Physical Medicine / OMM

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30451

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Now showing 1 - 8 of 8

Compensatory tibial torsion as a component of turnout in professional ballet dancers
(2021) Mirochnitchenko, Alissa; Surve, Sajid; Patterson, Rita
Purpose Classical ballet emphasizes external rotation (ER) of the hip joint as the primary mechanism of turnout, with ideal turnout being 90 degrees in each leg. Due to anatomical constraints, few dancers are able to achieve this ideal without compensating elsewhere in the kinetic chain. One mechanism of compensation for inadequate hip ER is tibial torsion. The purpose of this study is to determine the contribution of tibial torsion to turnout in a sample of professional ballet dancers. Methods The study sample consisted of five male and five female professional ballet dancers. Using motion capture technology, each dancer was filmed completing barre exercises at three times during the performance season. Rotational movement at the femoroacetabular, tibiofemoral and tibiotalar joints was approximated using motion markers. Results While the majority of external rotation during all movements originated at the femoroacetabular joint, females demonstrated 12-14 degrees of turnout originating at the tibiofemoral joint, and males demonstrated 15-17 degrees. Across all movements, females demonstrated more turnout originating at the hip joint than males. Conclusions According to classical ballet aesthetics, a turnout of 90 degrees is expected in each leg, with only 5 degrees of total turnout originating from each knee joint. The degrees of turnout originating from the knee in this sample exceed these values. Furthermore, the use of non-invasive motion-based testing such as motion capture allows for the creation of a three-dimensional model which may be used for performance tracking and injury prevention in dancers.
Baseline Range of Motion of the Lower Limb in Parkinsonian Gait is Consistent Among Treatment and Control Groups
(2021) Terrell, Zachary; Moudy, Sarah; Hensel, Kendi; Patterson, Rita
Purpose: Tens of thousands of people are diagnosed with Parkinson's disease (PD) each year, making PD the second most common neurodegenerative disorder. The overarching goal for this project is to examine the efficacy of osteopathic manipulative treatment (OMT), and osteopathic cranial manipulative medicine (OCMM) particularly, in improving Parkinsonian gait. However, the purpose of this study is to serve as a preliminary analysis and comparison of the baseline joint angle data across experimental PD groups. We hypothesize that no significant differences will be found in the baseline range of motion (ROM) of each joint across randomly-assigned treatment and sham PD groups. Methods: An 18-camera motion analysis system was used in conjunction with 54 reflective markers on the body to capture three-dimensional position data in a short treadmill walking trial before the application of a whole-body (including OCMM techniques), neck-down, or sham OMT protocol. Ankle, knee, and hip joint ROM in the sagittal plane during the gait cycle was compared across treatment and control groups. Results: Baseline ROM at the hip, knee, and ankle joints across experimental groups (two treatment groups and one sham group) was comparable within one standard deviation of the mean of each group. 5.4, 11.4, and 5.7-degree variations in mean ROM were found between groups at the hip, knee, and ankle respectively. Conclusion: This preliminary analysis shows that experimental groups are not likely to significantly differ in baseline range of motion. These results validate the randomization of participants in our research design.
Trauma-induced Neuropathy of the Ulnar Branch to the Abductor Digiti Minimi
(2021) Momin, Shahana; Wingard, Ann; Holbrook, Hayley; Hoelscher, Callie; Selod, Omar
Background Innervated by the ulnar nerve, the abductor digiti minimi (ADM) is an intrinsic muscle of the hand that serves as an abductor of the fifth digit. Denervation of the ADM can result in fifth digit weakness and atrophy. Classically, ulnar nerve entrapment at the cubital tunnel or Guyon's canal may present with these findings, and this would be evident on electrodiagnostic evaluation. There is no current literature documenting a case of fifth digit weakness and atrophy with electrodiagnostic studies showing an isolated neuropathy to the ulnar branch of the ADM. Case Presentation A 45-year-old male presented to an orthopedic clinic with weakness of his right fifth digit. As the patient arose from bed two months prior, he heard something pop and felt a sharp pain in his right fifth digit and hypothenar aspect. Physical exam showed diminished abduction of the right fifth digit and hypothenar atrophy. The patient was referred for an electromyogram (EMG) and nerve conduction study (NCS). EMG/NCS of the ulnar nerve, tested distally using the first dorsal interosseous muscle, was normal. Afterwards, he was sent to follow up with the orthopedic surgeon, who requested another EMG to specifically test the ADM. The repeated EMG study showed isolated neuropathy of the ADM. Discussion This patient's clinical case highlights the significance of using the history and physical exam findings to probe deeper despite unremarkable initial electrodiagnostic studies. This case also exemplifies the importance of exploring less common pathologies, as this is a unique and uncommon diagnosis.
