Abstract

Hamstring injuries in sports are common and often require rest or more active rehabilitative efforts before returning to sport-specific participation. This case report provides a potential framework of osteopathic manipulative treatment (OMT) for an acute traumatic superior innominate shear where traditional medical treatment, including physical therapy sessions, failed to provide significant and/or complete resolution.

In the present case report, a 17-year-old male high-school athlete presented with hamstring strain and proximal hamstring and low back pain, following a hurdle injury with fall on extended knee. He was found to have significant somatic dysfunctions related to his condition. An OMT approach was utilized to provide relief, restore his full squat range of motion, and ultimately return to non-restricted football and basketball participation.

Abstract

Athletes who throw overhead experience injuries to their throwing shoulders secondary to the mechanics of throwing.¹ The process of throwing is a coordinated, complex set of movements known as the kinetic chain.^1,2 Disruption anywhere about this chain can result in injury to the throwing shoulder.^1–3 The scapula’s interaction with the thoracic cage allows for normal motion, and injury or imbalance of the scapular stabilizers can result in SICK scapular syndrome and this, in turn, can result in an injury to the glenohumeral joint itself.

Osteopathic manipulative treatment (OMT) can be utilized to restore the kinetic chain to its full function and to decrease SICK scapular syndrome, thereby preventing injury and treating it if it occurs. The present case will demonstrate this and introduce a novel technique to treat the entire shoulder joint.

Abstract

Counterstrain (CS) is an osteopathic manipulative technique that utilizes indirect and passive positions of strained tissues to address musculoskeletal dysfunctions. As such, CS has potential as a treatment option for muscle strain injuries, such as rectus femoris origin (RFO) injuries. This case highlights an instance where the CS technique was used as an effective and inexpensive diagnostic tool to confirm the involvement of the reflected head of the rectus femoris muscle (RHRF) in an RFO injury.

The presentation of symptoms in this case, like many other hip pain cases, was nonspecific, making it difficult to diagnose without the use of advanced imaging techniques, which are often time consuming and costly for patients. The use of CS was able to support a diagnosis of a reflected head of the RFO injury. After an osteopathic structural examination, it was noted that the patient had multiple bilateral tender points of the anterior thoracic region and hip: anterior thoracic-10 (AT10), proximal psoas (PP, formerly abdominal lumbar 2), iliacus, and reflected head of the rectus femoris (RHRF).¹ In his 1981 text, Jones referred to an anterior medial trochanter tender point that is similar to the RHRF point; however, the location was described to be more lateral, rather than inferior, to the anterior inferior iliac spine than the RHRF point.² Once all tender points were identified, treatment using the CS technique was administered weekly over the period of a month, and the patient noted markedly reduced tenderness of the tender points treated and was able to reincorporate soccer and other athletic activities back into his life.

Abstract

After arthroscopic meniscectomy, it is important to ensure each patient regains as much of the original function of the knee as possible. The inherent structural and functional relationships among the bones, muscles, fascias, and lymphatics are vital. Each element should be a focus of treatment to reap maximum benefits and reduce long-term dysfunction. While increased range of motion and strengthening exercises are the current focus of postoperative rehabilitation, a more direct approach to the fascial and lymphatic systems should be instituted for those patients reporting swelling as a long-term sequela. In this case report, osteopathic manipulative treatment reduced recovery time for a 65-year-old woman following arthroscopic meniscectomy.

Abstract

Chest pain is an emergent presentation associated with a wide differential diagnosis including cardiac, pulmonary, gastrointestinal, and musculoskeletal origins. The evaluation of acute chest pain can be costly and can be a financial burden on the health care system. Integrating osteopathic diagnosis and treatment can assist with identifying and alleviating potential musculoskeletal sources of pain. This case illustrates how applying osteopathic manipulative medicine (OMM) benefited a 61-year-old woman presenting with anterior chest wall pain.

Patient response to OMM can assist physicians with better managing acute chest wall pain syndromes. Improved musculoskeletal education can potentially improve medical management of chest pain of musculoskeletal origin.