6. Sacral SD

Question 1

Static Testing

Answer 1

sacral sulcus, L5 rotation, ILA, 4 digit examination

Question 2

Sacral Sulcus Dx

Answer 2

1. Palpate the PSIS with thumbs
2. Move thumbs medially and inferiorly
3. Check symmetry (deep or shallow)

Question 3

L5 rotation Dx

Answer 3

1. Palpate Lumbar spine at level 5

2. Check for symmetry

Question 4

Inferior Lateral Angle Dx

Answer 4

1. Palpate with the heel of the hand in midline down sacrum until it drops anteriorly
2. Place one thumb near the thenar eminence to feel the inferior lateral angle of the sacrum
3. Place the other thumb roughly symmetrical to the first
4. Adjust slightly to find the inferior lateral angle
5. Compare each side for posterior/anterior and cephalad/caudal

Question 5

4 Digital Evaluation Dx

Answer 5

1. Place first fingers in sacral sulk
2. Place thumbs at the ILAs
3. Evaluate for symmetry - posterior/anterior and cephalad/caudal

Question 6

If a landmark is deep, it’s considered to be…

Answer 6

in flexion

Question 7

If a landmark is deep on the right, it is rotated to the…

Answer 7

left

Question 8

3 types of Static Testing

Answer 8

1. Lateralization
2. Active motion
3. Passive Motion

Question 9

Seated Forward Bending Test (SeFBT)

Answer 9

• Unilateral – positive test on side of dysfunction
• Tells the side of dysfunction
• Negative in bilateral dysfunction
• Torsion – positive test is opposite of the side of axis
• seated: sacral-ileo motion dysfunction
• *standing is ileo-sacral motion dysfunction

Question 10

Active Motion Test

Answer 10

Examine the flexion and extension motion

Question 11

Respiratory Motion Test

Answer 11

1. Place cephalad hand over sacrum with thenar and hypothenar eminence at the sacral base and the fingertips at the apex. Place the other hand on top of the cephalad hand pointing the opposite direction.
2. Have the patient exaggerate inhalation and exhalation.

Question 12

How should the sacral base move during inhalation? exhalation?

Answer 12

1. posteriorly

2. anteriorly

Question 13

Lumbar Spring Test

Answer 13

1. The patient lying prone on a treatment table.
2. The heel of the physician’s hand is placed over the spinous processes of the lumbar spine.
3. Pressure is then exerted through the heel of the hand toward the table (extending the lumbar spinal region).
4. The test is positive when the lumbar spine does not move well into extension. A positive backward bending test shows the sacrum is unable to flex (extended sacrum).

• negative: flexed sacrum
  positive: extended sacrum (means you don’t have spring)

Question 14

Sacral Axes

Answer 14

1. Superior Transverse Axis (S2 posteriorly)
2. Middle Transverse Axis (S2 anteriorly)
3. Inferior Transverse Axis (S3)
4. Left Oblique Axis (left base to right apex)
5. Right Oblique Axis (right base to left apex)
6. Vertical Axis
7. AP Axis

Question 15

Torsion

Answer 15

• restricted along oblique axis
• may be restricted in flexion or extension
• base may be restricted A or P

Question 16

Unilateral

Answer 16

• restricted along vertical axis

- may be restricted in flexion or extension

Question 17

Bilateral

Answer 17

• restricted along middle transverse axis

- may be restricted in flexion or extension

Question 18

Torsion Naming

Answer 18

part 1: named for rotation of the sacrum
part 2: named for axis involved

• flexed/forward: L/L or R/L
• *extended/backward: L/R or R/L

Question 19

L5 should be rotated in the ____ direction of the sacrum.

Answer 19

opposite

*if not, it is uncompensated, and should be treated first

Question 20

What does a flexed sacrum mean for L5? extended sacrum?

Answer 20

1. neutral

2. non-neutral