7. Adjustive Treatment Of Pelvic Dysfunction

Question 1

What vascular conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 1

• atherosclerosis of major blood vessels
• vertebrobasilar insufficiency
• aneurysm
• clotting disorder

Question 2

What articular conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 2

• Osteoarthritis (late stage)

- uncoarthritis

Question 3

What type of trauma conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 3

• fractures

- severe sprains

Question 4

What bone weakening conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 4

• Bone tumors

- osteopenia/osteoporosis

Question 5

What neurologic conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 5

• Space-occupying lesions

- diabetes (neuropathy)

Question 6

What psychological conditions are contraindication for adjunctive treatment of pelvic dysfunction?

Answer 6

• malingering
• hysterics
• hypochondriasis
• Alzheimer’s disease

Question 7

Restrictions of adjustive treatment of acute SI sprain:

Answer 7

Don’t adjust in direction of tissue damage/pain

Question 8

In the reparative and remodeling stages of tissue repair post SI sprain, what are the restitutions on adjustive treatment?

Answer 8

adjusting in the
painful direction (if restricted) can be beneficial but should be attempted gentle at first

Question 9

True or false. Unstable joints generally don’t benefit from adjusting, particularly in their
planes of instability.

Answer 9

True

Question 10

True or false. Hyper mobile joints do not benefit from adjusting.

Answer 10

Generally no, however, hypermobile or unstable joints can become temporarily restricted in which
case adjusting can be beneficial.

Question 11

Are lumbar disc herniations a contraindication for adjustment?

Answer 11

Relative contraindication although thinking is change on this and evidence is showing that adjustments do not worsen herniations unless there is progressive neurologic deficits

Question 12

SI sprain and resulting SI joint adjustive complications that although are rare, can occur.

Answer 12

• disruption of ligamentous or capsular tissue

- worsening of existing sprain

Question 13

Lumbar disc herniations and resulting SI joint adjustive complications that although are rare, can occur.

Answer 13

• worsening of lumbar disc herniations, although there is some controversy on this claim

Question 14

Hypermobile joint and resulting SI joint adjustive complications that although are rare, can occur.

Answer 14

• perpetuation of unstable joint

Question 15

The condition in which there is entrapment of the lateral femoral cutaneous nerve as it passes under the inguinal
ligament medial to the ASIS causing dysesthesia and pain along the lateral thigh.

Answer 15

Meralgia paresthetica

Question 16

What is the usual cause of meralgia paresthetica?

Answer 16

usually initiated by obesity or pressure from belt, etc.

Question 17

Meralgia paresthetica can be worsened by what adjustive treatment for SI dysfunction?

Answer 17

prone genu ilium adjustment may cause or worsen the

condition

Question 18

True or false. Adjustments should never be made in directions of marked pain and splinting.

Answer 18

True

Question 19

True or false. Adjustments should not be delivered to non-acute areas in directions of increased pain/tenderness, even if associated with abnormal increased resistance.

Answer 19

False, Adjustments may be delivered to non-acute areas in directions of increased pain/tenderness
if associated with abnormal increased resistance.

Question 20

Is it appropriate to deliver more than one adjustment at a single joint to relieve multiple directions of joint restriction.

Answer 20

Yes, if necessary, however one adjustment may clear multiple directions of restriction at a single joint.

Question 21

Beffa and Mathews used microphones taped over the lumbar and SI regions
to localize cavitation with lumbar and SI adjustments. What was their finding?

Answer 21

what is actually a lumbar sacral cavitation may often mistakenly be identified as a sacroiliac joint cavitation because the microphone that recorded the highest number of signals during SI adjustment was over the L5-S1 joint facet

Question 22

If we really want to

move the SI joint, we should choose methods that minimize ______ and maximize forces to the SI region.

Answer 22

lumbar rotation

Question 23

Motions which _____ joint surfaces (decrease synovial fluid pressure) create cavitations more readily.

Answer 23

gap

Question 24

What SI adjustments gap the joint and are more likely to produce cavitations?

Answer 24

• SI flexion using sacral base contact
• SI extension using PSIS contact with more medial to lateral vector
• SI extension using kickstart

Question 25

Motions which ____ joint surfaces (don’t decrease synovial fluid pressure) shouldn’t create cavitations.

Answer 25

approximate

Question 26

What SI adjustments approximate the joint and are more likely to produce cavitations?

Answer 26

• SI extension using sacral apex contact

If cavitation occurs, it is likely lumbosacral due to rotation in the setup

Question 27

Motions which ____ joint
surfaces probably don’t frequently cavitate (no decrease in synovial fluid pressure unless significant capsular stretching occurs).

Answer 27

glide or slide

Question 28

What SI adjustments slide or glide the joint and are more likely to produce cavitations?

Answer 28

Any typical flexion and extension adjustments of the SI joint without significant gapping

Question 29

Flynn et al investigated whether the presence or absence of a cavitation was related to patient outcome. What was their conclusion?

Answer 29

cavitation may not be relevant in terms of patient outcome and therefor should not be the focus of the clinician or the patient during manipulation