Download SCS techniques

Strain and Counterstrain
LC1
AC2
AC3
TR
AC4
AC5
AC6
ALC
Anterior
Cervical
Tender
Points
AC7
AC8
AC1 reg
AC1 rare
Lateral C1-LC1 (Rectus
Lateralis)




Tenderpoint


Treat this first before anterior tender points
Frontal headaches/eye pain
Always treat with AC1
On the transverse process of C1
Treatment


Supine
Sidebend toward the side of the tenderpoint
to exaggerate deformity. The mastoid
process and transverse process of C1 are
approximated on the involved side.
AC1

Tender point



Posterior surface of ascending ramus of the
mandible 2 cm superior to mandibular angle
Approach posterioly
Treatment





Supine
Neutral flexion/extension
Sidebend – away slightly
Rotate – away markedly
Direct motion with pressure on top of head
AC1 (Rare) - Scalenes

Tender point



Beneath and medial ot the mandibular
angle 2 cm anterior to angle
Push superiorly on the inferior surface
Treatment





Supine
Flexion – marked
Sidebend – slightly toward
Rotate – away as needed
Treat inion point posteriorly
AC2

Tender point:


Anterior surface of the tip of C2
Transverse Process
Treatment:
Supine
 Flexion – slight ot none
 Sidebend – Away (moderate – marked
usually)
 Rotate – away (moderate – marked
usually)

AC3

Tender point


Anterior surface of tip of C3
transverse process
Treatment
Supine
 Flexion – marked
 Sidebend – usually toward
 Rotate – away (moderate)

AC4

Tender point


Anterior surface of tip of C4
transverse process
Treatment
Supine
 Extension – slight
 Sidebend – away (moderate)
 Rotate – away (moderate)
 Exception to rule

AC5

Tender point


Anterior surface of tip of transverse
process of C5
Treatment
Supine
 Flexion – moderate
 Sidebend – away (moderate)
 Rotate – away (moderate)

AC6

Tender point


Anterior surface of tip of transverse
process of C6
Treatment
Supine
 Flexion – moderate
 Sidebend – away (moderate usually)
 Rotate – away (moderate usually)

AC7


Shorten sternocleidomastoid muscle –
clavicle
Tender point


Posterior superior surface of clavicle.
Approximately 3 cm lateral to medial end.
Push inferiorly on the superior surface of the
clavicle
Treatment




Supine
Flexion – marked; support lower neck, not
head
Sidebend – toward markedly
Rotate – away slightly
AC8 (SCM-sternal)

Tender point
Medial end of clavicle
 Push laterally


Treatment
Supine
 Flexion – slight
 Sidebend – away slightly
 Rotate – away markedly

TR (trachea)



Tight swallowing
Longus coli spasm
Tender point



Anywhere along either sid eof the trachea
More common near the superior aspect
Treatment




Supine
Flexion – marked, support lower neck
Sidbend – toward markedly
Rotate – away, slightly
ALC (Anterior Lateral
Column)



Longus coli muscle
Common with flattened cervical lordosis
Tender point



On a vertical line medial to the SCM muscle
and lateral to trachea
Push posteriorly toward anterior aspect of
vertebral bodies C3-6
Treatment




Supine
Flexion – marked of neck
Sidebend – toward tender point side
Rotate – away form tender point side
PC1 Inion
PC1
Posterior
Cervical
Tender
Points
PC2
PC3
PLC
PC4
PC5
PC6
PC7
PC8
PC1 (Inion)

Tender point


On medial border of main posterior muscle
mass of neck (semispinalis capitis), 3 cm
below posterior occipital protuberance (inion)
Treatment






Supine
Flexion – marked (chin tuck position)
Sidebend – toward slightly
Rotate – away slightly
Usually works better to monitor PC1 than
aC1 (rare)
Treatment position very similar
PC1 (regular)



