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OMM Year 1 > Exam 1 Spring > Flashcards

Exam 1 Spring Flashcards

1
Q

Inferior innominate shear

A

§side with the POSITIVE standing flexion test.

  • ASIS on affected side is inferior
  • PSIS on affected side is inferior
  • Pubic rami on affected side may be inferior

Ischial tuberosity inferior

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2
Q
A
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3
Q

Seated & Standing Flexion Tests: sacrum & ileum

A

Sacrum-

  • seated FT lower extremities = not influencing SIJ
  • positive test indicates the side (lateralization) but not the specific dysfunction, of sacroiliac dysfunction.

Ilium-

  • during the standing FT the lower extremities = influence SIJ
  • positive test indicates an iliosacral SD, or excessively tight contra-lateral hamstrings.
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4
Q

Joints significant in gait

A
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5
Q
A

-Deep sulcus and post/inf

ILA are opposite so we have

an oblique axis

-The sacrum has rotated

towards the right; L5 rotated to

the left

Dx: R on R sacral torsion

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6
Q

Shuffling gait

A

typ in parkinson’s

pattern:

  • small, flat-foot shuffle (less ground clearance)
    • rigid, temor, pausing mvmts, shuffling with haste,
    • diff: start, stop, turn
  • trucal flex

1st noticable signs: non-rhyth pattern with random/poor timed arm swings

tx: L-dopa

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7
Q

cranial concept of pelvis

A

sacrum connects innominates –> occiput motion

alts affect either side: alters biomech model via dural attachement

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8
Q

Superior Innominate shear

A

§shear-named for the side with the POSITIVE standing flexion test.

  • ASIS on affected side is superior
  • PSIS on affected side is superior
  • Pubic rami on affected side may be superior
  • Ischial tuberosity superior
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9
Q

Ataxic gait

A

reeling, unsteady with wide base: tend to fall towards side of lesion

pattern:

  • irreg steps
  • lateral veering
  • carefully watching ground

most prominent with sudden turns/stop/start

reasons:

  • injury to cerebellum, SC, peripheral sensory NS
  • inpair of joint position sense: afferent fibers disruption in peripheral N/posterior roots/posteiror columns of SC
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10
Q

Spondylolisthesis

A

anterior slippage of vert: usu @ L5 on S1

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11
Q

Low Back Pain Expanded Differential Dx (10)

A

PPP A A COMIC

Prostatitis

Paget’s disease

PID

AAA

Abscess

Ca lesions

Ovarian cysts/CA; endometriosis

Multiple myeloma

Infection

Compression fracture

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12
Q

pubic shear

subjective complaints?

A

caliper: gapping

subjective:

  • UTI symptoms: burning, freq, fullness, weak stream, dysuria, dysparunia (painful sex)
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13
Q

Muscular Action during STANCE Phase

A
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14
Q

most important part of gait

A

flex of stance knee

if knee locked up = E expend up 50%

    • another detm lost = 300% lost
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15
Q

Sacral/Innominate Motions during Gait

A
  1. Weight shift to the left
  2. Posterior rotation of innominate
  3. Rotation of whole pelvis to the left
  4. L/L sacral torsion
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16
Q

Innominate/Iliosacral Rock/ Compression Test

A
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17
Q

Lower Extremity Joints during Gait: Ankle

A

body wt = just medial of center: eversion –> inversion

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18
Q

Forward Sacral Torsions with Gait

A

Left stance leg =

Left on Left torsion

Right stance leg =

Right on Right torsion

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19
Q

Traumatic Sacral SD

A

slip/fall on butt

MVC –> F from “braking” foot –> leg –> pelvis

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20
Q

Anterior SIJ

A

synovial

different orientation than posterior/lig aspect

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21
Q

herniated disc

A

type 2 F SD –> flat lordosis –> shearing stress

rad pain –> butt

  • init disinterpred as SI pain/dysfx

neuro exam important for distinguishing SI pain from disc protrusion

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22
Q

Forward Sacral Somatic Dysfunctions on Oblique Axis

A
  • We have 4 possibilities for forward sacral somatic dysfunctions:
  • Left on Left sacral torsion
  • Left on left sacral rotation
  • Right on Right sacral torsion
  • Right on Right sacral rotation
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23
Q

what does the external oblique form distally?

A

inguinal lig as it txverses ASIS –> pubic tubercle

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24
Q
A
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25
Q

Sacral Torsion Rules

A
  • Rule #1: When L5 is sidebent, a sacral oblique axis is engaged on the SAME side as the sidebending.
  • Rule #2: When L5 is rotated, the sacrum rotates the opposite way on an oblique axis.
  • Rule #3: The seated flexion test is found on the opposite side of the oblique axis.
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26
Q

respir-circ model of pelvis

A

pelvic diaphragm & bone –> interstitial homeostasis

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27
Q

M affecting ilial/pubic motion

A

RAGS

Rectus femoris

Adductors

Gracilis

Sartorius

hypertonia = pubic, ant/med knee pain

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28
Q

posterior SI lig

A

referred pain to hip and groin

connects PSIS –> S3/S4, erector spinae, thoracic/lumbar fascia

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29
Q

6 Determinants of Gait:
4 + 5

A

combined actions of the foot, ankle and knee of the stance leg

smooth pathway:

