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OMM and the Athlete Lower Body Workshop

OMM and the Athlete Lower Body Workshop. Jake Rowan DO Dept of OMM MSUCOM. Goals/Objectives. Review OPP and how they apply to sports medicine Discuss functional biomechanics Review palpatory dx Discuss OMM tx approach . An Osteopathic Approach to Treatment.

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OMM and the Athlete Lower Body Workshop

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  1. OMM and the AthleteLower 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 palpatorydx • 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 • Asymmetry of position • Comparing left to right and superior to inferior • Range of motion restrictions • Standing Flexion Test • Stork Test • Seated Flexion Test • Tissue 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 ManipulationTo 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

  11. Tx Approach Principles - LBP • Pelvis • Pubes • Ilium • Lumbar spine • Lower Thoracic • Sacrum • Core stability

  12. Lumbar Spine and Sacrum

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

  14. 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 The Lower Extremity (LE)

  15. PROPRIOCEPTIVE BALANCEAssessment & Treatment

  16. PROPRIOCEPTIVE BALANCEAssessment and Treatment

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

  18. The Pelvis

  19. The Pelvis

  20. Lower Extremity

  21. ILIOPSOAS & RECTUS FEMORIS

  22. Gluteal Muscles

  23. Hip Capsule

  24. Circumduct in a counterclockwise direction internally FADIR Circumduct in a clockwise direction externally FABER Assessment of Hip Capsule Pattern

  25. 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

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

  27. 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

  28. Muscle Energy Technique of the Hips & Thighs

  29. MET Rx for Hips & Thighs • Motion Tested • ABduction • Muscles Tested • ADDuctors

  30. MET Rx for Hips & Thighs • Motion Tested • ADDuction • Muscles Tested • Abductors – Gluteus medius & minimis

  31. MET Rx for Hips & Thighs • Motion Tested • ADDuction • Muscles Tested • ABductors – Tensor Fascia Lata

  32. MET Rx for Hips & Thighs • Motion Tested • Internal rotation with hips in neutral • Muscles Tested • External rotators – obturators, gemellus, quadratusfemoris, piriformis

  33. MET Rx for Hips & Thighs • Motion Tested • Internal rotation • Muscles Tested • External rotators - piriformis

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

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

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

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

  38. MET Rx for Hips & Thighs • Motion Tested • Knee flexion • Muscles Tested • Quadriceps group

  39. MET Rx for Hips & Thighs • Preferred Prone Position for Tx of iliopsoas and Rectus Femoris

  40. MET Rx for Hips & Thighs • Tx for rectus femoris • Tx for iliopsoas

  41. The Knee and Proximal Leg

  42. THIGH MUSCLES

  43. KNEE JOINT

  44. KNEE JOINT • 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.

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

  46. Lower Extremity

  47. CALF MUSCLES

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

  49. KNEE: MOBILIZATIONWITHOUT IMPULSE Thumbs on medial or lateral meniscus. Circumduct and extend knee.

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