Osteopathic Principles applied to Sports Medicine. Mark Rogers, DO, MA

Transcription

1 Osteopathic Principles applied to Sports Medicine Mark Rogers, DO, MA 199

2 Incorporating Osteopathic Principles Into Your Practice 17 th Annual VCU Sports Medicine Update in Primary Care December 2011 Mark Rogers, D.O., M.A., CAQSM Associate Professor, Dept Family and Sports Medicine Virginia College of Osteopathic Medicine Team Physician, Virginia Tech Team Physician, Pulaski Mariners Objectives Discuss history of manual medicine and sports Review osteopathic principles as they pertain to sports medicine Review how osteopathic manipulative medicine relates to the functional and biomechanical exam and treatment Discuss some of the osteopathic manipulative treatments used in ankle sprains Resources Foundations for Osteopathic Medicine, 3nd edition Outline of Osteopathic Manipulative Procedures The Kimberly Manual Principles of Manual Sports Medicine 200

3 Osteopathic Medicine To find health should be the object of the doctor. Anyone can find disease. --Dr. A.T. Still, 1874 Why Name it Osteopathy? Osteopathy is compounded of two words, osteon, meaning bone, (and) pathos, (or) pathine), to suffer. I reasoned that the bone, Osteon, was the starting point from which I was to ascertain the cause of pathological conditions, and so I combined the Osteo with the pathy and had as a result, Osteopathy. Early History Charles Bell (1811) Discovers the function of individual spinal nerves for motor and sensory function Dr. William Beaumont (1833) Published first experiments on gastric digestion and response to foods and emotion from a patient with a gunshot wound in abdomen 201

4 Early History Thomas Brown MD (1828) Spinal Irritation Pain about an internal organ may be caused by a disturbed spinal vertebrae with a shared nerve supply John Hilton MD (1863) Anatomist and Surgeon Sympathies Visceral pain without sore spots or inflammation Treatment of viscera by resting the spine Historical Aspects of Manipulation Chinese Manual Therapy Predates Acupuncture Bone Setters Healing practitioners who used manual therapy as an integral part of their care Sir Herbert Barker Was a well known British bonesetter of the late 1800s, who was knighted by the crown for his eminence Early published papers in The Lancet and British Medical Journal Historical Aspects of Manipulation & Sports Hippocrates Father of Medicine 460 BC Well known Greek Sports Physician Physician for the Olympics Use of manipulation well documented Physical structure is the basis of medicine 202

5 Historical Aspects of Manipulation & Sports Galen 150 AD Followed Hippocrates teachings The most influential Roman Physician Served under Marcus Aurelius Principal Physician to the Gladiators Wrote up to 600 works Historical Aspects of Manipulation & Sports Phog Allen, D.O. Legendary Basketball Coach at Kansas University Osteopathic Physician Athletic Trainer Well known for his use of manipulation in ailing athletes Osteopathic Medicine s Roots in Virginia Andrew Taylor Still Born in Jonesville, Va. in 1828 to a Methodist minister who practiced medicine and farming Dr. Still maintained his mindbody-spirit approach to medicine Coined the osteopathic principles in 1874 Kirksville College of Osteopathic Medicine (1892) 203

6 Early Osteopathy A perfectly adjusted body will produce pure blood and plenty of it, deliver it on time and in quantity sufficient to supply all demands in the economy of life -- A.T. Still, M.D. Classical Osteopathic Philosophy of Health Health is a natural state of harmony between body, mind and spirit The human body is a perfect machine created for health and activity A healthy state exists as long as there is normal flow of body fluids and nerve activity Classical Osteopathic Philosophy of Disease Disease is an effect of underlying, often multi-factorial causes Illness is often caused by mechanical impediments to normal flow of body fluids and nerve activity Environmental, social, mental, and behavioral factors contribute to the etiology of disease and illness, thus need to be addressed in management Removal of mechanical impediments allows optimal body fluid flow, nerve function, and restoration of health 204

7 4 Tenets of Osteopathic Philosophy The body is a unit The body possesses self-regulatory, self-healing, and health maintenance mechanisms Structure and function are reciprocally interrelated Rational therapy is based on an understanding of body unity, selfregulatory mechanisms, and the interrelationship of structure and function Somatic Dysfunction Impaired or altered function of related components of the somatic (body framework system) skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic and neural elements Includes changes related to: Tissue Texture Asymmetry Restriction of Motion Tenderness Active range of motion Physiologic barrier Anatomic barrier 205

8 Motion Loss Active range of motion Pathologic barrier Physiologic barrier Anatomic barrier Shift of midline Active range of motion Pathologic barrier Loss of motion The Goal of OMM Therapeutic application of manually guided forces to improve physiologic function and /or support homeostasis Utilizing concepts of the unity of the living organism s structure (Anatomy), and function (Physiology) and using the art of medicine 206