Correcting occipitomastoid suture slippage using a high velocity low amplitude technique to improve coordination and balance
(2021) Koster, Eva; Heinrich, Carl; Paredes, Dante
Background: Cranial osteopathic manipulative treatment (OMT) is a field with a lot of room for more research into the indications and efficacy of its application in patients with neurological symptoms and disturbances. Case Information: An 83-year-old Caucasian male with a history of chronic intermittent neurological disturbances is found to have significant occipitomastoid (OM) suture slippage. He had been experiencing significant vertigo, balance, gait, and coordination issues that were negatively affecting his quality of life and made him prone to severe falls. High velocity, low amplitude (HVLA) treatment was periodically performed to the OM suture bilaterally in biweekly intervals to address misalignment. After treatment, the patient reported significant and immediate improvement in balance and coordination. This case study reviews cranial osteopathic medicine and OMT, mechanisms of injury, clinical findings, and treatment for patients with OM suture slippage. Conclusions: Patients presenting with neurological variations from baseline represent a unique challenge to physicians in that an array of generalized symptoms as well as focal neurological deficits can all point to different diagnoses or the same. Furthermore, multiple systems influence a single sensory and/or motor function. This case illustrates a patient who had consistently received temporary relief from these neurological disturbances after cranial HVLA to the OM suture. Results could potentially be unique to the patient physiology and provider experience, however the success of using cranial HVLA to help with gait and coordination is an exciting endeavor that could help other patients with neurological disturbances.
Stiff Person Syndrome and Osteopathic Manipulative Medicine as a Treatment Modality: A Case Study
(2021) Gautam, Rupali; Khowaja, Sanober; Aston, James
Background: Stiff-person syndrome (SPS) is a rare autoimmune and neurological condition characterized by progressive muscle stiffness, rigidity, and painful muscle spasms of the trunk and limbs, impairing mobility. The goal of treatment is to control symptoms and improve mobility and function. Patients often require a combination of therapies, including medications and physical therapy. However, the application of osteopathic manipulative treatment (OMT) has yet to be explored in such patients. Case Information: We present a case of a 41-year-old, White female who sought treatment at the Osteopathic Manipulative Medicine clinic for her worsening full-body and respiratory spasms and decreased mobility related to her SPS. The patient reported a medical history of SPS, Postural Orthostatic Tachycardia Syndrome (POTS), Polycystic Ovarian Syndrome (PCOS), Hypothyroidism, Chronic Interstitial Cystitis, Failed Back Syndrome, and an unspecified autoimmune disease. Her past surgical history includes a lumbar fusion, cervical fusion, dilation and curettage, cholecystectomy, appendectomy, and knee arthroscopy. The patient received the SPS diagnosis one-year prior by a neurologist who detected increased GAD-65 antibodies and has since been managed with Clonazepam as pharmaceutical therapy. During OMT sessions, she exhibited full-body spasms that lasted up to one minute. Following subsequent OMT appointments, fewer spasmodic events have been noted. After 6 months of OMT, she has noticed reduced spasm frequency. Conclusions: This case illustrates the potential benefits of OMT for patients with SPS. Further treatment and follow-up are necessary to understand the long-term prognostic impact of OMT on functionality.