Frontal Headaches
Tender point
 On occiput lateral to main muscle mass
 Approximately 3.5 cm from midline
Treatment
 Supine
 Extension – at C1 level. Lift heat to create flexion of
lower cervical region prior to extending C1. Allows
more extension. Augment extension of C1 by hand
pressure on top of head.
 Sidebend – away slightly
 Rotate – away slightly
PC2


Frontal headaches and/or eye pain
Tender point



1. on lateral side of main muscle mass of
neck below occiput. 1.5 cm lateral to midline
2. superior surface of the spinous process of
C2
Treatment




Supine
Extension – same as PC1
Sidebend – away slightly
Rotate – away slightly
PC3


Pain up back of head, tinnitus, vertigo
Tender point


On the inferior surface of the spinous
process of C2
Treatment




Supine
Flexion – marked
Sidebend – away or toward
Rotate – away
PC4


Occipital heacaches, common with TMJ
dysfunction
Tender point




1. on spinous process of C3 in the
depression below the spinous process
2. in muscle mass between C4 spinous
process and C4 transverse process
Forward bending of neck helps to palpate
these points
Treatment




Supine with head over end of table
Extension – to level or flexion
Sidebend – away
Rotate – usually away
PC5 / PC6 / PC7


PC5: whole head hurts
Tender point


On spinous process of corresponding
vertebrae above i.e. PC6 on spinous
process of C5
Treatment





Supine
Extension – marked to level
Sidebend – usually away
Rotate – away
The main difference between these points
and inferior to T2 is how much extension or
backward bending is utilized
PC8

Tender points


Anterior to the trapezius at the base of the
neck on the posterior surface of the tip of the
tip of the C7 transverse process (push up on
transverse process)
Treatment




Supine
Extension – slight
Sidebend – away markedly
Rotate – away (slight to moderate)
PLC (Posterior Lateral
Column)

Tender point


2 cm lateral to the spinous processes
of C2-C7
Treatment
Supine with head off end of plinth
 Extension – moderate
 Sidebend – toward moderate
 Rotate – away

AT1
AT2
AT3
AT7
AT4
Anterior
Thoracic
Tender
Points
AT5
AT6
AT8
AT9
AT10
AT12
AT11
AT5-AT8
 Requires lots of force
 Optional technique involves placing
patient supine and fulcruming at level
over knee/thigh of clinician. This
allows greater thoracic flexion at AT5AT7

Anterior thoracic tender points are
typically more tender supine than
sitting
 AT1-AT6

Increased thoracic kyphosis
 T4-T5 pain posteriorly
 Fatigued/ low energy
 Increased difficulty with respiration –
deep breath

AT7-AT12
 Chronic diarrhea AT10
 Stomach problem AT7-AT12
 Thoracolumbar pain posteriorly

AT1

Tender Point


Midline in suprasternal notch. Push
inferiorly.
Treatment
Seated with fingers interlocked on top
of head. Clinician places arms around
patient and locks hands over the
manubrium.
 Flexion – created by leaning patient’s
trunk backward slightly

AT2

Tender Point


Middle of Manubrium
Treatment

Seated, same as AT1 but clinician
locks hands lower at junction of
manubrium and sternum
AT3

Tender point


On sternum just below sternal angle
Treatment



Seated with arms dropped back and off edge
of plinth/table
Clinician pulls backward/inferiorly on
patient’s arms creating a fulcrum at the
desired level. Clinician uses his chest and
abdomen to force patient’s thoracic spine in
flexion. Augment thoracic flexion by
internally rotating arms
Flexion of cervical region also
AT4
Lethargy
 Tender point



On body of sternum at level of 4th rib
interspace
Treatment
Seated. Same as AT3 but 1.5 cm
lower
 Flexion

AT5


Lethargy
Tender point


On body of sternum at 5rth rib interspace
level (at nipple line)
Treatment


Seated with arms at side. Clinician locks
fingers anteriorly over the tender point.
Flexion is created by pullingthe patient
backward using medial edges of hands as
the fulcrum. Clinician leans against patient’s
upper thoracic area
Flexion
AT6
Grumpy point
 Tender point



