Overview of Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
Osteopathic medicine is a type of healthcare that treats the whole person, paying attention to the mind, body, and spirit. This approach rests on the belief that these three aspects are all linked, and any issues in any part could cause pain or sickness. One part of this approach is the Osteopathic Manipulative Treatment (OMT), which uses hands-on techniques to identify and correct physical issues, aiming to improve movement, boost the nervous system, ease pain, and restore balance in the body’s chemistry.
“Somatic dysfunction” is a term used when there are issues in how the body’s systems are working, including the musculoskeletal (bones and muscles), vascular (blood vessels), lymphatic (fluid transport), and central nervous (brain and spinal cord) systems. An osteopathic physician might use OMT to help the body help itself when dealing with these sorts of problems.
For example, the fibula, a small bone located on the outer side of the lower leg, helps to move both the knee and ankle joints. If there’s a problem with how the fibula is functioning (this is called ‘fibular head somatic dysfunction’), then the person could have pain in the knee and ankle, and may walk abnormally.
Two therapeutic hands-on techniques that can be used for this issue involve Muscle Energy Techniques (METs) and high-velocity, low-amplitude (HVLA) techniques. METs help to get rigid joints moving, strengthen weak muscles, stretch tight muscles and tissues, and enhance blood flow. In an MET treatment, the patient helps the doctor by tensing the targeted muscle, and the doctor provides resistance to help the muscle move. HVLA is a technique where the doctor applies a quick, precise push to help free up a restricted joint. In both cases, the aim is to improve the body’s movement and function.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
The fibula is a slender bone that runs from the knee to the ankle, on the outside of your leg. It’s divided into four sections: the head, neck, shaft, and distal end. Even though it doesn’t bear weight, the fibula is important for keeping your ankle stable.
At the top of the fibula, it connects with the tibia, which is a larger bone in your leg. On the bottom, it helps form your ankle. There are ligaments, which are tough bands of tissue, that wrap around where the fibula joins the tibia to keep the joint secure.
This joint is important because it helps distribute pressure across the ankle, reduce bending in your tibia, and handle weight-bearing loads. When you bend your knee, the top of the fibula moves forward due to looseness in certain ligaments, and when you extend your knee, the same area moves back due to tightening in these ligaments. The stability of this joint can be reduced when the knee is bent and these ligaments are relaxed, which can lead to injury.
Further down the leg, the fibula and the tibia are connected by a type of ligament called the interosseous syndesmotic membrane. As you move your ankle, the fibula turns to accommodate the range of motion.
The common peroneal nerve, which is responsible for movement and sensation in the leg, runs down the leg and wraps around the head of the fibula. This nerve can be compressed, causing symptoms like foot drop, numbness on the outside of the leg, or sensory issues in the foot.
Knowing the movement patterns of the fibula is crucial when examining it for dysfunction. The top of the fibula forms a joint that allows minor forward and backward movements. The bottom of the fibula forms a joint that enables slight outward movement to allow for movement of another bone in the foot during movement like pulling your foot up towards your leg.
Two key methods for examining these movement patterns are the muscle energy technique (MET) and the high-velocity low-amplitude (HVLA) technique. In MET, a person is positioned towards a movement barrier and instructed to push against resistance. This helps induce changes in the joint by triggering the Golgi tendon reflex, a natural reflex which helps maintain stability and movement coordination. In HVLA, a quick thrust is applied to the joint to correct movement and joint function. This may cause a ‘pop’ sound which is thought to be a nitrogen bubble escaping the joint area when pressure is applied quickly.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
MET and HVLA are types of treatments that target the fibular head, which is a bone found near your knee. These treatments are considered safe and are often used to address issues related to certain conditions.
The fibular head muscle energy technique, or MET, is frequently used when you’re experiencing limited movement in the fibular head. This limitation can be connected with knee pain, fibular neuritis (which is inflammation of the fibular nerve causing pain), ankle pain, and changes in the normal way of walking, also known as gait abnormality.
