The Effectiveness of Osteopathic Treatment in the Treatment of

DIPLÔME EN OSTÉOPATHIE (D.O.)
Présenté et soutenu publiquement
Le 15 Octobre 2012
À Montréal
Par
ORSINI, LUCIA
Née le 12 aout 1981 à Oakville, ON, Canada
The Effectiveness of Osteopathic Treatment in the
Treatment of Patellofemoral Pain Syndrome.
Membres du jury
Président : VOYER, Guy D.O.
Assesseurs : BURKE, Andy D.O.
DELANGE, Carla D.O.
DUFRESNE, Carl D.O.
DURAND, Véronique D.O.
MARINE, Karyne D.O.
MICHEL, Daniel D.O.
TURMEL, Serge D.O.
.
II
Thesis Director
Eric Sanderson DO
Material Taken from
Fascial Course 1: Fascia of the Lower Extremities
III
ACKNOWLEDGEMENTS
I would like to thank all the volunteers for their participation in this study. Without them it would not
have been possible to carry out this work.
My sincerest gratitude goes to Janice Manson who edited my work on this thesis and who inspired and
encouraged me throughout this journey. Her patience, kindness and humor kept me going on this
journey. Thank you so much for keeping me on track, and being a constant cheerleader throughout.
Special thanks also goes to Eric Sanderson who advised me throughout this process. He provided
invaluable insight and organization throughout this journey. I appreciate the unrelenting support and
encouragement during the many emotional peaks and valleys of this project. He is a constant source of
inspiration in the field of Osteopathy.
Special thanks and perpetual gratitude to my loving family who provided constant support and unlimited
patience during this writing. I am immensely grateful for all time, and preparation of special treats to
keep me fueled during this process.
And finally, I would like to express my gratitude to my friends and patients who may have been neglected
in this process. Thank you for your support and words of encouragement, and reminding me of the
distant light at the end of the tunnel. Thank you all for your patience and believing in me
IV
Table of Contents
THESIS ADVISOR..........................................................................................................................II
ACKNOWLEDGEMENTS............................................................................................................III
TABLE OF CONTENTS................................................................................................................IV
LIST OF CHARTS OR TABLES .................................................................................................VI
ABSTRACT.....................................................................................................................................VII
RÉSUMÉ .........................................................................................................................................VIII
HYPOTHESIS ................................................................................................................................IX
1 CHAPTER ONE: INTRODUCTION ........................................................................................1
1.1 OVERVIEW ............................................................................................................................. 2
1.2 BACKGROUND ..................................................................................................................... 4
1.3 METHODOLOGY OF SUTHERLAND ACADEMY............................................................. 6
1.4 ON COMPLEXITY ................................................................................................................. 7
1.5 METHODOLOGY..................................................................................................................... 8
2 CHAPTER TWO: BACKGROUND INFORMATION......................................................... 9
2.1 PATELLOFEMORAL PAIN SYNDROME OVERVIEW ..................................................... 10
2.2 ETIOLOGY .............................................................................................................................. 10
2.2.1 OVER TRAINING................................................................................................................. 10
2.2.2 BIOMECHANIC CONSIDERATION.................................................................................. 11
2.2.3 QUADRICEPS ANGLE......................................................................................................... 12
2.2.4 MUSCULAR IMBALANCES .............................................................................................. 13
2.2.4 TISSUE HYPOXIA................................................................................................................ 14
2.3 SIGN AND SYMPTOMS ........................................................................................................ 16
2.4 CONVENTIONAL TREATMENT .......................................................................................... 17
3 CHAPTER THREE: CONTEXTUAL INFORMATION...................................................... 19
3.1 INFLAMMATION PROCESS.................................................................................................. 20
3.1.2 OSTEOPATHIC CONSIDERATIONS FOR INFLAMMATION......................................... 25
3.2 FASCIA...................................................................................................................................... 28
3.2.2 FASCIA AND ITS INNATE NERVOUS SYSTEM.............................................................. 30
3.2.3 FASCIAL CHAINS................................................................................................................. 32
3.2.4 FASCIAL INVESTIGATIONS............................................................................................... 37
3.2.4.2 FASCIA LATA..................................................................................................................... 39
3.2.4.3 FASCIA ILIACA ................................................................................................................. 40
3.3 ANATOMICAL DISCUSSION................................................................................................. 42
3.3.1 JOINT ANATOMY................................................................................................................. 43
3.3.2 MENISCI................................................................................................................................. 47
3.3.3 ARCHES OF THE FOOT....................................................................................................... 50
