Osteopathic Treatment of the Lower Extremities

by Tyler Cymet, DO, FACOFP

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    00:01 When you want to evaluate a patient with leg pain, you want to look at the Tensor Fasciea Latae and iliotibial band.

    00:07 This is a common problem with runners and a lot of people who have overuse injuries The way you do evaluations for this is called the Ober test And what you'll do is you have a patient lay on their side, slightly flexed and you take their leg and you extend and ABduct the leg You hold it and you can ask them to hold it and then you say, "can you drop your leg towards the table?" and you direct it.

    00:32 If they can do that, they do not have a tight Tensor Fasciae Latae and they have a negative Ober test, so this is a good sign.

    00:40 We're gonna talk about some of the counterstrain points in the lower extremity.

    00:44 In evaluating, we're gonna start by looking at the greater trochanter for piriformis tenderpoints and if you find it on the greater trochanter that's great and that's the tender point that's easy to treat by extending and ABducting the leg untill the tenderpoint relaxes That's one tender point.

    01:07 You wanna look a little bit below, you can have about 5-6 inches below which is the lateral trochanteric tender point.

    01:17 and the third place is usually the ischial tuberosity, we may have a tender point as well.

    01:24 and those are usually treated with extension of the leg, internal rotation or flexion.

    01:30 So those are things you can do to get rid of those tender points Let me have you turn over.

    01:38 Now we're gonna talk about tender points on the knee because you will have patellar tender points in the patellar tendon just below the knee cap, just below the patella.

    01:49 You may also have a medial or a lateral patellar tender point.

    01:54 and because there's limited motion here, it's gonna be hard to figure out how you're gonna go ahead and get that treated.

    02:02 Whether you extend and you don't get much extension, you're gonna give a little extension and internal rotation.

    02:11 Medially, if you have a medial tender point, you're gonna push laterally and twist a little bit to help treat that tender point and find a position of ease.

    02:21 So these are difficult tender points to treat but once you do get it, you hold it for 90 seconds find the position of ease and then reassess afterwards.

    02:33 There are three tender points in the ankle.

    02:35 The first tender point to look at is just inferior to the medial malleolus.

    02:40 And when you find the position of ease with that, you want to invert it.

    02:44 There's a tender point just anterior to the calcaneus in the ball of the foot.

    02:48 and that's treated with plantar flexion to try and relieve and find the position of ease.

    02:53 And then you have the third point is just inferior to the lateral malleolus and that's treated with eversion to find the position of ease.

    03:04 I want to demonstrate the test we have described earlier for the ankle.

    03:07 We're gonna start with the anterior drawer test which is testing for the talofibular ligament or lateral ligament of the ankle.

    03:14 You stabilize the tibia and fibula, grab the calcaneus, put the patient in 10-15 degrees of plantarflexion and pull out at the calcaneus.

    03:25 looking for dimpling at the lateral ligament area, looking for laxity and looking for looseness.

    03:34 If the anterior talofibula is intact, you wanna check for the calcaneaofibular ligament which is the same position but just induce some internal rotation and again push forward, hold, look for laxity, dimpling or changes.

    03:48 If you wanna check for the deltoid ligament on the inside, that's the Klieger test and you externally rotate and pull forward as well checking the deltoid ligament And the last test is the Thompson's test We'll have you put on your stomach, and this checks for the achilles tendon Basically, squeeze the gastrocnemius and watch the foot motion.

    04:16 Squeeze the gastrocnemius, if the foot moves, then the tendon is intact.

    04:24 Looks good.

    04:26 I want to talk about the evaluation of the fibula, particularly the head of the fibula So if you wanna examine it, you wanna bend the knee, take a look, find the head of the fibula and look at the motion See whether you have gliding anteriorly or posteriorly Where's the restriction, and where's the dysfunction.

    04:44 So if he doesn't move anteriorly, he has a fibular head restriction anteriorly, with a posterior fibular head somatic dysfunction You were gonna have the opposite motion so if you move it posteriorly at fibular head, the other end is gonna move anteriorly So in order to treat this kind of dysfunction, you're going to flex, invert and have him push his foot out towards my hand and relax and monitoring, push again and relax Push through for 2-5 seconds and monitor the fibular head Fibular head is an important area where you have knee pain or other pain on the side of the leg.

    About the Lecture

    The lecture Osteopathic Treatment of the Lower Extremities by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Osteopathic Treatment of the Lower Extremities

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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