The anterior fibular head thrust treatment, also known as HVLA, is typically used when the front part of the fibular head is causing pain in the lower half of your body or changes in your normal walking pattern.
The posterior fibular head thrust technique, another type of HVLA, is often used when the back part of the fibular head is causing problems. This might include pain in the lower part of your body, inflammation in the fibular nerve, or changes in your normal way of walking.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
There might be multiple reasons why certain techniques during physical treatment, such as MET (Muscle Energy Technique) and HVLA (High-Velocity Low-Amplitude thrust) techniques, cannot be used on patients. These include the patient not wanting the procedure, recent injuries that could worsen with certain positions, or a patient’s inability to follow instructions. More specific reasons for not being able to use these techniques are:
* If the treatment involves the fibular head muscle, which is a method commonly used in MET, it must not be used if there’s a fresh sprain in the ankle, a new break in the fibula (bone in the leg), a condition where blood clots happen easily known as deep vein thrombosis, and loosening of the ankle joint.
* For the Anterior fibular head thrust (a type of rapid, small movement often used in HVLA techniques), it cannot be used if there is a new fracture in the fibula, a risk of blood clot in the vein, or if the knee is unstable or inflamed.
* Similarly, the Posterior fibular head thrust cannot be done if the patient has a fresh ankle sprain, a new fracture in the fibula, a risk of blood clot in the vein, or if the knee is unstable or inflamed.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
In order to carry out two particular techniques used in physical therapy – the Muscle Energy Technique (MET) and the High Velocity Low Amplitude (HVLA) technique – it’s important that certain equipment is on hand. This includes a table designed for osteopathic manipulation therapy (OMT) – a type of physical therapy, an exam table, or a massage table. A pillow is needed to keep you, the patient, comfortable, and you may be given a gown or shorts to wear in order to expose your lower leg area beneath the knee. A stool is also used, which is for the comfort of your doctor while they are conducting the treatment.
Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction?
When it comes to OMT, which stands for Osteopathic Manipulative Treatment, a special method of hands-on care, there are typically two main people involved:
First, you have a doctor who has been specially trained in OMT. This training could have happened while they were in medical school, or it could have been additional training they received after graduating. This doctor knows how to safely perform OMT to help treat various conditions.
Second, the person receiving the OMT, who we refer to as the patient, must have agreed to receive this treatment and should have no medical reasons that would make this treatment unsafe for them. In other words, they have given their consent and there’s nothing in their health condition that would put them at risk during the treatment.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
Before a doctor starts any examination or treatment, it’s important that they explain to you what could happen, the good and bad parts of the treatment, and other options you might have. After making sure you understand and agree to the treatment, the doctor can then begin the physical examination. A certain part of your leg, called the fibular head (located on the side and just a bit below your knee), can give the doctor a lot of useful information.
The first step is for you to lie down on your back on the examination table with your knee bent. The doctor will then hold the fibular head with their thumb and forefinger, and try to move it in different directions. This helps the doctor find out if there is any restricted movement. If the fibular head is harder to move forwards and outwards, it suggests that it is positioned towards the back. If it’s tougher to move backwards and inwards, it indicates a frontward positioning.
Evaluating the fibular head can sometimes be tricky. To help with this, the doctor might move your ankle to check if it prefers to turn inward or outward. Understanding this hint can help the doctor to better determine the fibular head’s position. Slightly rotating your lower leg can also give them clues. If your leg prefers to turn outward, it suggests that the fibular head is likely to be at the back. The doctor might also compare the position of the fibular head to the level of your lower leg bone (tibial plateau) to know if it is positioned more frontwards or backwards when compared to the other knee.
How is Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction performed
These certain techniques are performed to improve the movement of your fibula, which is one of the bones in your lower leg. Here’s how they’re done:
Fibular Head Muscle Energy:
- You will sit or lie down on your back.