9 General Concepts of OMM in Athletes Restore maximal, pain free movement of the musculoskeletal system in postural balance Minor injuries can produce disabilities May affect overall function Effective diagnosis and treatment requires an understanding of the STRUCTURE and FUNCTION relationship Curr. Sports Med. Rep., Vol. 7, No. 1, pp , 2008 Evidence-Based Osteopathic Manipulation Summary Benefit > Risk for Acute, subacute and chronic mechanical low back and neck pain Cervicogenic headaches Knee Osteoarthritis Prenatal OB Pediatric Neurologic Development Can reduce: Pain Medication use PT utilization Hospital days Disability/Impairment Work days lost Post-op pulmonary complications Post-op ileus Post-MI complications Increase in: Patient satisfaction How is Manipulation Proposed to Work? Biomechanical orientation Release of facet joint synovial entrapment Relaxation of hypertonic musculature by sudden stretching Unbuckling of motion segments that have become disproportionately displaced Disruption of articular or periarticular adhesions 207

10 Functional Biomechanical Exam Postural examination Approximate foot position A-P and lateral curves Examine foot, knee and hip alignment Leg lengths Functional Biomechanical Exam Brolinson PG. Curr Sports Med Rep 2003; 2:47 56 Kuchera, M. Foundations for Osteopathic Medicine, 2 nd edition, Routine Pre-Competition OMT Standing Flexion Test Assess leg length Assess transitional areas in T and L spine Assess innominants Assess any rib dysfunctions Assess C spine Determine any sacral dysfunction 208

11 Routine Pre-Competition OMT Begin ST of thoracic and lumbar spine TART changes Lateral recumbent roll for SI and lumbar dysfunction SI and pubic symphysis ME technique Thoracic HVLA Rib articulatory treatment Especially 1 st rib Cervical ST and HVLA Any particular treatment for other specific dysfunctions as indicated Inversion Ankle Sprain Typically with plantar flexion Thin posterior portion of talus offers little ankle stability Relying dynamically on soft tissue support Peroneal muscles are eccentrically loaded rapidly Weight of body coming down jams talus into the crural (distal tib/fib) articulation Inversion Ankle Sprain Stich Woodbridge Ankle Injury 209

12 Inversion Ankle Sprain Inversion Ankle Sprain Soft tissues Peroneal muscles Anterior tibialis Extensor digitorum Navicular/cuboid dysfunction Talus dysfunction Fibular head Tibia Femur Hip Sacrum 3 rd rib/thoracic vertebra Inversion Ankle Sprain Soft Tissue 210

13 Inversion Ankle Sprain Foot Dysfunction Somatic dysfunction Navicular Cuboid Diagnosed by pain and decreased motion Trigger points Navicular Dysfunction Mechanism Chronic Posterior Tibialis dysfunction Calcaneo-navicular (spring) ligament insufficiency Acute inversion ankle sprain Exam Prominent (& usually tender) navicular bone May have increased pronation Peroneus Longus Insertion Spring Ligament Treatment of Navicular Dysfunction Articulatory Technique Restore arch by gapping superior aspects of navicular bone & applying plantar to dorsal pressure Can be done with one rapid action or with slow steady pressure Recheck findings 211

14 Cuboid Dysfunction Mechanism Chronic peroneus muscle dysfunction Calcaneo-cuboid ligament insufficiency Often concomittant with navicular dysfunction Exam Prominent (& usually tender) cuboid bone Supination may be noticeable Treatment of Cuboid Dysfunction Articulatory Technique Grasp cuboid snugly & chalking the 5 th metatarsal head onto the cuboid gently Or chalking the cuboid onto the calcaneus. Chalking the cue stick! Inversion Ankle Sprain Talus Dysfunction Anterior dysfunction Restricted in dorsiflexion Pt will complain of anterior talar pain or jamming with attempted dorsiflexion, & possibly of reduced calf stretch when attempted Diagnose by Swing Test 212

15 Treatment of Talus Dysfunction HVLA Technique (Talar Tug) Treatment of Talus Dysfunction Articulatory Technique Treatment of Anterior Talus Muscle Energy Technique Flex knee and keep foot parallel to floor until barrier is felt Have patient gently plantarflex (away from barrier) while maintaining position 2 to 3 seconds rest Engage new barrier Repeat 3-5 times Pushing the talus back into the talocrural joint 213

16 Treatment of Posterior Talus Muscle Energy Technique Extend knee and keep foot parallel to floor until barrier is felt Have patient gently dorsiflex (away from barrier) while maintaining position 2 to 3 seconds rest Engage new barrier Repeat 3-5 times Pulling the talus out of the talocrural joint Inversion Ankle Sprain Fibular Head Dysfunction Anterior restriction Can be associated with iliotibial tendonitis, and/or mimic lateral meniscal tears Pt will complain of lateral knee pain, usually with weight bearing & pivoting Rule out Maisonneuve Fx if known to be a traumatic mechanism Inversion Ankle Sprain Fibular Head Dysfunction Remember plane of tib-fib joint is about 30 0 Anterolateral Posteromedial Goal of all the following treatments are for the return of anterolateral glide of the proximal fibular head & to allow external rotation of tibia 214

17 Treatment of Posterior Fibular Head Articulatory Technique Treatment of Posterior Fibular Head Articulatory Technique 215