Hello, I'm Brett DeGoyer. I'm a primary care sports medicine specialist working for Samaritan Healthcare in Moses Lake, Washington. So with the approach of manual medicine or osteopathic manipulative treatment, keep in mind a couple things. One, make sure you're very deliberate with your patient, that they know what you're doing, where you're touching, and why you're doing what you're doing. I also want to say that these approaches are not meant to be complete or exhaustive, but a demonstration of very simple techniques that can be done in the office very quickly and simply. This first technique is to demonstrate myofascial release. And the explanation for this technique is really found in the name, myofascial release. You're working with the muscles, the fascia or connective tissue, to release the tension and promote better blood flow, better lymphatic flow, and to release any tension that might be grabbing on the nerves that are running in those planes between the muscle and the fascia. This specific technique is going to be along the posterior knee, starting just above the knee joint, almost to the mid-thigh, and then going all the way down to where the gastrocsoleus complex is found. The treatment technique is to use your fingertips to dive deep into the tissue and then pull out laterally to stretch those tissues and hold until you feel those tissues relax. So as I come under the back part of the thigh, about midway or just distal to, I'm putting my fingers deep, pushing anteriorly, and then pulling them out away from each other until I feel relaxation. And then I move and go down to the next level. And I keep repeating that until I hit right at the gastrocsoleus complex, just distal to the knee joint. And you can repeat that as often as you feel is needed. Typically, once is enough if you spend enough time feeling for that relaxation. This next technique for myofascial release is on the patella itself. And that's just grasping either with your fingers or with the webs between your thumb and index finger. To grab that patella, find the areas that are tight, and put a little stretch. You can also add in a little bit of rotation. And the same idea is you're trying to get those tissues to relax to promote better blood flow, better lymphatic flow, and to reduce any tension across the nerves that may be irritated in this manner. Moving up, down, superior, inferior, lateral, medial, rotation in, rotation out. And you can feel free to repeat that as often as necessary. The last technique is to do ligamentous articular strain. This technique is taking the ligaments that span the articulations, compress them together to also promote relaxation. The way to do it about this femorotibial joint is to grasp just above the patella, along the femur, just below the patella, along the tibia, and then add posterior compression down towards the table, and then compression of your hands together at the same time. So compression down and together. And then you can add in a little bit of torsion as well until you find that area that's balanced between all those forces in tension. And then you hold until you feel relaxation. Once that happens, you can balance to a new point of tension that's balanced. And then once that's relaxed, you let go and then retest.

2nd Edition, CASE 25

2nd Edition

Knee

manual medicine

osteopathic manipulative treatment

myofascial release

ligamentous articular strain

Brett DeGoyer