8. Pelvic Adjustments

Question 1

Extension and distraction of the SI joint in side posture can be done using:

Answer 1

• ilium contact with forearm, hypothenar or fingertips and thigh to thigh, genu pincer, caudad leg kick and cephalad leg kick
• sacrum contact with hypothenar or forearm contact on sacral apex and any stance that takes hip flexion past 90 degrees.

Question 2

What is the vector for side posture adjustment of extension and distraction of the SI joint with ilium contact?

Answer 2

P->A
M->L
I->S

Question 3

What is the vector for side posture adjustment of extension and distraction of the SI joint with sacrum contact.

Answer 3

P->A

L->M

Question 4

Extension and distraction of the SI joint in prone can be done using:

Answer 4

• two handed contact over PSIS and sacral apex
• One handed (reinforced) contact over PSIS
• genu ilium with PSIS contact

Question 5

In the prone, two handed contact over PSIS and sacral apex adjustment for extension and distraction of the SI joint, what is the PSIS vector and the scrap apex vector?

Answer 5

• PSIS vector: P-A, I-S

- sacral apex vector: P-A & S-I

Question 6

In the prone, one handed contact over PSIS adjustment for extension and distraction of the SI joint, what is the vector?

Answer 6

P->A
I->S
M->L

Question 7

In the prone, genu ilium with PSIS contact adjustment for extension and distraction of the SI joint, what is the vector?

Answer 7

P->A

M->L

Question 8

What are the adjustments for flexion and distraction of the SI joint in side posture?

Answer 8

• ischial tuberosity contact with palm or forearm contact and low fencer, straddle thigh, double thigh to shin or split leg stance
• hypothenar-sacral base contact with dysfunctional side up or down

Question 9

What is the vector for all flexion and distraction adjustment of the SI joint in side posture with ischial tuberosity contact?

Answer 9

P->A with scooping

Question 10

Is the patient’s hip flexed at 90 degrees or above 90 degrees when adjusting flexion and distraction of the SI joint in side posture?

Answer 10

Above 90 using low fencer stance, straddle thigh, double thigh to shin or split leg/knee to popliteal fossa

Question 11

When adjusting flexion and distraction in side posture with a hypothenar-sacral base contact and dysfunctional side down or up, what static listing is being fixed?

Answer 11

PS sacrum

Question 12

What is the vector for all flexion and distraction adjustments of the SI joint in side posture with hypothenar-sacral base contact?

Answer 12

P->A (pound down the high spots)

Question 13

What are the adjustments for flexion and distraction of the SI joint in prone?

Answer 13

• two handed contact over inferior ischium and sacral base

- one handed contact over sacral base

Question 14

When doing a flexion and distraction adjustment of the SI joint in prone using Two-handed Contact Over Inferior Ischium & Sacral Base, what are your ischial and sacral base contacts?

Answer 14

• inferior ischium vector: P-A, S-I

- sacral base vector: P-A, I-S

Question 15

If you want to gap the SI as well as extend it, which would be better, Innominate Contact vs. A Sacral Contact?

Answer 15

Innominate contact using a PI type setup will gap the joint more than a sacral contact suing an AI type setup.

Question 16

What factors should be considered when choosing an Innominate Contact vs. A Sacral Contact?

Answer 16

• dr. Preference
• mechanical advantage
• patient comfort
• possibility of lumbosacral dysfunction
• trial and error

Question 17

Upper and lower SI joint dysfunction is palpated separately using what test?

Answer 17

Gillet’s

Question 18

If there is more of an upper SI joint dysfunction, what contact would deliver more force to the upper part of the joint?

Answer 18

PSIS contact or a sacral base contact

Question 19

If there is more of a lower SI joint dysfunction, what contact would deliver more force to the lower part of the joint?

Answer 19

Ischial tuberosity contact or a sacral apex contact

Question 20

How would you treat an SI extension dysfunction using blocking when patient is in prone?

Answer 20

• block placed at the level of the ischial tuberosity
  on side where extension is desired
• block placed under the ASIS of the opposite side may increase the effect
• gravity or combined thrust/mobilization can be used to create desire motion in joint

Question 21

How would you treat an SI extension dysfunction using blocking when patient is in supine

Answer 21

• block placed under PSIS on side where extension is desired
• block placed under the ischial tuberosity of the opposite side may increase the effect
• force of gravity creates the desired joint motion over time

Question 22

How would you treat an SI flexion dysfunction using blocking when patient is in prone?

Answer 22

• block placed under ASIS on side where flexion is
  desired
• block placed at the level of the ischial tuberosity of the opposite side may increase the effect
• gravity or combined thrust/mobilization can be used to create desire motion in joint

Question 23

How would you treat an SI flexion dysfunction using blocking when patient is in supine?

Answer 23

• block placed under ischial tuberosity on side
  where flexion is desired
• block placed under the PSIS of the opposite side
  may increase the effect
• force of gravity creates the desired joint motion
  over time

Question 24

When would you suspect pubic symphysis dysfunction?

Answer 24

• patient complains of pain in the pubic symphysis region

- SI pain and dysfunction unaffected by your best efforts to treat the SI joints

Question 25

What are some static physical finding that may be found with pubic symphysis dysfunction?

Answer 25

• pain
• vertical displacement of one pubic bone palpated or seen on x-ray
• anterior displacement of one pubic bone palpated (uncommon)
• separation of the pubic symphysis palpated or visualized on x-ray (uncommon and usually related to pregnancy/childbirth)

Question 26

What are some motion physical findings that may be found with pubic symphysis dysfunction?

Answer 26

• pain
• lack of translational/shearing motion
• excessive translational/shearing motion