REMEMBER THE DTM FLOW…
1. Identify provocative movement
2. Consider involved neurology for potential neuropathic component
3. Assess for neural sensitivity
4. Apply treatment to improve mechanical interface of the involved neuro
5. Re-test provocative movement
6. Apply homecare and perform regularly until sensitivity to movement normalizes
Common Diagnosis
- Meralgia paresthetica
- Trochanteric bursitis
- Hip labral tear
- Femoral acetabular impingement
- Sciatica
- Medial meniscus tear
- Patellofemoral syndrome
- ITB syndrome
- Chronic hamstring strain
Target Neurology
- Lateral femoral cutaneous nerve
- Posterior femoral cutaneous nerve
- Saphenous nerve
- Iliohypogastric nerve
- Ilioinguinal nerve
- Genitofemoral nerve
- Obturator nerve
- Superior cluneal nerves
- Inferior cluneal nerves
A reminder…some of these nerves (femoral and sciatic nerves, primarily) are “mixed nerves” carrying both motor and sensory function. As such, an evaluation of motor function to rule out nerve root involvement in a radicular process is warranted. Not uncommonly, we will see such radicular processes and “sciatica” manifest as part of a foot or leg pain condition referred to our office and the primary driver for their pain is upstream nerve root compression. DTM may temporarily help with some of the symptoms, but the potential for a nerve root issue must be evaluated! Consider McKenzie evaluation as part of your work up and home care.
Don’t overlook the saphenous nerve in cases of medial knee and lower leg pain! This is especially warranted in cases of suspected medial meniscus lesion and after total knee replacement.
In your history, consider the potential compressive effect of tight waistbands on these nerves. Commonly affected are pregnant women, workers wearing tool belts, those with recent weight gain but no change in pants size, and even tight workout apparel.
