MET: Type I Dysfunction

by Tyler Cymet, DO, FACOFP

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    00:00 We're back to treating short leg syndrome and leg length discrepancies that are apparent but not real. So we're going to talk more about the short leg syndrome diagnosing and treating it.

    00:13 I'm going to start by talking about muscle energy techniques or type 1 mechanics, type 1 or neutral mechanics when a patient side-bends and rotates to opposite sides.

    00:24 It's when you have fluid motion and you can use this fluid motion to treat a person quickly and easily and restore normal function.

    00:33 In this type 1 dysfunction, we're going to talk about treating a leg length abnormality. Again, it's not a change in the leg length.

    00:42 It is a short leg syndrome. But you can lie the patient on the side and with the concavity of the curve, move the patient posteriorly rotate them and help induce motion that way.

    00:57 You want to monitor the motion and make sure that you're getting the hips and the sacrum and the pelvis all moving.

    01:05 You can flex the legs to approximately 90 degrees bending the knees and using that as a fulcrum.

    01:11 Then feel the motion in the sacroiliac region.

    01:17 You may want to side bend the patient as well.

    01:19 Again, you're using type 1 mechanics and side-bending and rotating to opposite sides. If you don't have motion with just positioning, you just move it to a muscle energy procedure and you have the person push down engaging their muscles.

    01:36 You don't want them to use their lower leg muscles.

    01:39 You want them to use their hip muscles.

    01:43 Then you have the patient relax and repeat as long as you have an increase in motion. The patient will push down again and again. Do this at least three times.

    01:51 But as long as they have more motion each time, I'm happy.

    01:55 The passive stretch after the last repetition and then reassess the leg lengths.

    02:02 Next technique, facilitated positional release is another way of treating a short leg syndrome. In this case, you'll place the patient in the prone position. I usually put a pillow under their belly. First of all, it's comfortable.

    02:17 Second of all, a lot of times I use the pillow as a fulcrum and to help induce the motion. So I've got a greater lever of motion in treating the patient. I stand to the left of the patient and to the other side of the hypertonic muscle so that I can use gravity and use positioning to help treat it.

    02:38 I'll monitor the muscle as I treat it to make sure that the tightness goes away and that I have an easing or freedom of motion. I'll also stabilize the patient with my leg, my hip, or my hand in order to keep the patient's ilium from moving. I'll then use the other side of the patient to move the pelvis and to make sure I get a freedom of motion monitoring the sacroiliac joint with my finger.

    03:09 If you need to, you can cross the leg over and put the hand on the patient's thigh in order to pull them and induce the motion necessary and then hold it make sure that you have the full motion that you need. Hold it and then give it three to five seconds and let it relax.

    03:27 You may want to induce extension and external rotation as well.

    03:31 That just helps you find the barrier and lock up the area that needs to be treated. Occasionally, a torsional motion is needed in order to free up motion. Hold the position for three to five seconds, release, and then I usually flip them over check the ASIS, knee length, medial malleolar length.

    03:52 You can also do this with a patient in a prone position.

    03:56 What you do is you have the patient lay prone again with a pillow under their belly. You may want to put a pillow under their thigh as well for comfort.

    04:05 Stand to the left side of the patient and monitor the lumbar spine, the sacrum, and the pelvis. You can monitor the transverse processes where you'll have the most tenderness or you can monitor from motion. I'll grasp the lower extremity or the ankle in order to make sure I can engage a barrier.

    04:28 Bring the patient's leg into abduction and find where you have the restricted motion. Again, this is facilitated positional release.

    04:38 So you want to hold them in that position for three to five seconds.

    04:42 You'll rotate them until you find the barrier and where you can no longer go.

    04:47 Then you may want to add a downward pressure on the extremity in order to engage the barrier and find out where you need to hold them in order for the body to reset itself. Hold it for three to four seconds or until you feel the release. Then put them back in a neutral position and reassess leg lengths. You can do this in a lumbar flexion technique as well where you're going to use gravity and have the patient, while they're laying prone take their leg off the side of the table.

    05:17 You want to get behind the patient.

    05:18 You may want to put the foot against your white coat in order to help induce motion. Get the leg parallel to the table, and then monitor the transverse processes on that side to see if you can find an increase in tenderness, decrease in tenderness and see how the motion is changing.

    05:41 When you drop the leg off the table, you want to position yourself lateral to the patient so you can move the patient well, grasp the patient's knee or have them locked in against your body and use your body to engage them, and then use the positioning to help release the functioning. You may want to push the knee forward. But again, find the area of restriction, and then hold it in that place, and then reassess.

    06:12 Other causes for a short leg syndrome, where they have, when a person has a discogenic pain syndrome, they may have a right-sided dysfunction, a herniated disc on the right.

    06:24 Even though that's not the cause of the short leg syndrome, it can result in a patient locking up, not moving comfortably.

    06:32 You may want to treat that even though you're not treating the disc itself, you're treating the secondary causes of the disc.

    06:41 So I put in the patient prone with the pillow under the belly.

    06:45 You can sit on the patient's right side facing towards the head.

    06:51 Monitor the ease of the disc motion.

    06:54 You will notice that after a treatment and after holding them, you can get some easing of the hypertonicity, lessening of the muscle spasm and better motion.

    07:05 While the pain will still be there with weight-bearing and with motion, they are given an area of comfort and ability to have more comfort in their functioning.

    07:14 So make sure you monitor the muscle and monitor the sacroiliac junction while you're doing this procedure so you have a good sense of where the restricted motion is and what you can do.

    07:27 You may want to rest the leg against you because again in this procedure, you want to eliminate the weight-bearing nature of the condition since you're not going to be fixing the problem itself.

    07:40 You're just treating the secondary manifestations.

    07:42 So making sure you monitor the muscles while you're doing this is important for safety reasons.

    07:47 You may want to also use traction as a way of pulling on the muscle easing the hypertonicity and making the person more comfortable.

    07:57 I use my hand to monitor it, just gentle pressure over the muscle.

    08:02 Three to five pounds is enough to tell when it's easing up.

    08:05 Sometimes you need to induce rotation to get the locking up and find out where the barrier is.

    08:11 Hold it for three to five seconds. Allow the release to occur and reassess the muscle and the leg lengths that you're finding on exam.

    08:23 Those are some of the initial treatments for short leg syndrome.

    08:28 This is going to be a very common condition. You will see this a lot.

    08:33 You will treat this a lot and you will witness it a lot.

    08:37 Oftentimes, when you just watch people walking, you will see them walking funny.

    08:42 You will start noticing this and diagnosing this in the mall, with your friends and just realize that this is something that may have deeper causes.

    08:54 It may just be a temporary musculoskeletal functioning.

    08:58 But notice it and understand what you can do to treat it and how treatment will make people comfortable and life better for them. Thank you.

    About the Lecture

    The lecture MET: Type I Dysfunction by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • MET – Type I Dysfunction
    • FPR – Superficial Muscle Hypertonicity
    • FPR – Lumbar Flexion Dysfunction
    • FPR – Discogenic Pain Syndrome

    Included Quiz Questions

    1. Muscle Energy Technique for Lumbar Type 1 Group Curve Dysfunction
    2. Facilitated Positional Release of Lumbar Paraspinal Muscles
    3. Facilitated Positional Release of Lumbar Extension Dysfunction
    4. Facilitated Positional Release of Lumbar Flexion Dysfunction
    1. Facilitated Positional Release
    2. Counterstrain
    3. Muscle Energy Technique
    4. High Velocity Low Amplitude Thrust

    Author of lecture MET: Type I Dysfunction

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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