Osteopathic manipulative treatment of a 27-year-old man after anterior cruciate ligament reconstruction.

Increasing instability of the knee developed in a 27-year-old man who had torn his anterior cruciate ligament (ACL) approximately 10 years prior to surgical intervention. After initial conservative treatment, including use of a functional brace for activity, the patient opted for surgical reconstruction with a patellar tendon graft. One of the authors conducted three preoperative examinations to assess the condition of the patient's musculoskeletal system. These manual examinations included findings of somatic dysfunction in the lumbo-pelvic region. In addition, there was extension of muscular tension from the injured left knee and ankle into the lower thorax and ribs 6 through 9. During the postoperative rehabilitation process, examination at regular intervals included documentation of somatic dysfunction and osteopathic manipulative treatment (OMT). Following ACL reconstruction and OMT, the patient showed increasingly stable mobility in the lumbopelvic region. Furthermore, episodic new dysfunctions readily resolved with OMT. The patient returned to his regular sports activities 6 months after surgery.

A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 2. Bilateral segmental motor behaviors.

In part 2 of their report, the authors continue to evaluate myoelectric data obtained from spinal motion dynamics involved in clinical rotation tests. They add to the ipsilateral regional analysis of motor performance as previously presented and analyze the total bilateral myoelectric activity gathered concurrently at individual thoracic vertebral segments during simultaneous rotation left and right motion tests. The authors' hypothetical consideration concerns the nature of composite behaviors at these vertebral segments during active and passive motions and the role that postural dynamics play in movement function. They consider these concepts in the context of the study's experimental design and also within the broader concept of the osteopathic musculoskeletal examination. Results revealed pronounced similarity in individual spinal electromyographic patterns whether motions were volitional or physician induced. Analysis demonstrates the bell-shaped myoelectric behavior pattern originally reported in part 1. The authors also discuss a functional model for this myoelectric activity involving a helical spinal motor pattern with a focal area of transition that is dynamic in response to postural and motion demands.

A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 1. Ipsilateral regional motor performance.

Osteopathic physicians may use regional diagnostic rotation tests of the spine during physical examinations for patient evaluations. Clinical judgments of these responses relate to symmetry as a criterion for mobility. This first part of a two-part study reports the authors' investigation of regional ipsilateral myoelectric activity during responses to active and passive shoulder and trunk rotations on the left- and right-side muscles with subjects seated. Results indicate symmetry existed in both active and passively induced regional rotation tests. Further, the distribution (profile) of ipsilateral myoelectric activity in the thorax reflected a bell-shaped activity curve that peaked at thoracic levels 6 and 7. This profile element demonstrates remarkable similarity between volitional and physician-induced rotation motions. These myoelectric data justify symmetry and profile as tangible standards for making clinical judgments of regional responses to spinal rotation diagnostic tests.