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OMM and the Athlete Lower Body Workshop Jake Rowan DO Dept of OMM MSUCOM.

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Presentation on theme: "OMM and the Athlete Lower Body Workshop Jake Rowan DO Dept of OMM MSUCOM."— Presentation transcript:

1 OMM and the Athlete Lower Body Workshop Jake Rowan DO Dept of OMM MSUCOM

2 Goals/Objectives Review OPP and how they apply to sports medicine Discuss functional biomechanics Review palpatory dx Discuss OMM tx approach

3 An Osteopathic Approach to Treatment The role of the physician is to facilitate the healing process The focus of treatment is the patient The 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.

4 OPP - Manual Medicine Approach Somatic Dysfunction – Impaired or altered function of related components of the somatic system (skeletal, arthrodial and myofascial structures) and the related vascular, lymphatic, and neural elements

5 Diagnostic Triad of Somatic Dysfunction A A symmetry of position – Comparing left to right and superior to inferior R R ange of motion restrictions – Standing Flexion Test – Stork Test – Seated Flexion Test T T issue texture abnormalities – Change in soft tissue texture

6 MANUAL MEDICINE APPROACH Physician needs to identify the problem, make the Dx, and Rx the appropriate TX – Tx – surgery, drugs, manipulation, therapeutic exercise Goal 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

7 MODELS OF MANUAL MEDICINE Biomechanical model. Neurologic model. Respiratory-circulatory model. Bioenergy model. Organ system model.

8 Models, 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/setting Activating Forces - intrinsic and extrinsic.

9 Tx Approach Principles Treat the axial skeleton first Extremities: start proximal work distal – LE – pelvis, hip, knee, ankle, foot, toes – UE – scapula, SC, AC, glenohumeral, elbow, wrist, hand, fingers

10 Tx Approach Principles Motor Control – Balance – Core stability – Stretch before strengthening


12 Tx Approach Principles - LBP Pelvis – Pubes – Ilium Lumbar spine Lower Thoracic Sacrum Core stability

13 Lumbar Spine and Sacrum

14 Muscle Imbalance Three dimensional evaluation of function of the lumbar spine and pelvis. Used diagnostically and therapeutically. The Pelvic Clock

15 The Lower Extremity (LE) The primary fxn of the LE is ambulation – The 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/running Dysfxn in the LE alters the functional capacity of the rest of the body – particularly the pelvic girdle

16 PROPRIOCEPTIVE BALANCE Assessment & Treatment

17 PROPRIOCEPTIVE BALANCE Assessment and Treatment

18 Tx Approach Principles - LE Pelvis Lumbar spine Lower T-spine Sacrum Hip Knee Ankle Foot Toes

19 The Pelvis


21 Lower Extremity


23 Gluteal Muscles

24 Hip Capsule

25 Assessment of Hip Capsule Pattern Circumduct in a counterclockwise direction – internally – FADIR Circumduct in a clockwise direction – externally – FABER

26 Posterior Hip Capsule Stretch Operator’s hand is placed over the ischial tuberosity with the other hand controlling the flexed hip and knee Operator abducts/adducts and internally/externally rotates the against restrictive barriers Operator’s activating force is repetitive mobilization in a posterior direction through the shaft of the femur

27 Acetabular Labrum Mobilization Technique Internal & external hip rotation. Lateral to medial impaction- distraction of femoral head. Anterior to posterior impaction- distraction femoral head.

28 Anterior 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 femur Operator gently lifts knee and applies a series of mobilizing forces in an anterior direction to proximal femur Operator fine-tunes against resistant barriers with internal/external rotation and medial/lateral directional forces

29 Muscle Energy Technique of the Hips & Thighs

30 MET Rx for Hips & Thighs Motion Tested – ABduction Muscles Tested – ADDuctors

31 MET Rx for Hips & Thighs Motion Tested – ADDuction Muscles Tested – Abductors – Gluteus medius & minimis

32 MET Rx for Hips & Thighs Motion Tested – ADDuction Muscles Tested – ABductors – Tensor Fascia Lata

33 MET Rx for Hips & Thighs Motion Tested – Internal rotation with hips in neutral Muscles Tested – External rotators – obturators, gemellus, quadratus femoris, piriformis

34 MET Rx for Hips & Thighs Motion Tested – Internal rotation Muscles Tested – External rotators - piriformis

35 MET Rx for Hips & Thighs Motion Tested – External rotation with hip in neutral Muscles Tested – Internal rotators – gluteus minimus & medius, tensor fascia lata

36 MET Rx for Hips & Thighs Motion Tested – External rotation – hip flexed 90% Muscles Tested – Internal Rotators – Gluteus medius & minimus

37 MET Rx for Hips & Thighs Motion Tested – Hip flexion (straight leg raising) Muscles Tested – Hip Extensors – hamstrings; gluteus max & adductor magnus when hip flexed

38 MET Rx for Hips & Thighs Motion Tested – Hip extension Muscles Tested – Hip flexors – iliopsoas, rectus femoris – Modified Thomas Position – Treat L-spine first

39 MET Rx for Hips & Thighs Motion Tested – Knee flexion Muscles Tested – Quadriceps group

40 MET Rx for Hips & Thighs Preferred Prone Position for Tx of iliopsoas and Rectus Femoris

41 MET Rx for Hips & Thighs Tx for rectus femoris Tx for iliopsoas

42 The Knee and Proximal Leg



45 Joint stabilization: – Medial meniscus. – Lateral meniscus. – Articular capsule. – Medial collateral ligament. – Lateral collateral ligament. – Posterior ligaments. – Oblique popliteal ligaments. – Anterior cruciate ligament. – Posterior cruciate ligament.

