Lumbar tender points, anterior

Figure 50-1 shows the locations of the anterior lumbar tender points. Anterior tender points will generally require a position of flexion. The positioning is accomplished by using the lower extremities as levers to move the lumbar spine. 

The counterstrain tender points of the lumbar spine are named for the dysfunctional lumbar vertebrae. Anterior tender points are treated with the patient supine and posterior tender points are treated with the patient prone. Many of the counterstrain techniques for lumbar somatic dysfunctions are facilitated by slight rotation of the patient s thighs and pelvis, and by resting some part of the patient s leg on the physician s thigh or knee. 

The abdominal L2 tender point is an additional tender point for the second lumbar vertebra and is found 2 inches lateral to the umbilicus. The treatment is the same as for the anterior inferior iliac spine tender point except that the thighs are rotated toward the tender point (the equivalent of rotation away from the tender point at the vertebral level) (Fig. 50-4). 

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