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Other lower limb treatments

Notes

Notes

Lower limb

Below are several techniques that are less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. These lists are not fully inclusive but are meant to highlight some of the most common or useful applications of each technique.

Articulatory (Spencer technique of the hip)

The Spencer technique (of the shoulder) can also be used at the hip, but please note that the order of applied motions is different when applied to the hip joint.

Spencer technique of the hip involves engaging restrictive barriers and is usually passive. If a significant barrier is encountered, muscle energy can be used to help reduce this restriction by having the patient move directly opposite the direction of the Spencer technique step. The hip variation of the Spencer technique can be used to treat general hip somatic dysfunction, bursitis and tenosynovitis. The patient lies supine with the dysfunctional hip near the edge of the table.

Stages
  • 1: Flexion
  • 2: Extension
  • 3 & 4: Circumduction with compression / traction
  • 5: Internal rotation
  • 6: External rotation
  • 7: Abduction
  • 8: Adduction

Balanced ligamentous tension

Fibular (inversion) dysfunction

  1. With the patient supine, sit at the side of the leg with somatic dysfunction and instruct the patient to flex their hip and knee to 90º
  2. Place the thumb of your cephalad hand slightly superior and lateral to the dysfunctional fibular head
  3. With your other hand, control the foot by grabbing just inferior to the lateral malleolus
  4. Push with the cephalad thumb towards the foot, while the other hand inverts the foot and ankle, until a balanced point of tension is palpated
  5. Hold this position until a release (in the direction of ease) is palpated

Femorotibial dysfunctions with sprain

Example: cruciate ligament sprain
  1. With the patient supine, stand at their side near the knee with the somatic dysfunction
  2. With the patient’s leg fully extended, place your cephalad hand over the anterior distal femur and your caudad hand over the tibial tuberosity
  3. Gently apply pressure downward (toward the table), and compress your two hands together to approximate the femur and tibia
  4. Add internal or external rotation to the tibia until a balanced point of tension is palpated
  5. Hold this position until a release (in the direction of ease) is palpated

Ankle (tibiotalar) dysfunction

Example: left posterior tibia (anterior talus)
  1. With the patient supine, stand at the foot of the table on the side of the ankle with somatic dysfunction
  2. With the patient’s ankle in neutral, place one or both hands over the distal tibia and press downward (toward the table)
  3. Add internal or external rotation to the tibia until a balanced point of tension is palpated
  4. Hold this position until a release (in the direction of ease) is palpated

Soft tissue

Hypertonicity of hip girdle muscles, direct inhibition

Example: Left piriformis hypertonicity
  1. With the patient in the right lateral recumbent position, instruct them to flex the hips and knees to 90º, and stand at their hips facing them
  2. Apply a firm, downward pressure (toward the table) with your thumb(s) over the muscle belly of the piriformis
  3. Hold this position until a release is palpated