The Effect of Osteopathic Manipulation Techniques on the Lymphatic System
(2021) Parker, Madison; Williams, Arthur; Mallet, Robert T.; Tune, Johnathan; Hodge, Lisa
Purpose: Osteopathic manipulation techniques (OMT) have been utilized by osteopathic physicians to treat a variety of conditions. However, the mechanisms by which OMT aides the body in healing are not well understood. The long-term goal of our research is to advance our understanding of the impact of OMT during disease, such as sepsis. The purpose of this study is to develop a large animal model and to establish surgical techniques that will be used in these future studies. We hypothesized that the abdominal lymphatic pump technique (LPT) will enhance thoracic duct lymph (TDL) flow. Methods: The thoracic duct was exposed via thoracotomy then cannulated using an angio-catheter. TDL was collected from 2 swine (1 male, 1 female) during 10-minutes of baseline, 4-minutes of LPT, and 10-minutes post-LPT. TDL flow was measured by timed collection during each condition. TDL was centrifuged to remove the cellular components, and the supernatant was stored for biomarker analysis. Results: TDL flow increased from an average of 1.68 mL/min to 3.25 mL/min during LPT administration. Immunological assays will be performed to identify changes in lymph composition during OMT. Conclusion: In our pilot study, LPT increased TDL flow in both our swine subjects and demonstrated surgical feasibility. In future studies we will study the physiological effects of OMT during sepsis. This knowledge would provide an evidence-based foundation for the use, or contraindication, of OMT during sepsis and aid osteopathic physicians during their therapeutic decision making.
Movement Patterns in Dancers: analysis of pelvis and hip movement in elite ballerinas
(2021) Mirochnitchenko, Alissa; Surve, Sajid; Patterson, Rita
Purpose: Ballet dancers place extreme demands on their bodies throughout their careers. To reduce injury risk and prolong a ballet dancer's career, attention must be paid to correct positioning and joint biomechanics. The specific aim of the Movement Patters in Dancers study was to observe changes in posture and movement throughout the ballet performance season. Methods: The study sample consisted of five male and five female professional ballet dancers. Using motion capture technology, each dancer was filmed completing barre exercises at three different times during the performance season. Movement of the pelvis was analyzed in three planes of motion: medial/lateral, flexion/extension, and torsion about a longitudinal axis. Additionally, the hip angle, defined as the angle between the femurs, was calculated. Results: Dancers demonstrated consistency in pelvis movement in all planes throughout the performance season. The degrees of motion observed in each plane varied with the direction in which the movement was performed (side, front, and back). No significant changes were observed between visits. Hip angle varied between the left and right side in both male and female dancers, with female dancers demonstrating larger differences between legs. Conclusions: The pelvic stability demonstrated in this study was reflective of dancers' level of proficiency and training. The difference in hip angle between the left and right legs could be explained by dancers having a dominant leg. Further analyses of the collected data can contribute towards creating a model to assess dancers at different levels of training and assist dancers recovering from injury.
Whole Body OMT as a Treatment for Postural Instability in Parkinson's Patients
(2021) Patterson, Rita; Gibson, Keenan; Hensel, Kendi
Background: Osteopathic Manipulation Treatment (OMT) is a manual therapy directed at relieving somatic dysfunction in patients. OMT has shown in previous studies to improve postural stability in specific patient groups and may be a treatment option for movement disorders. Parkinson's Disease (PD) is one such movement disorder where falls are a major cause of patient morbidity. However, an OMT protocol for PD has not been established. Methods: We performed a randomized control trial on PD and healthy patients to determine the efficacy of an OMT protocol. Group A received OMT treatment of the full body including cranial manipulation, Group B received OMT treatment from the neck down, and Group C received a "sham" OMT treatment. Pre- and Post-treatment clinical measurements of postural stability consisted of Functional Reach (FR) and Timed Up and Go (TUG) tests. Biomechanical measurements of quiet standing sway were observed using a 12 Camera motion analysis system and a force plate. Results: Patients showed improvement in the times to complete the TUG test across all three treatment groups with the greatest improvement (-0.52 s) demonstrated by Group A (p < 0.05). FR results showed improvement in all three treatment groups with the greatest change (+3.5cm) occurring in Group B (p< 0.05). Biomechanical data showed an increase in the RMS in the x and z directions following treatment (p >0.05). Conclusions: Full body OMT that includes cranial techniques may improve postural stability and be considered as part of a multi-therapy management of PD.

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