All anterior tender points are treated in flexion. This can be achieved with the patient in a sitting or supine position, and should be adjusted as needed for symptom improvement prior to holding for a minimum of 90 seconds.
All posterior cervical tender points are treated in extension. This can be achieved with the patient supine or sitting, and should be adjusted as needed for symptom improvement prior to holding for a minimum of 90 seconds.
Almost all cervical tender points are treated by side bending away and rotating away. You can remember this with the mnemonic ‘SARA’. Remember to add flexion or extension to ‘SARA’ if you are treating an anterior or posterior cervical point, respectively. To achieve proper counterstrain treatment, identify the trigger point and quantify the level of discomfort as 10/10. Place the patient into the position of ease by first flexing or extending depending on the tender point location, followed by fine-tuning with sidebending and rotating away until discomfort is decreased by a minimum of 70%, or a 3/10. Hold this position for 90 seconds, then passively return to neutral and reassess for symptom improvement.
The anterior tender point for C7 is unique in its treatment. Like all other tender points, treatment is completed by rotating away. However, the head should be sidebent toward the tenderpoint. This is because of the attachments and motion of the sternocleidomastoid. Remember, the goal of counterstrain is to shorten the muscle and allow for relaxation. The SCM is shortened by passively sidebending toward and rotating away from the tender point.
Treatment for the posterior central tender point of C1 is unique in that it is treated with nothing more than flexion. It is the only posterior cervical tender point to be treated with flexion, and does not require sidebending or rotation given its central location.
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