Xiphisternal junction
Treatment
Seated with arms at side. Same as
AT5 but lower
 Flexion

AT7



Stomach pain, gastritis
Tender point
1. Under the costochondral margin of 7th rib (pain with
deep breath)
2. 2 cm below xiphoid. 1 cm lateral to midline
Treatment
 Seated. Clinician has his foot on the table. Patient has
opposite arm resting on pillow on clinician’s thigh who
stands behind patient. Patient’s feet side-straddle (on
table on side of tenderpoint)
 Flexion
 Sidebend – toward by translating trunk to opposite
side
 Rotation – away by placing involved side arm across
front of body
AT8

Tender point


2 cm below AT7. 1.5 cm lateral of
midline
Treatment

Same at AT7 with more thoracic
flexion
AT9

Tender point


Just above umbilicus. 1.5 cm lateral to
midline
Treatment

Same as AT7 with more thoracic
flexion
AT10


Tender point
 Just below umbilicus. 1.5 cm lateral to midline
 Can often feel anterior body of L3 vertebrae 1.5” in
Treatment
1. Supine with head of table raised. Rest patient’s flexed
legs on clinician’s thigh. Clinician stands on side of
tender point. Produced marked flexion at the level of
dysfunction. Rotate knees slightly toward tender side
for fine tuning
2. Straight table technique – place pillows under “hips”
to obtain flexion of pelvis on lumbar spine. Then
proceed as above
AT11

Tender point


Suprapubic region. 2 cm lateral to
midline. Medial to ASIS levels
Treatment

Same as AT10 with fine tuning
AT12

Tender point


Crest of ilium at mid-axillary line. On
inner table of iliac crest. Push caudad
at iliac crest
Treatment

Same as AT10. Fine tune
PT1-2
PT3-5
PT6-9
Posterior
Thoracic
Tender
Points
PT10-12
T1-5 – most often tender on sides of
spinous processes.
 T6-12 – usually more sensitive
paravertebrally or just lateral to
spinous processes.
 TL junction – usually most sensitive
on the posterior tips of the transverse
processes. At times, lateral to the
spinous processes.

With posterior thoracic, the closer the
tender point to the midline the more
backward bending force is needed
(split table helpful).
 The further the tender point from the
midline, the more sidebending is
needed. Sidebend away from the side
of the tender point






Pre-position trunk or legs to create some
sidebending away if/as necessary
Transverse process – more sidebend than
rotation
Spinous process – more rotation than
sidebend
Diffuse posterior pain – usually have
anterior tender points as well
Localized specific posterior pain – posterior
tender points
PT1 / PT2

Tender point



Treatment





On the side of the spinous process of T1 and
T2
Occassionaly, PT1 also has a tender point 2
cm above the lateral epicondyle at the elbow
Prone with arms alongside body or supine
with head off end of table
Extension – if prone, cradle chin in palm and
extend to level
Sidebend – away
Rotate – away
T1-T5 similar to lower posterior cervicals
PT3 / PT4 / PT5



Tender point
 On the side of the spinous process T3, T4, T5
 Sometimes PT 4 has a tender point 2 cm above the
medial epicondyle at the elbow
Treatment
 Prone with arms along side the head. Arm assists in
obtaining extension
 Extension – cradle chin in palm, extend to level
 Sidebend – away
 Rotate – away
T1-T5 similar to lower posterior cervicals
PT6 / PT7 / PT8 / PT9

Tender point


Lateral to spinous process, 2 cm or less
Treatment






PT6 through PL2
Prone. Arm of involved side alongside head.
Opposite arm hangs off side of table. Raise
arm of involved side by grasping axilla. Pull
arm cephalad with slight traction effect
Extension – slight, more for lower levels
Sidebend – away, main force used is
sidebending
Rotate – trunk toward
Place cervical spine in rotation to side of
tender point
PT10 / PT11 / PT12 / PL1 /
PL2

