orewa osteopathy
working examples of osteopathic approach
Working examples - actual cases from the clinic
Sacroiliac joint disturbance - Iliotibial band tension - knee pain
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Sharon recently presented to the clinic with lateral knee pain of insidious onset. From her history she could not recall a specific incident occurring at the knee joint itself however on taking her history the incident she recalled a heavy step off a curb 6 weeks prior to her visit (which was two weeks prior to her knee pain developing). Following a physical examination the following biomechanical pattern became clear and was likely to explain her presentation:
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Her sacro-illiac joint was very restricted on the left side and her left inominate (pelvic) bone was anteriorly rotated. In response to this her gluteus maximus muscle was hypertonic (very tight). The gluteus maximus muscle has connections along the pelvic brim, over the sacroiliac joint and onto the sacrum. If there is a problem with the position of the pelvic bones or the sacroiliac joint there will often be reactive tension in this muscle.
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The gluteus maximus muscle feeds into a fibrous band of tissue that runs down the side of the leg. This band is called the iliotibial band (ITB) and it acts like a support strut down the side of the leg. The ilio-tibial band (ITB) runs from the hip region down to the top of the head of the fibula (near the knee). Various muscles around the hip region feed into this band and control how taught it is. In Sharon's case this band had become very tight due to the tension in the gluteus maximus muscle. There are a couple of points along the line of the ITB where it runs over boney prominences. In Sharon's case the tension of the band was such that it had begun rubbing on the lateral condyle just above the knee causing friction, mild inflammation and the lateral knee pain that she had complained of. Sharon's pain was relieved by treating the biomechanical picture described here.
Flat feet - Pelvic imbalance - upper back pain and headaches
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The following is a good example of how a very distant fact or can precipitate symptoms in other parts of the body.
Three years ago Singa had a few beers at a mates place. After a few sing alongs he thought it best that he sleep on his mates couch. After a very uncomfortable nights sleep on a couch with high arm rests, he woke with a very sore neck and headache. Unfortunately the headache didn't resolve and for the next 3 years Singa was plagued with regular headaches and a sore neck. After getting temporary relief from various treatment modalities Singa decided to see an Osteopath. On hearing Singa's story things didn't seem to add up. Surely one bad night's sleep couldn't cause headaches and neck pain for such a long period of time. On examination of Singa the answer appeared to come from his feet. Singa had marked pes planus or flat feet. With the arch of his feet dropping inwards, a resultant internal rotation occured through his legs. His body compensated for this drop by tightening his gluteus muscles and the external rotators in his hip. Tightening these muscles meant that the knees would align forwards instead of medially (which is important for walking).
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Singa's right foot was dropped more that the left. The drop on the right side made Singa's right innominate bone rotate forward causing tension through the lower right side of his back. When an area of muscle in the spine becomes tight it pulls the spine slightly to one side. This pull needs to be compensated for by muscles on the other side of the spine in order to orientate the spine correctly. What often results is a zig-zag tension pattern up the back. This was the case with Singa. The tension ended up in his neck and constantly unsettled the area resulting in discomfort in his neck and regular headaches. Singa's pain took a while to settle however after fitting an orthotic to support his arches and treating his biomechanical problem he was finally headache free.