1 Flashcards
Flexors pull pelvis which direction? Extensors?
Flexors: anteriorly
Extensors: posteriorly
Major hip flexors
Iliacus and Psoas
What nerve pierces the piriformis?
Sciatic n.
Contraction of the piriformis may cause what?
Sciatica
Function of the piriformis
Abductor when hip is FLEXED
External rotator when hip is EXTENDED
*ONLY rotator that connects directly to sacrum
How to determine LATERALITY?
Pelvic Compression
Standing Flexion
Positive side for Standing Flexion test?
Innominate will lock out and move most CEPHALAD
Pubic shears are often seen with what?
Rotations
Upslips
What is Lumbarization of the sacrum?
When S1 and S2 do NOT fuse
Sacrum has how many vertebrae?
5
S1-S5
Where are sacral epidural nerve blocks performed?
Sacral hiatus
How many vertebrae make up the Coccyx?
4
C1-C4
*Lowest part of spinal cord
What are the 3 true pelvic ligaments?
Posterior sacroiliac ligaments: PSIS to 3rd/4th sacral segments
Interosseous sacroiliac ligaments: from medial sacral crest to iliac tuberosities
Anterior sacroiliac ligaments: attach from 3rd sacral segment to preauricular surface of ilium
What do the Sacrospinous and Sacrotuberous ligaments do?
Prevent apex of sacrum from moving posteriorly and superiorly (like the attic door movement…going up)
*Opposite=Iliolumbar ligament–stabilizes posterior motion..attaches 4th/5th lumbar vertebra to iliac crests
What does the sacrospinous ligament attach?
Attaches sacrum to ischial spine
*Creates greater and lesser sciatic foramen
Ileum vs ischium
Ileum=top part
Ischium=lower part
Cranial and Sacral dura attachment
Cranial dura: C1-C2
Sacral: S2
Force closure vs Form closure
Force closure: muscles holding object by pressure on sides
Form closure: roman arch. (Sacrum=keystone between iliums)
3 transverse axes of motion on sacrum
Superior (S1): “respiratory”. At level of articular process of S2. Inhalation: base goes posterior, apex-anterior..”Think of sacral base as moving back to let in air”
Middle (S2): “Postural” or “Sacroiliac”. Flexion/extension in sitting/standing. Level of S2 body. Flexion: base goes anterior
Inferior (S3 axis): “Iliosacral”. axis for rotation of iliums on sacrum…at inferior pole of lower sacral articulation
Cranial motions
Sacral base goes posteriorly and apex anteriorly during CRANIAL FLEXION
Base anterior and apex posteriorly during CRANIOSACRAL EXTENSION
(opp. of sacrum movements)
Craniosacral flexion/extension is VERY different than postural flexion/extension
W/ flexion, SBS moves up
Nutation vs Counternutation
Nutation: Nodding forward (base goes anterior)
Counternutation: (base goes posterior). Occurs w/ craniosacral/SBS flexion
Dynamic motion occurs around what axes?
Oblique
Where to place hands during 4-pt passive test
Contact each sacral sulci and ILA
Put force around oblique axis…looking for ease of motion
Where to put palms during Side Bending
Palms on ILA’s…give cephalad force
Fred Mitchell Sr.: described muscle energy in 1958. Held 5 day tutorial. Son later published his manual.
JAOA article by Dr. Vick- evaluated reported injuries from manipulation. Risk=1 in million
S. Haldeman: unpredictability of Cerebral Vascular Ischemia..more common injuries from tennis etc
True
Golgi Tendon Reflex
They are stretched whenever muscles contract
They detect degree of skeletal muscle tension and send this info to CNS…synapse w/ inhibitory interneurons…cause reflex relaxation of the muscle
Purpose: prevent tissue disruption
SUDDEN STRETCH activates golgi tendon organ.
Spinal somatic dysfunction involves: Vertebral segment
*segment above and below the disc between the 2
True
Where does dura attach?
Superior transverse axis (S2) (Foramen magnum, C1, C2, S2)
Motion from SBS is transferred through the dura to the sacrum
*dura is like a string…it’s attached at the foramen magnum in your skull and to your S2 articular processes on your sacrum. The string pulls on the sacrum, moving it forward or backward-opposite of cranial movement.
Sacroilial motions are for what?
*So sitting on butt, you’re having the sacrum move ON the ilium…so the seated flexion test is measuring sacral movement and blocking out ilium
The flexion tests
How to treat Forward Torsion (L on L, R on R)
Modified Sims position, Axis side down, feet together and hanging off table as you hug the table
How to treat Backward Torsion (L on R, R on L)
Lateral recumbent, Axis side down, one foot off the table and the other on the table, as you hug the table
How to treat Unilateral Sacral Extension
Sphinx position, anterior/inferior force on sacral sulcus
How to treat Unilateral Sacral Flexion
Prone, anterior/superior force on ILA
Doctor on SIDE OF DYSFUNCTION
Seated flexion and pelvic compression being positive on OPPOSITE sides is a clue….only happens in TORSIONS
True
Sacral sulci become MORE SYMMETRIC in the Sphinx test=anterior torsion or unilateral flexion
True
2 muscle groups of pelvis
Levator ani
Coxxygius