Tender point


Lateral to spinous process or on tip of
transverse process
Treatment





Prone
Raise cephalic end of table to extend to level
Pull back on anterior pelvic on tender point
side to sidebend and rotate
Sidebend – away
Rotate – pelvis toward 30o-45o
PL
AR1
AR2
Anterior
Ribs –
Depressed
Tender
Points
AR3-6
INT4-6
AR1

Tender point


Beneath the clavicle on the first costal
cartilage to the sternum
Treatment




Supine
Mild cervical flexion
Rotate – toward, markedly
Sidebend – toward. Greatest force is applied
in sidebending
AR2

Tender point
1. On second ribs in mid-clavicular line
2.. High in medial axilla

Treatment


Same as AR1
With decreased shoulder abduction,
be sure to check AR1-AR2
AR3 – AR6

Tender point


On anterior axillary line inferior rib margins at
corresponding levels
Treatment




Sitting
Flexion – slight, neck and trunk
Sidebend – toward. This is accomplished by
leaning patient to opposite side with the
patient’s axilla on clinician’s knee (who is
standing behind patient). Sidebend toward by
translating patient’s trunk away from tender
point. If patient’s feed are on plinth on tender
point side, the sidebend can be increased
Rotate – toward. Let involved side arm hang
behind patient to augment
INT4 – INT6

Tender point


On or between costal cartilage just lateral to
sternum at the corresponding level
Treatment






Patient seated and leaning toward opposite
side with opposite axilla supported on
clinician’s knee. Clinician standing behind
patient.
Cervical flexion
Patient’s feet on table on tender point side
Trunk flexion
Sidebend – toward. Created by translating
trunk away
Rotate – away, by placing patients involved
side arm across front of body
PR1
Posterior
Ribs –
Elevated
Tender
Points
PR2-6
PR1

Tender point


Posterolateral aspect of first rib, beneath the
margin of trapezius at side on neck
Treatment





Sitting
Opposite axilla over clinician’s knee, lean
patient mildly toward opposite side, then
position head/neck
Extension – mild
Sidebend – away, mild
Rotate – toward, moderate
PR2 – PR6




Tender point
 Posteriorly at angle of ribs on superior surface. Adduct
patient’s arm across front of body to move scapula
laterally and allow easier palpation of rib angles
Treatment
 Sitting
 Axilla on affected side is resting on clinician’s knee.
Lean patient toward tender point side. Opposite arm is
hanging loosely behind patient’s back. Patient’s feet are
on table opposite of tender point side.
 Sidebend – away by translating trunk toward tender
point side.
 Rotate – away
For 2nd rib, rotate neck away moderately also
Treat spinal tender points (thoracic) before rib tender
points, even if somewhat more tender
Anterior
Lumbar
Tender
Points
AbL2
AL1
AL2
AL3
AL4
AL5

AT9-AL1


AL1 & AL 2


Often involved with patient who can’t stand
upright
AL3 & AL4


Similar procedure for 5 levels
Virtually no rotation. Sidebend through legs
AL2 & AL5

Are the “key” tender ponts in this area
AL1

Tender point


Medial to anterior superior iliac spine. ¾”
deep. Push medial to lateral
Treatment






Supine with head of table elevated
Patient’s flexed legs rest on clinician’s thigh
Clinician on tender point side
Flexion – marked at level of dysfunction
Sidebend – mild, toward
Rotate – knees toward tender point side
AL2

Tender point


Medial inferior surface to anterior
inferior iliac spine
Treatment
Supine
 Clinician opposite tender point side
 Flexion – patient’s legs flexed 90o
 Rotate – knee away from tender point
60o (markedly)
 Sidebend – away, slightly. Push feet
toward floor