- Your knee is bent to a 90-degree angle.
- The doctor will shift your fibular head (part of your lower leg bone) depending on your specific restrictions. Here’s how it works: if the fibular head needs to move to the back, they will pull it slightly forward and to the side; otherwise, they will pull it toward the midpoint of your body. During this, your foot will move in a particular way that corresponds to the original restriction.
- You are asked to resist some ankle movements, for around 3 to 5 seconds.
- Afterward, you’ll relax and your doctor will slowly move your ankle to a different position. Your fibular head is relocated again based on your specific requirements.
- This process of muscle contraction and stretch is repeated around 3 to 5 times or until the mobility of your fibular head is restored.
- Finally, your doctor will check how your fibula moves.
Anterior Fibular Head Thrust (HVLA):
- You will lie on your back for this procedure.
- Your doctor will place part of their hand on the front part of your fibular head and then grasp the bottom part of your tibia with the other hand.
- Your fibular head is pushed towards the middle of your body by pressing into it, and your lower leg bone (tibia) is rotated.
- You’ll be asked to take a deep breath and when you exhale, your doctor will promptly apply a small, quick push into your fibular head.
- After the procedure, your doctor will reassess the movement of your fibular head.
Posterior Fibular Head Thrust (HVLA):
- You will lie on your back for this procedure, too.
- Your doctor then positions a joint in their hand next to the back of your fibular head and holds the bottom part of your tibia with the other hand.
- The lower part of your leg is rotated outwards and your knee is bent until the doctor’s hand is sandwiched between the back of your fibular head and your thigh.
- You are then asked to take a deep breath, and while you are exhaling, your doctor applies a quick, short push by bending your knee.
- This procedure is followed by checking the mobility of your fibular head again.
Remember, all of these techniques are performed with the intention of restoring the unrestricted movement of your fibula (lower leg bone).
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction
Osteopathic manipulative treatment, or OMT, on the “fibular head” – the top part of the smaller bone in your lower leg – is generally a safe medical procedure. The most common side effects that people might have are fatigue, headaches, discomfort around the area treated or tingling pains that spread out from the treatment area. Fortunately, these side effects typically go away in about a day after treatment. Resting and drinking plenty of fluids can help make you more comfortable if you have discomfort after an OMT session.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures – Fibular Head Dysfunction?
Knee and ankle pain can be complex to handle for many people. Common treatment options include medicines like NSAIDs, doing special exercises with a physiotherapist, resting and immobilizing the injured area, and getting steroid shots. However, if patients have a certain type of dysfunction in the fibular head, a specific part of the lower leg bone, a method called OMT (osteopathic manipulative therapy) can help. OMT is a hands-on treatment method that doctors use to diagnose, treat, and prevent illness or injury, offering a safe, in-office way to help relieve pain.
Ankle sprains, a common source of fibular head dysfunction, are often encountered in medical practices. The good news is that adjusting or manipulating the injured area often improves the condition. The most common type of sprain is a supination or inversion ankle sprain where the ankle rolls outward. During this type of sprain, a bone in the ankle (talus) and part of the lower leg bone (distal fibula) can get jammed in the front, causing the distal fibular head to shift forward and the fibular head to move backward. This misalignment leads to an external rotation of the tibia (shinbone), triggering a twisting force and internal rotation of the thigh bone (femur). This, in turn, might cause rotation in the hip bones and stress in the triangular bone at the base of your spine (sacrum). As the late Dr. Philip Greenman, a renowned osteopath, emphasized, “There is no such thing as a mild ankle sprain.”
For cases where the misalignment of the fibular head is substantial, patients may experience weakness when trying to lift the front part of their foot due to irritation of the fibular nerve, a nerve of the lower leg. If adjusting the fibular head is too painful, doctors may use a gentler approach such as the balanced ligamentous tension technique. However, a detailed discussion of this technique is beyond the coverage of this article.
