Transcript The Osteopathic Evaluation and Treatment of Acute Basketball

American College of
Osteopathic Pediatricians
 Although
basketball was not introduced
during Dr AT Still’s tenure, OMT has a
practical place in the evaluation, diagnosis
and treatment of basketball injuries. The
number of injuries seen in basketball has
continued to rise over the years along with
the number of participants.
 The most common injuries seen are strains
and sprains of the ankle and knee followed by
contusions. The ankle is the most commonly
injured structure in basketball, followed by the
knee.
 Ankle
sprains are classified into grade I, II or
III. X-rays should be attained according to
the Ottawa ankle rules to rule out fractures.
 Most ankle injuries result from an inversion
mechanism where the foot is plantar flexed
and the sole of the foot is inverted medially.
 The foot is supported laterally by 3 ligaments
and the peroneus muscle. The ligaments are
relatively weak, and when the exerted force
exceeds the strength of the supporting
structures, tearing of the ligament fibers and
muscle fibers occur.
The anterior talofibular ligament is the weakest and
most frequently injured structure. After an acute
ankle sprain, the durability of the ligament can be
assessed by the anterior drawer test.
 Subluxation of the tibia on the talus likely indicates
damage to the anterior talofibular ligament. If
excessive laxity of the ankle joint is noted, there is
likely concomitant damage to one of the other
ligaments as well; most likely the calcaneofibular
ligament.
 Eversion injuries of the ankle are rare and when
noted, associated avulsion fracture must be ruled
out.
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There has been conflicting evidence regarding the overall
incidence of injury between male and female athletes.
However, there has been a significant disparity noted between
the numbers of injuries to the anterior cruciate ligament seen
in female basketball players when compared to male
basketball players. This is thought to be multi-factorial, and
includes neuromuscular, hormonal and structural differences
between the sexes.
All of the ligaments and both menisci in the knee can be
assessed via different stress tests. The injured knee should
always be compared to the contra lateral knee.
If a soft end feel, or excess laxity of the joint is noted, there is
likely damage to the ligaments.
 Radiographic
examination is usually required
after an acute knee injury. Initial radiographs
can be obtained to rule out any avulsion
fractures. Subsequent MRI imaging is usually
required to diagnose ligamentous or meniscal
damage.
 Due to the competitive nature of athletes, it is
not surprising that here are a higher number
of injuries that occur during competition
relative to practice.
Traditional therapy for sprained ankles/knees
includes rest, ice, compression bandages,
elevation and analgesics. The main focus of this
therapy is to decrease the swelling and edema to
help facilitate the return of full range of motion.
 There has been some evidence reported that
OMT techniques can help reduce ankle edema,
pain and increase the range of motion and
ultimately lead to less time out of competition.
Most knee ligament and meniscal injuries require
surgical correction, but OMT can play an important
role in the rehabilitation phase.

 How its performed
 1: Patient is on their
side with the affected leg
up
 2:Physician is seated beside the table
 3: The tender point is located, typically
anterior to the lateral malleolus
 4: The ankle is everted until the tissues soften
and the patient reports maximal relief at the
tender point.
 5: The position is held for 90 seconds and
then the ankle is brought back to the neutral
position and the tender point is reassessed.
 How
 1:
its performed
Patient is in the supine position
 2:
The physician stands at the side of the
involved leg
 3:
The physician inverts the foot to stretch
the peroneus muscle and kneads the
muscles to promote lymphatic flow
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1: Patient is in the supine position
2: The physician stands on the side of the involved leg
3: The patients hips and knees are flexed to 90 degrees.
4: The physicians cephalad hand stabilizes the patient’s knee
and holds the posterior fibular head between his thumb and
index finger.
5: The physicians other hand everts and dorsiflexes the foot
and internally rotates the lower leg
6: The patient then attempts to return his ankle/knee to the
neutral position while the physician maintains isotonic
resistance for 3-5 seconds.
7: The patient relaxes for 3-5 seconds and then the process is
repeated until no new barriers are encontered and normal
range of motion is restored.
OMT evaluation consisting of observation,
range of motion testing, and specific tests
relative to each joint can adequately diagnose
and assess the need for further intervention.
The data suggests that OMT techniques
focusing on relieving the swelling and
increasing the range of motion of the joints in
addition to the traditional therapy of rest, ice,
compression wraps, and elevation leads to a
faster recovery.

Eisenhart
et all performed a study that evaluated the
efficacy of osteopathic manipulative treatment for
patients with grade 1 and 2 acute ankle sprains. They
used soft tissue, muscle energy, counterstrain, fascial
and lymphatic drainage techniques. They found that
after 1 session within the emergency department,
patients had a statistically significant improvement in
edema and pain and a trend toward increased range of
motion when compared to the control group. At the 1
week follow-up appointment, both groups had an
improvement in edema and pain, but there was a
statistically significant improvement in the range of
motion in the group that received OMT when compared
to the control group.
 These
specific modalities of soft tissue,
muscle energy and HVLA are a worthwhile
adjuvant treatment option that can help
relieve tissue swelling and enhance the range
of motion. If these techniques are done
properly and in a timely manner, the data
suggests that it can ultimately lead to less
time lost from participation. In conclusion, the
data suggests that the OMT module is easily
performed within the time frame of an office
visit or basketball game.
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
---
Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
---
---
Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
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---
---
--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
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 Question1: A, B, C, D, E.
 Question2: A, B, C, D, E.
 Question3: A, B, C, D, E.
 The
most common form of ankle sprains
are:
a. inversion
b. eversion
c. rotation
d. aversion
e. reversion
 The
weakest ligament of the ankle is:
 a. anterior talofibular
 b. posterior talofibular
 c. calcaneofibular
 d. anterior talocalcanel
 e. posterior talocalcanel
 Subluxation
of the tibia on the talus likely
indicates damage to the:
 a. anterior talofibular
 b. posterior talofibular
 c. calcaneofibular
 d. anterior talocalcanel
 e. posterior talocalcanel
 I, _________________________,
successfully completed the Pediatric
OMT Module on __ __ 20__
Signatures:
 Pediatric Resident ____________________
 Pediatric Residency
Director____________
(
Please print and give to program
director.)