AbL2 (Abdominal

Tender point


5 cm lateral to umbilicus
Treatment
Supine
 Clinician on tender point side
 Flexion – more than AL2
 Rotate – knee toward tender point
(60o)
 Sidebend – away. Elevate feet
upwards to create

AL3

Tender point


Lateral surface of anterior inferior iliac spine
Treatment





Supine
Clinician opposite tender point side
Flexion – flex thighs 50o – 90o
Sidebend – away markedly by pulling feet
toward clinician
Rotate – slightly to fine tune
AL4

Tender point


Inferior surfaced of anterior inferior
iliac spine
Treatment

Same as AL3 with fine tuning
AL5

Tender point


Anterior surface of pubic bone, 1.5 cm lateral
to pubic symphysis
Treatment





Supine
Clinician on tender point side
Flexion – flex thighs 60o – 135o
Sidebend – away, slightly
Rotate – knees toward side of tender point
PL1
QL
PLRL2
PL2
PL3
Posterior
Lumbar
Tender
Points
PL4
UPL5
PL3 (Iliac)
PL5
PL4 (Iliac)
LPL5
PL3 (Iliac)

Tender point


3 cm below margin of ilium and about 7 cm
lateral to posterior superior iliac spine
Treatment





Prone
Clinician on side opposite tender point
Extension – lift leg on affected side and
support on clinician’s thigh
Adduct – mild
Rotate – full external. The higher the hand
placement o the thigh by the operator, the
greater the external rotation created
PL4 (Iliac)

Tender point


4 cm below margin of ilium and just posterior
to the border of the tensor fascia lata
Treatment





Prone
Clinician on side opposite the tender point
Extension – same as PL3
Adduct – slight
Rotate – moderate external rotation
UPL5 (Upper Pole)


Tender point
 Superior medial surface of the posterior superior iliac
spine.
 Apply pressure caudad and lateral toward posterior
superior iliac spine (45o angle)
Treatment
 Prone
 Clinician on side opposite tender point
 Extension – via leg. Major movement required
 Adduct – very slight
 Rotate – mild external rotation
LPL5 (Lower Pole)

Tender point
1. 2 cm below posterior superior iliac spine in
small saddle between posterior superior iliac
spine and posterior inferior iliac spine
2. on sacral promontory in midline

Treatment






Prone
Clinician seated on tender point side
Leg on tender point side is dropped off table
and resting on clinician’s thigh. Patient’s hip
flexed approximately 90o patient’s pelvis is
rotated posteriorly and hip adducted slightly by
pressure at the knee
Flexion – hip 90o
Adduction – slight
Rotation – pelvis rotate posteriorly
QL (Quadratus Lumborum)


Tender point
1. On the lateral tips of the transverse processes of L2-4
2. In the angle between the transverse process of L1 and
the 12th rib
Treatment
 Prone
 Sidebend trunk toward tender point side
 Sidebend legs toward tender point side
 Abduct and extend hip of (on tender point side) and rest
on clinician’s thigh
 Gently hike hip and fine tune with mild rotation (internal
or external
 Extension –hip, mild
 Abduction – hip, moderate
 Rotate – fine tune, mild

May complain of
Lateral trunk shift
 Decreased sidebend away
 Pain with prolonged sitting
 Pain rolling in bed

PLRL2 (Posterior Flexed L2)
(Psoas Major Muscle)


Tender point
 Over the posterior aspect of transverse process of L2
Treatment
 Prone
 Clinician sits on same side as tender point
 Flexion – hip off edge of table to 90o and support
patient’s knee on clinician’s thigh
 Abduction – hip, slight to nont
 Rotation – fine tune by using clincian’s t high to direct
a force up the shaft of femur to rotate pelvis
Vertical lumbar pain on tender point
side
 Difficulty finding comfortable sleep
position
 Restless leg syndrome

IL
ALT
AMT
Anterior
Pelvis / Hip
Tender
Points
LISI
ING
ADD
LIFO
GMi/TFL
LISI (Low Ilium – Sacoiliac)