46 KNEE JOINT BURSA Subcutaneous prepatellar bursa. Suprapatellar bursa. Deep infrapatellar bursa. Subcutaneous infrapatellar bursa. Infrapatellar fat pad.

47 Lower Extremity


49 KNEE: MOBILIZATION WITHOUT IMPULSE Thumbs on medial meniscus. Gap medial compartment and extend knee.

50 KNEE: MOBILIZATION WITHOUT IMPULSE Thumbs on medial or lateral meniscus. Circumduct and extend knee.

51 KNEE: MENISCAL TRACKING Rotation into extension.

52 KNEE: EXTENSION COMPRESSION TEST Restriction of extension and pain provocation indicate lack of terminal external torsion of the tibia and/or meniscal injury.

53 MET KNEE: Dx OF INTERNAL AND EXTERNAL ROTATION External rotation of the tibia Internal rotation of the tibia

54 KNEE: MET Tx OF INTERNAL AND EXTERNAL ROTATION Position – Tibia internally rotated Motion restriction – External rotation of tibia Position – Tibia externally rotated Motion restriction – Internal rotation of tibia

55 Proximal Tibiofibular Joint This articulation is intimately related to the knee and is equally important to the ankle Proximal tib/fib jt has an anteroposterior glide and is influenced by the biceps femoris Plane of the joint is approx 30% from lateral to medial – Testing should be done within the plane of the joint

56 PROXIMAL 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.

57 Lower Extremity

58 MET Dx Fibular Head Patient supine or sitting on table Operator grasps the proximal fibula between thumb/thenar eminence & fingers – Be careful not to compress peroneal nerve Operator translates the fibular head ant/post

59 MET Tx for Posterior Fibular Head Dx – Posterior fibular head Motion restriction – Anterior glide Operator inverts and internally rotates the foot – Anterolateral force on posterior fib head Patient should evert and dorsiflex foot

60 MET Tx for Anterior Fibular Head Dx – Anterior fibular head Motion Restriction – Posterior glide Operator inverts and externally rotates patients foot – Posteromedial force on anterior fib head Patient everts & plantar flexes the foot

61 HVLA for Posterior Fibular Head Dx – Posterior fibular head Motion Restriction – Anterior glide

62 HVLA for Posterior Fibular Head Dx – Posterior fibular head Motion Restriction – Anterior glide Patient Prone Operator’s index finger metacarpophalangeal jt is posterior to the fibular head in the popliteal space – Add slight external rotation to leg

63 HVLA of Anterior Fibular Head Dx – Anterior fibular head Motion restriction – Posterior glide Patient supine Operator internally rotates leg 30% – thenar eminence is placed over proximal anterior fibular shaft

64 The Ankle and Foot Help 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

65 DISTAL TIBIOFIBULAR ARTICULATION Dx: Antero- posterior glide of distal tibio- fibular joint. Related to dysfunction at proximal tibio- fibular joint.

66 RESTRICTED ANTERIOR DISTAL TIB-FIB JOINT Thumb on anterior aspect of distal fibula. Compressive posterior thrust through left thumb.

67 RESTRICTED POSTERIOR DISTAL TIB-FIB JOINT Thumb on posterior aspect of distal fibula. Compressive anterior thrust through left thumb.

68 Dx: MORTISE JOINT DORSIFLEXION RESTRCTION Thumbs on neck of talus. Hands introduce dorsiflexion of talus at mortise joint.

69 Rx MORTISE JOINT DORSIFLEXION RESTRICTION Left hand web on neck of talus.Resist plantar flexion.

70 Internal vs External Rotation Restrictions Restricted internal/medial rotation. Restricted external/lateral rotation. Muscle energy activating force


72 Rx INTERTARSAL JOINTS Thumb under middle cuneiform. Resist forefoot dorsiflexion.

73 Dx CALCANEOCUBOID JOINT Test internal- external rotation of cuboid. Palpate tenderness & prominence of cuboid tubercle.

74 Rx CALCANEOCUBOID JOINT Lift cuboid. Plantar flex & medially rotate forefoot. Resist dorsiflexion of forefoot or HVT of acute plantar flexion. MET OR HVLA ACTIVATING FORCE

75 J-STROKE FOR CALCANEOCUBOID JOINT Control forefoot and thumbs on cuboid. Throw foot to floor.

76 Review OPP Review Functional Biomechanics and the use of OMT in treating the athlete Questions ?

77 Osteopathic Medicine The science of medicineThe art of caringThe power of touch

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