3.4 SOFT TISSUES DISCUSSION................................................................................................. 53
3.4.1 JOINT CAPSULE................................................................................................................... 54
3.4.1.2 JOINT MOTIONS................................................................................................................ 57
3.4.2 ILIOTIBIAL BAND................................................................................................................ 58
3.4.3 DELTOID OF THE HIP.......................................................................................................... 60
3.5 KNEE.......................................................................................................................................... 63
3.6 EXTRACELLULAR MATRIX................................................................................................. 70
3.7 PRIMARY RESPIRATORY MECHANISM............................................................................ 71
3.7.1 FROM PRIMARY RESPIRATION TO FASCIAL BIODYNAMICS................................. 72
3.8 POLYGONS OF FORCE........................................................................................................... 74
3.8.1 ANTERIOR AND POSTERIOR POSTURE.......................................................................... 77
3.9 BIOMECHANICAL CONSIDERATIONS............................................................................... 78
3.6 EMBRYOLOGY........................................................................................................................ 82
V
4 CHAPTER FOUR: OSTEOPATHIC CONSIDERATIONS................................................. 92
5 CHAPTER FIVE: METHODOLOGY..................................................................................... 95
6 CHAPTER 6: RESULTS AND CONCLUSIONS .................................................................. 104
6.1 OVERVIEW ............................................................................................................................. 105
6.2 QUANTITATIVE RESULTS AND STATISTICAL ANALYSIS ......................................... 106
6.3 SUGGESTIONS AND IMPROVEMENTS FOR FUTURE STUDY...................................... 111
7 BIBLIOGRAPHY....................................................................................................................... 113
APPENDICES................................................................................................................................ 117
APPENDIX A: RECRUITMENT LETTER............................................................................... 118
APPENDIX B: CONSENT FORM ............................................................................................. 115
APPENDIX C: KNEE PAIN QUESTIONNAIRE...................................................................... 122
APPENDIX D: LETTER FROM STATISTICIAN ................................................................... 125
VI
LIST OF ILLUSTRATIONS, PHOTOS AND FIGURES
Figure 1, p. 13
The Quadriceps angle in males and females
Figure 2, p. 31
typical muscle nerve depicting three times as many sensory neurons than
motor neurons
Figure 3, p. 34
This diagram displays the five different muscular chains of Godelieve Struyf
Denys
Figure 4, p. 40
Cross-section through the middle of the thigh.
Figure 5, p. 54
Illustration of a right rectus femoris with the three origins.
Figure 6, p. 60
This schema shows the comparison of the deltoid of the upper extremity, and
the lower extremity
Figure 7, p. 64
This diagram illustrates the iliotibial band
Figure 8, p. 66
Illustrates the directions of pull of the vasti muscles in relation to the ‘Q’
angle.
Illustrates the longitudinal fibers and the aponeurotic expansion of the
quadriceps tissue.
Figure 9, p. 67
Figure 10, p. 68
This schema illustrates the medial and lateral patella ligaments of the patella
Figure 11, p. 76
This picture shows the gravity lines of Littlejohn.
Figure 12, p. 78
Illustration of the three main posture types
Figure 13, p. 80
Illustrates the attachment of the psoas #26, to the lumbar spine and its relation
to the kidney
Figure 14, p. 81
Relationship of the psoas with the left colon
Figure 15, p. 84
Development of the somites
Figure 16, p. 86
Diagram that depicts the upper and lower limb buds
Figure 17, p. 88
This schema demonstrates the upper and lower limb positions
Figure 18, p. 107
Reveals posture percentage of subjects in study
Figure 19, p. 108
Pre and post treatment questionnaire scores
Figure 20, p. 109
Changes in questions 1-4 of study group
VII
ABSTRACT
The purpose of this study is to determine the effectiveness of osteopathic treatments on
patellofemoral pain syndrome. The treatment method was based on the teachings of Sutherland
Academy. The method followed the use of fascial chains in which the goal was to normalize the
connections from the foot up to the sacral iliac joint. This within study design consists of volunteers
between the ages of 15 and 60. Upon completion of health history evaluation forms, and knee pain
questionnaires, the subjects were assessed, and the results recorded. The participants were randomly
selected into two groups. The control group receives 2 therapeutic treatments of effleurage, while the
remainder of the subjects received three manual osteopathic treatments. This was a quantitative study and
the results showed that the osteopathic treatments were successful in treating patellofemoral pain
syndrome.
VIII
RÉSUMÉ
L’objectif de cette étude est de déterminer l’efficacité des traitements ostéopathiques sur le syndrome
fémoro-patellaire. La méthode de traitement a été basée sur l’enseignement de l’Académie Sutherland. La
méthode suivie l’utilisation de chaines faciales dans lequel le but était de normaliser les connexions à
partir du pied jusqu’au joint iliatique sacrial. La conception des études se compose de bénévoles âgés
entre 15 et 60 ans. Une fois les formes d’évaluations de santé et de douleur au genou complétées, les
sujets ont été évalués et les résultats enregistrés. Les participants ont été sélectionnés au hasard et séparés
en deux groupes. Le groupe contrôlé ont reçu deux traitements thérapeutiques d’effleurrage, tandis que les
reste des sujets ont reçu trois traitements manuels d’ostéopathie.
Ceci était une étude quantitative et les résultats ont démontrés que les traitements ostéopathiques ont
réussis à traiter le syndrome fémoro-patellaire.
IX
HYPOTHESIS
Osteopathic treatment of the fascial chains of the lower extremity can effectively treat patellofemoral pain
syndrome.