Tender point
On superior surface of lateral ramus of
pubic bone. 2 cm lateal to pubic
symphysis
 Push cadad


Treatment
Supine
 Flexion – 90o to 110o of hip on tender
point side
 Sidebend – none
 Rotate – none

LIFO (Low Ilium – Flareout)

Tender point


Treatment





Inferior medial surface of the descending
ramus of the pubic bone (start palpation at
ischial tuberosity)
Supine
Flexion –patient’s thigh
Abduct femur moderately to accentuate the
low flareout
Rotate femur externally – markedly by
pushing the foot toward the midline
Treat LIFO before LISI
AMT (Anterior Medial Trochanter)
(Rectus Femoris)

Tender point


1 cm lateral to the anterior inferior iliac
spine (AIIS)
Treatment
Supine
 Flex hip 130o
 Abduct – none
 Rotate – none

ALT (Anterior Lateral Trochanter)
(Sartorius)

Tender point


2 cm lateral to AIIS. Flex the hip to
find this tender point
Treatment
Supine
 Flex hip 90o
 Abduct – moderate
 Rotate – external, little or none

IL (Iliacus)

Tender point


Anterior and deep in iliac fossa (push
posterior and medial)
Treatment
Supine
 Patient’s ankles supported on
clinician’s thigh. Extreme flexion of
hips and external rotation of both
femurs. Full abduction

ING (Inguinal Ligament)




Hip internal rotator dysfunction
Tender point
 Lateral surface of pubic bone just below the inguinal
ligament attachment. Push medial
Treatment
 Supine
 Clinician stands on tender point side
 Flexion – flex hip 90o and rest on clinician’s thigh. Move
the leg on the tender point side under opposite leg of
patient. This produces crossing of knees and thighs
 Adduction of femur
 Rotate – internal rotation of femur
Groin pain
ADD (Adductor)

Tender point
1. Origin of adductors to pubic bone
2. Occasionally in muscle belly

Treatment




Supine
Adduction – marked
Cross leg of tender point side in front of
opposite leg
Flexion – slight
GMi (Gluteus Minimus)

Tender point


Anterior border of gluteus minimus
muscle. Superior and anterior to the
greater trochanter. Push posterior and
medical above greater trochanter
Treatment
Supine
 Flexion – hip to 90o
 Abduction – slight
 Rotate – marked internal

TFL (Tensor Fascia Lata)

Tender point


Belly of TFL muscle approximately 6
cm cephalad and anterior to the
greater trochanter
Treatment
Supine
 Flexion – hip 90o-100o
 Abduction – hip, slight
 Rotation – draw foot laterally to create
internal rotation of hip

SAR (Sartorius)
(Connection with RK Technique)

Tender point




1. Proximal tendon 2 cm lateral from anterior
inferior iliac spine
2. Mid belly of muscle
3. Distal sartorius on medial side of knee (RK)
Treatment




Supine
Flexion – hip and knee 90o
Abduction – hip, moderate
Rotation – external, moderate
HISI
PLT
Posterior
Pelvis / Hip
Tender
Points
MPSI
HFO-SI
PMT
GM
PIR
LT
HISI (High Ilium – Sacroiliac)
Common
 Tender point



3 cm lateral to the posterior superior
iliac spine
Treatment
Prone
 Extension – hip, supported on
clinician’s thigh
 Abduct - slight

HFO-SI (High Flare-Out Sacroiliac)


May be associated with coccygodynia
Tender point



1. 4 cm below and slightly medial to PSIS in
the area of the inferior lateral angles of the
sacrum
Occasionally on the ischial tuberosity
Treatment




Prone
Clinician on side opposite tender pont
Raise leg on the tender point side high
enough to clear opposite leg and adduct
across, scissoring the legs
Correction is by increasing/accentuating the
high ilium and flareout. Occasionally, the
opposite leg is extended mildly and adducted
MPSI (Mid-Pole Sacoiliac)


