis counterstrain tender points.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Jillian Dunbar
Editor: Robyn Hughes, MScBMC
Key Takeaways
Pelvic counterstrain is a technique used in osteopathic manipulative medicine (OMM) and physical therapy to alleviate pain and dysfunction in the pelvis. It is based on the principle that certain structures in the pelvis, such as the muscles and ligaments, can become restricted in their movement and function, leading to pain and dysfunction. Pelvic counterstrain can be used to treat a variety of conditions such as pelvic pain, sacroiliac joint dysfunction, and coccyx pain.