Working Examples 1: Iliotibial band syndrome and sacroiliac joint strain
This Working Examples #1 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 she recalled a heavy step off a curb 6 weeks prior to her visit.
Following a physical examination the following biomechanical pattern became clear and was likely to explain her presentation:
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.
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.
Working Examples 2: Low back and neck pain due to leg length inequality
The following is a good example of how a distant factor can precipitate symptoms in other parts of the body.
Pete broke his left tibia in a motocross accident in July 2012. He made a full recovery from the fracture, however, once he was back on his feet Pete began to suffer regular low back, neck pain, and headaches. He came to see us late in 2012. On examining Pete he had what we as Osteopaths call somatic dysfunctions in his sacroiliac and lumbosacral junction and at the top of his neck.
A somatic dysfunction is where a joint in the body is essentially not functioning right, it displays restriction, often has tight and tender muscle around it and can be out of alignment. It can be caused by a variety of things: trauma, postural issues, chronic imbalance and congenital issues.
In Pete’s case he had acquired an imbalance due to his tibial fracture. Sometimes when a long bone is fractured in the body it heals shorter than prior to the fracture. On examination Pete’s left leg was about 1.2cm shorter that the right leg.
The difference in leg length created a higher right hip which compressed the right sacroiliac and lumbosacral joints. It also created a zig-zag type compensatory pattern through his spine which went right up to his neck. Some of the joints in his neck were also imbalanced and dysfunctional and this precipitated in his headaches.
Pete responded well to a small corrective heal lift place in all his left shoes and a brief course of Osteopathic treatment to correct the dysfunctions.
Working Examples 3: Tension Headaches
Julia came to the Orewa Osteopathy clinic with her Mum in May 2013. She had been suffering from headaches at the back and the front of her head for about 3 months. She also had a very stiff neck. There was no clear incident that had caused her headaches. The headaches were worse on school days and generally worsened throughout the day when sitting a lot.
Julia’s structural examination of her neck was largely unremarkable apart from having some tightness in her movements. However on palpating (assessment via touch) the muscles at the top of Julia’s shoulders and in her neck she was in a lot of pain. Contacting where these muscles attach to the base of the cranium reproduced her familiar frontal headache which is a strong sign of a headache coming from the neck.
Julia was diagnosed with a tension headache. Deep tissue therapy helps with tension headaches but what is more important is correcting what is almost inevitably poor head and shoulder posture. This can be a challenge, particularly in adolescence, however, Julia was pretty good about observing her new posture and was symptom free after about 4 visits.
Working Examples 4: Low back pain
The most common presentation at our clinic.
Two weeks prior to visiting the Orewa Osteopathy clinic, John, a builder by trade was lifting some timber when he hurt his lower back. In addition to low back pain, he also felt a dull pain running down the back of his right leg to about his knee. He had a history of back pain, though nothing that had ever affected his legs.
Following an examination it was clear that John had a strained a disc in his lower back. Fortunately the pain in his leg was referred and not sciatic type pain where the nerve root is involved, which is a more significant injury and takes longer to heal. It should be noted that even with nerve root involvement prognosis for full recovery with conservative management is still very good – around 80%.
John’s type of back problem can be helped in clinic with treatment but it also requires appropriate injury management while the affected tissue heals.
In addition to Osteopathic treatment, John’s management consisted of a short course of over the counter anti-inflammatory medication, McKenzie protocol exercises, reduced duties at work and rest periods during the day. In view of preventing future back injuries, we also addressed John’s lifting technique.
John made a full recovery.