Ilium flare in - superiorly
Tender point



Treatment




Middle of the buttocks in slight depression
Direct palpating finger medially (located
medial to piriformis)
Prone
Extension – slight, occasionally slight flexion
Abduction – moderate, major component
Helpful with dysmenorrhea, may decrease
cramping intensity by 50-60%
PIR (Piriformis)


Tender point
 In the muscle belly, 8 cm medial and slightly cephalad
to the greater trochanter
Treatment
1. Similar to LP5
 Prone
 Clinician seated on tender point side
 Leg on tender point side suspended off side of table
with patient’s anterior aspect on ankle resting on
operator’s thigh
 Flexion – 120o at hip
 Abduct –moderate, horizontally
 rotate – usually internal
 Piriformis – muscle belly
2. Occasionally will clear with the posterior lateral
trochanter technique (easier)
 Piriformis - tendon
PLT (Posterior Lateral Trochanter)


Hip external rotator dysfunction
Tender point




Posterosuperior lateral surface of greater
trochaner
Tender point is near the insertion of the piriformis
muscle
Push anterior and medial
Treatment





Prone
Clinician on tender point side
Extension – hip, support thigh on clinician’s knee
Abduction – slight
Rotate – marked external
PMT (Posterior Medial Trochanter)

Tender point


On a line from the lateral inferior surface of
ischial tuberosity to the medial aspect of the
posterior surface of the femur
Treatment






Prone
Clinician on side opposite tender point
Clinician pins patient’s ankle in his/her axilla
Extension – hip, moderate
Adduction – marked
Rotate – marked external
LT (Lateral Trochanter (LT)

Tender point


12 cm below greater trochanter on
lateral side of the shaft of the femur.
Push medially
Treatment
Prone
 Flexion – hip, minimal
 Abduction – hip
 Rotate – hip, internal or external,
slight

GM (Gluteus Medius)

Tender point
On a line 1 cm below the iliac crest
 Follow medial to lateral with palpation


Treatment
Prone
 Clinician on tender point side
 Extension – hip, clinician places knee
under patient’s thigh
 Abduction – hip, moderate
 Rotate – marked, internal

S1
Sacral
Tender
Points
S1
S2
S3
S5
S5
S4
PS1


Backward sacral torsion dysfunction
Tender point


1.5 cm medial to inferior aspect of PSIS
bilaterally
Treatment



Prone
Apply a downward pressure (toward table)
on the opposite corner of the sacrum from
which the tender point is found to produce
rotation around an oblique axis
Twist heel of hand for subtle fine
tuning/rotation
PS2


Sacral extension dysfunction
Tender point


Midline on sacrum between the first and
second spinous tubercles
Treatment



Prone
Apply a downward pressure to the apex of
the sacrum in midline to produce rotation
around a transverse axis
Twist heel of hand for subtle fine
tuning/rotation
PS3
Sacral extension dysfunction
 Tender point



Midline on sacrum between the
second and third spinous tubercles
Treatment
Prone
 Apply a downward pressure to the
apex of the sacrum in midline
 Twist heel of hand for subtle fine
tuning/rotation

PS4
Sacral flexion dysfunction
 Tender point

Midline on sacrum just above sacral
hiatus
 Approach inferior to superior


Treatment
Prone
 Apply a downward pressure to the
sacral base in midline
 Twist heel of hand for subtle fine
tuning/rotation

PS5


Forward sacral torsion dysfunction
Tender point


1 cm medial and 1 cm superior to the inferior
lateral angles bilaterally
Treatment



Prone
Apply a downward pressure to the opposite
corner of the sacrum from where the tender
point is found
Twist heel of hand for subtle fine
tuning/rotation
CYX (Coccyx Point)
Coccygodynia
 Tender point



Either side of tip of coccyx
Treatment
Prone
 Apply a downward pressure to the
apex of the sacrum
 Rotate sacrum toward side of tender
point (95%). Rotate away from the
side of tender point (5%)
