Osteopathic Evaluation and Treatment of the Lower Extremities

00:01 <b>When you want to evaluate a patient with leg</b> <b>pain, you want to look at the Tensor Fasciea Latae</b> <b>and iliotibial band.</b> <b>This is a common problem with runners and</b> <b>a lot of people who have overuse injuries</b> <b>The way you do evaluations for</b> <b>this is called the Ober test</b> <b>And what you'll do is you have a patient</b> <b>lay on their side, slightly flexed</b> <b>and you take their leg and you</b> <b>extend and ABduct the leg</b> <b>You hold it and you can</b> <b>ask them to hold it</b> <b>and then you say, "can you drop</b> <b>your leg towards the table?"</b> <b>and you direct it.</b> <b>If they can do that, they do not</b> <b>have a tight Tensor Fasciae Latae</b> <b>and they have a negative Ober test,</b> <b>so this is a good sign.</b> <b>I want to demonstrate the test we</b> <b>have described earlier for the ankle.</b> <b>We're gonna start with the anterior</b> <b>drawer test which is testing for the</b> <b>talofibular ligament or</b> <b>lateral ligament of the ankle.</b> <b>You stabilize the tibia and</b> <b>fibula, grab the calcaneus,</b> <b>put the patient in 10-15 degrees of</b> <b>plantarflexion and pull out at the calcaneus.</b> <b>looking for dimpling at the lateral ligament area,</b> <b>looking for laxity and looking for looseness.</b> <b>If the anterior talofibula is intact, you</b> <b>wanna check for the calcaneaofibular ligament</b> <b>which is the same position but</b> <b>just induce some internal rotation</b> <b>and again push forward, hold, look</b> <b>for laxity, dimpling or changes.</b> <b>If you wanna check for the deltoid ligament</b> <b>on the inside, that's the Klieger test</b> <b>and you externally rotate and pull forward</b> <b>as well checking the deltoid ligament</b> <b>And the last test is the Thompson's test</b> <b>We'll have you put on your stomach, and</b> <b>this checks for the achilles tendon</b> <b>Basically, squeeze the gastrocnemius</b> <b>and watch the foot motion.</b> <b>Squeeze the gastrocnemius,</b> <b>if the foot moves,</b> <b>then the tendon is intact.</b> <b>Looks good.</b> <b>I want to talk about the evaluation of the</b> <b>fibula, particularly the head of the fibula</b> <b>So if you wanna examine it, you</b> <b>wanna bend the knee, take a look,</b> <b>find the head of the fibula</b> <b>and look at the motion</b> <b>See whether you have gliding</b> <b>anteriorly or posteriorly</b> <b>Where's the restriction, and</b> <b>where's the dysfunction.</b> <b>So if he doesn't move anteriorly, he has</b> <b>a fibular head restriction anteriorly,</b> <b>with a posterior fibular</b> <b>head somatic dysfunction</b> <b>You were gonna have the opposite motion so</b> <b>if you move it posteriorly at fibular head,</b> <b>the other end is gonna move anteriorly</b> <b>So in order to treat this kind of</b> <b>dysfunction, you're going to flex,</b> <b>invert and have him push his</b> <b>foot out towards my hand</b> <b>and relax</b> <b>and monitoring,</b> <b>push again</b> <b>and relax</b> <b>Push through for 2-5 seconds</b> <b>and monitor the fibular head</b> <b>Fibular head is an important area where you have</b> <b>knee pain or other pain on the side of the leg.</b> <b>We're gonna talk about some of the</b> <b>counterstrain points in the lower extremity.</b> <b>In evaluating, we're gonna start by looking at the</b> <b>greater trochanter for piriformis tenderpoints</b> <b>and if you find it on the</b> <b>greater trochanter that's great</b> <b>and that's the tender point</b> <b>that's easy to treat by extending</b> <b>and ABducting the leg untill</b> <b>the tenderpoint relaxes</b> <b>That's one tender point.</b> <b>You wanna look a little bit below, you</b> <b>can have about 5-6 inches below</b> <b>which is the lateral</b> <b>trochanteric tender point.</b> <b>and the third place is usually the ischial</b> <b>tuberosity, we may have a tender point as well.</b> <b>and those are usually treated with extension</b> <b>of the leg, internal rotation or flexion.</b> <b>So those are things you can do</b> <b>to get rid of those tender points</b> <b>Let me have you turn over.</b> <b>Now we're gonna talk about tender points on the</b> <b>knee because you will have patellar tender points</b> <b>in the patellar tendon just below the</b> <b>knee cap, just below the patella.</b> <b>You may also have a medial or a</b> <b>lateral patellar tender point.</b> <b>and because there's limited</b> <b>motion here, it's gonna be hard</b> <b>to figure out how you're gonna</b> <b>go ahead and get that treated.</b> <b>Whether you extend and you</b> <b>don't get much extension,</b> <b>you're gonna give a little</b> <b>extension and internal rotation.</b> <b>Medially, if you have a medial tender</b> <b>point, you're gonna push laterally</b> <b>and twist a little bit to help treat that</b> <b>tender point and find a position of ease.</b> <b>So these are difficult tender points to treat but</b> <b>once you do get it, you hold it for 90 seconds</b> <b>find the position of ease and</b> <b>then reassess afterwards.</b> <b>There are three tender points in the ankle.</b> <b>The first tender point to look at is</b> <b>just inferior to the medial malleolus.</b> <b>And when you find the position of ease</b> <b>with that, you want to invert it.</b> <b>There's a tender point just anterior to</b> <b>the calcaneus in the ball of the foot.</b> <b>and that's treated with plantar flexion to try</b> <b>and relieve and find the position of ease.</b> <b>And then you have the third point is</b> <b>just inferior to the lateral malleolus</b> <b>and that's treated with eversion</b> <b>to find the position of ease.</b>