CPA 2.1: Lab (5) Sacral Dx & Tx with MET & ART Flashcards
The sacral base is the reference point for determining what motions of the sacrum?
Flexion/extension
What are the lateralization tests for the sacrum?
Seated flexion test and/or Pelvic compression test
What are the 4 passive motion tests for the sacrum?
- Static symmetry of sacrum (sulci, ILA)
- Lumbar Spring Test
- Side bending passive evaluation
- 4 point sacral evaluation
What is a positive test for seated flexion; how is this related to the axis for a torsion?
- One PSIS moves farther superiorly at the end range of motion (usually first side to move)
- Axes for torsions are opposite the positive side
What is a positive test for Pelvic/ASIS Compression; how is this related to the axis for a torsion?
- “Hard end-feel” or “restriction of motion” on one side
- Indicates SI joint dysf. on the side of restriction
- Axes for torsions are opposite the positive test side
What is a positive and negative test indicative of when doing the Lumbar Spring Test?
Negative = ease of springing motion
- Indicates either normal motion or preference for anterior sacral base motion unilaterally or bilaterally
Positive = resistance to springing
- Indicates a preference for posterior sacral base motion unilaterally or bilaterally
What is a sidebending passive evaluation of sacrum used to diagnose?
Unilateral dysfunction
What does the 4 point sacral evaluation help diagnose?
Sacral torsion dysfunction
What is a positive and negative test for the backward bending/sphinx test of the sacrum; what motion should occur at the sacrum during backward bending?
Positive test: inequality between right and left sides increases end feel changes (worse)
Negative test: sacral sulci and ILAs even out during the exam
*Backward bending increases lumbar lordosis and brings sacrum into flexion position. Sulci move anteriorly and ILAs move superiorly
What is the normal motions of the sacrum through respiration; what does this indicated for inhalation/exhalation if there is a restriction?
- Base should move posteriorly during inhalation, if restricted, bilateral sacral FLEXION
- Base should move anteriorly during exhalation, if restricted, bilateral sacral EXTENSION
What is the ME treatment for a bilateral sacral flexion?
- Pt is prone w/ physician standing beside pt
- Place thenar and hypothenar eminence of caudad hand on ILAs (i.e., apex of the sacrum. Cephalad hand on top of this hand.
- Apply anterior/superior force on the ILAs, as pt inhales, exaggerate sacral extension by applying the anterior force, resist sacral flexion during exhalation
- Repeat this process for 3-5 respiratory cycles or until no new barriers
What is the ME treatment for a bilateral sacral extension?
- Pt is prone in sphinx position, physician standing beside pt
- Place index and middle finger of caudad hand on sacral sulcus. Cephalad hand goes on top of this hand.
- As pt inhales, resist sacral extension. As pt exhales, exaggerate sacral flexion by applying an anterior and inferior force
- Repeast this process for 3-5 respiratory cycles or until no new barriers
What is the ME treatment for a Unilateral Sacral Flexion?
- Pt is prone, physician stands on side of dysfunction
- Palpate sacral sulcus/base of the sacum w/ cephalad hand, while caudad hand ABducts and IR hip of the affected side
- Place heel of caudad hang on ILA of dysfunctional side, place cephalad hand on top of that hand, exert anterior/superior force on ILA. As pt inhales, continue downward force on ILA to encourage sacral extension. As pt exhales, resist motion of sacrum to prevent flexion.
- Repeat until no new barriers
What is the ME treatment for a Unilateral Sacral Extension?
- Pt is prone w/ physician standing on side of dysfunction
- Palpate sacral sulcus/base of the sacrum w/ cephalad hand, while the caudad hand ABducts and ER hip (gaps anterior aspect of affected SI joint)
- Place hypothenar eminence cephalad on sacral sulcus on side of dysf. Place caudad hand on top of that hand. Exert anterior/inferior force on sacral sulcus. As pt inhales, resist sacral extension. Encourage sacral flexion by exerting an anterior/inferior force on the sacral sulcus during exhalation.
- Repeat this process for 3-5 respiratory cycles
How do we treat a Forward Torsion (L on L or R on R) w/ ME?
- Pt in modified sims position w/ axis side down. Hips and knees are flexed to 90 degrees w/ chest down on th table as much as possible and arms hanging over the table
- Physician at side of table, monitoring at L5-S1 interspace, while flexing hips and knees until motion is felt at monitoring hand
- Pt inhales and exhales deeply 3x, reaching w/ their hand, on side opposite the axis, toward the floor after each exhalation (induces additional rotation)
- Rest pt’s knee on your thigh (if doc seated). Caudad hand grasps pt’s heels to flex or extend hips (rare) until L5 neutral relative to S1
- With caudad hand, lower pt’s legs towards floor by pushing at the feet until reaching sidebending restrictive barrier
- Instruct pt to lift their feet towards ceiling for 3-5 secs, then pt relaxes.
- Move patient into next barrier by pushing feet further towards floor. Repeat ME technique until no new barriers.
How do we treat a Backward Torsion (R on L or L on R) w/ ME?
- Pt at edge of table in lateral recumbent position w/ axis side down. Flex top hip and knee to 90 degrees. Pull pt’s lower arm toward physician to produce posterior rotation so that pt’s back gets closer to table and front faces ceiling.
- Pt takes 2-3 deep breath, after each exhalation have the pt reach back w/ the top arm
- Physician standing facing the pt, monitoring L5-S1 interspace. Place pt’s top foot on doc’s thigh and induce further flexion of top hip and knee until motion is felt at monitoring hand
- Apply gentle force on pt’s knee towards the floor (ADducting top hip), until motion is palpated at L5-S1. Instruct pt to lift knee up against your hand (toward ceiling/into ABduction) for 3-5 secs, then pt relaxes
- Move pt into next barrier by flexing hip and knee more and pushing knee towards the floor. Repeat ME tech. until no new barrier met.
