Presentation on theme: "OMM and the Athlete Lower Body Workshop"— Presentation transcript:
1OMM and the Athlete Lower Body Workshop Jake Rowan DODept of OMMMSUCOM
2Goals/Objectives Review OPP and how they apply to sports medicine Discuss functional biomechanicsReview palpatory dxDiscuss OMM tx approach
3An Osteopathic Approach to Treatment The role of the physician is to facilitate the healing processThe focus of treatment is the patientThe patient is treated in the context of the disease process they are experiencing.The patient has the primary responsibility for his or her health.There is a somatic component of disease and manipulative therapy can restore the body’s function, enhance wellness, and assist in recovery from disease and injury.
4OPP - Manual Medicine Approach Somatic DysfunctionImpaired or altered function of related components of the somatic system (skeletal, arthrodial and myofascial structures) and the related vascular, lymphatic, and neural elements
5Diagnostic Triad of Somatic Dysfunction Asymmetry of positionComparing left to right and superior to inferiorRange of motion restrictionsStanding Flexion TestStork TestSeated Flexion TestTissue texture abnormalitiesChange in soft tissue texture
6MANUAL MEDICINE APPROACH Physician needs to identify the problem, make the Dx, and Rx the appropriate TXTx – surgery, drugs, manipulation, therapeutic exerciseGoal for Manipulation To improve mobility of tissues (bone, joint, muscle, ligament, fascia, fluid) and restore to normal physiological motion if possible.Restore the maximal pain free movement of the musculoskeletal system in postural balance
7MODELS OF MANUAL MEDICINE Biomechanical model.Neurologic model.Respiratory-circulatory model.Bioenergy model.Organ system model.
8Models, Mechanisms & Activating Forces Model relates to the therapeutic objective of the intervention.Method relates to the approach to the restrictive barrier. ( Direct, Indirect, Combined).Depend on the clinician, patient, and environment/settingActivating Forces - intrinsic and extrinsic.
14Muscle ImbalanceThe Pelvic ClockThree dimensional evaluation of function of the lumbar spine and pelvis.Used diagnostically and therapeutically.
15The Lower Extremity (LE) The primary fxn of the LE is ambulationThe complex interactions of the foot, ankle, knee, and hip regions provide a stable base for the trunk in standing and a mobile base for walking/runningDysfxn in the LE alters the functional capacity of the rest of the body – particularly the pelvic girdle
25Assessment of Hip Capsule Pattern Circumduct in a counterclockwise directioninternallyFADIRCircumduct in a clockwise directionexternallyFABER
26Posterior Hip Capsule Stretch Operator’s hand is placed over the ischial tuberosity with the other hand controlling the flexed hip and kneeOperator abducts/adducts and internally/externally rotates the against restrictive barriersOperator’s activating force is repetitive mobilization in a posterior direction through the shaft of the femur
27Acetabular Labrum Mobilization Technique Internal & external hip rotation.Lateral to medial impaction-distraction of femoral head.Anterior to posterior impaction-distraction femoral head.
28Anterior Hip Capsule Stretch Operator flexes knee and grasps anterior aspect of distal femur with one hand and the other contacts the posterior aspect of the proximal femurOperator gently lifts knee and applies a series of mobilizing forces in an anterior direction to proximal femurOperator fine-tunes against resistant barriers with internal/external rotation and medial/lateral directional forces
49KNEE: MOBILIZATION WITHOUT IMPULSE Thumbs on medial meniscus.Gap medial compartment and extend knee.
50KNEE: MOBILIZATION WITHOUT IMPULSE Thumbs on medial or lateral meniscus.Circumduct and extend knee.
51KNEE: MENISCAL TRACKING Rotation into extension.
52KNEE: EXTENSION COMPRESSION TEST Restriction of extension and pain provocation indicate lack of terminal external torsion of the tibia and/or meniscal injury.
53MET KNEE: Dx OF INTERNAL AND EXTERNAL ROTATION External rotation of the tibiaInternal rotation of the tibia
54KNEE: MET Tx OF INTERNAL AND EXTERNAL ROTATION PositionTibia internally rotatedMotion restrictionExternal rotation of tibiaPositionTibia externally rotatedMotion restrictionInternal rotation of tibia
55Proximal Tibiofibular Joint This articulation is intimately related to the knee and is equally important to the ankleProximal tib/fib jt has an anteroposterior glide and is influenced by the biceps femorisPlane of the joint is approx 30% from lateral to medialTesting should be done within the plane of the joint
56PROXIMAL TIBIOFIBULAR JOINT Gliding synovial joint with anterior and posterior head ligaments.Relates to tibial torsion.Relates to distal tibiofibular joint at the ankle.Tibiofibular interosseous membrane.
58MET Dx Fibular Head Patient supine or sitting on table Operator grasps the proximal fibula between thumb/thenar eminence & fingersBe careful not to compress peroneal nerveOperator translates the fibular head ant/post
59MET Tx for Posterior Fibular Head DxPosterior fibular headMotion restrictionAnterior glideOperator inverts and internally rotates the footAnterolateral force on posterior fib headPatient should evert and dorsiflex foot
60MET Tx for Anterior Fibular Head DxAnterior fibular headMotion RestrictionPosterior glideOperator inverts and externally rotates patients footPosteromedial force on anterior fib headPatient everts & plantar flexes the foot
61HVLA for Posterior Fibular Head DxPosterior fibular headMotion RestrictionAnterior glide
62HVLA for Posterior Fibular Head DxPosterior fibular headMotion RestrictionAnterior glidePatient ProneOperator’s index finger metacarpophalangeal jt is posterior to the fibular head in the popliteal spaceAdd slight external rotation to leg
63HVLA of Anterior Fibular Head DxAnterior fibular headMotion restrictionPosterior glidePatient supineOperator internally rotates leg 30%thenar eminence is placed over proximal anterior fibular shaft
64The Ankle and FootHelp arrives: MSU trainer Tom Mackowiak (left) and team doctor Jeff Kovan tend to Spartan junior guard Kalin Lucas after he went down with a sprained ankle against Wisconsin
65DISTAL TIBIOFIBULAR ARTICULATION Dx: Antero-posterior glide of distal tibio-fibular joint.Related to dysfunction at proximal tibio-fibular joint.
66RESTRICTED ANTERIOR DISTAL TIB-FIB JOINT Thumb on anterior aspect of distal fibula.Compressive posterior thrust through left thumb.
67RESTRICTED POSTERIOR DISTAL TIB-FIB JOINT Thumb on posterior aspect of distal fibula.Compressive anterior thrust through left thumb.
68Dx: MORTISE JOINT DORSIFLEXION RESTRCTION Thumbs on neck of talus.Hands introduce dorsiflexion of talus at mortise joint.
69Rx MORTISE JOINT DORSIFLEXION RESTRICTION Left hand web on neck of talus.Resist plantar flexion.
70Internal vs External Rotation Restrictions Restricted internal/medial rotation.Restricted external/lateral rotation.Muscle energy activating force