  • heel strike: ankle form dorsi –> plantar flex (knee @ fulcrum)
  • heel lift: metatarsal P (plantar flex) lifts COG, counteracted by knee flex
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30
Q

Forward Sacral Somatic Dysfunctions on Oblique Axis

A
  • Left rotation of the sacral base on a left oblique axis with L5 rotated right = Left on Left forward sacral torsion
  • Right rotation of the sacral base on a right oblique axis with L5 rotated left = Right on Right forward sacral torsion
  • Naming Rule: we name the direction of sacral rotation 1st followed by the oblique axis. So a left on left sacral torsion means the sacrum has rotated left on a left oblique axis.
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31
Q

intraspinal dura attaches …

A

posterior longitudinal ligament of S2:

integrates cranial base with sacrum

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32
Q

subjective complaints of Inferior Innominate Shear

clincal?

A

pelvic pain with tiss-tex changes @: ipsilat SI jt & pubis

rare –> usu corrected with ambulation

clinical: bungee jumping

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33
Q

Muscular Action during STANCE Phase

A

before heel strike: dorsiflex contract concentrically

after hell strike –> onto foot flat: dorsiflexors contract eccentrically

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34
Q

possible ways to distinguish functional vs. structural leg length issue?

A

functional:

  • ant-innominate rotation with ipsi med-malleolus lower

structural:

  • ant-innominate rotation with ipsi med-malleolus higher
  • ant-innominate rotation without change in leg length
    • innominate resolved but now medial malleolus ipsi higher after OMT
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35
Q

Normal sacral motion during ambulation only involves

A

•anterior motion of the sacrum around these oblique axes

does not move posterior during normal walking cycle

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36
Q

waddling gait

A

roll side to side: penguin walk - pelvic rotation/tilt on swing side = increased

causes:

  • muscular dystrophy
  • weak hips
  • exaggerated lordosis
  • pot-bellied posture
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37
Q

subjective complaints of superior innominate shear

clincal scenario?

A

pelvic pain with tenderness @:

  • ipsi SI jt
  • QL
  • pubic rami/symphysis

Clinical scenario; patient misjudges last step of stairs or curb, landing hard on the ipsilateral foot, creating a superior shear.

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38
Q
A

-Deep sulcus and post/inf

ILA are opposite so we have

an oblique axis

-The sacrum has rotated

towards the right; L5 rotated to

the left

Dx: R on L sacral torsion

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39
Q

Left Unilateral Sacral Flexion OMT

A

pt on stomach

  • abduct/interal rotation lower extremity –> post sacral base
  • respir assistance –> engage barrier with hand
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40
Q

•The seated flexion test will be ________ on the ______side of the deep sulcus in a ________ sacral dysfunction on an oblique axis, _______ the axis

A

positive

same

forward

opposite

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41
Q

Antalgic Gait

A

pain

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42
Q

Left Unilateral Sacral Extension

A

pt on stomach, tv stance

  • abduct/internal-rot LE –> sacral base anterior
  • respir assistance: engage barrier with hand
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43
Q

How to Differentiate Forward vs. Backward Sacral Dysfx

A
  • Seated Flexion Test
  • L5 mechanics: type I for forward; type 2 for backward
  • Spring Test
  • POSITIVE with Backward Sacral dysfx; Will not spring, non-compliant to posterior to anterior spring if sacral base is posterior.
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44
Q

Trendelenburg Test

A

Superior gluteal nerve palsy

  • Fracture neck of femur
  • Dislocation of hip
  • Perthe’s disease: avascular necrosis of head of femur, late stages of TB hip.
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45
Q

Posterior Innominate Rotations

A

named for the side with the POSITIVE standing flexion test

  • PSIS on affected side is inferior
  • ASIS on affected side is superior
  • Pubic tubercle superior on affected side
  • Ischial tuberosity inferior on affected side
  • Motion about an inferior transverse axis
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46
Q

if the sacrum and L5 are rotated in the same direction ….

A

sacral rotation dysfx

tx:

  • MET for sacral torsion
  • L5
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47
Q

Pubic motion

A

Caliper: flex/extend

Torsional: swing-tilt

Supero-inferior: one legged wt-bearing

fib-cartilaginous jt

M forces = rotational about tx axis

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48
Q

ischiorectal fossa

A

•potential space between the inferior pelvic diaphragm and the urogenital diaphragm.

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49
Q

what do we know?

A

-Deep sulcus and post/inf

ILA are opposite so we have

an oblique axis

-The sacrum has rotated

towards the left; L5 rotated to

the left

Dx: L on L sacral rotation

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50
Q

Backward Sacral Rotations and Torsions

A

•Seated flexion test +

  • •contralateral to deep sulcus and oblique axis

•THE SPRING TEST IS POSITIVE !!!

  • oblique axis through the deep sulcus & post/inf ILA

•Sacral sulcus is shallow on dysfunctional side

  • •By convention we consider and label the deep sulcus
  • Posterior and/or inferior ILA
  • L5 follows NON-neutral mechanics
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51
Q

Coccygodynia

A

pain in coccyx usu due to trauma

  • also: infection, disloc, fx

pain = worse: sit/pooping strain/sex

  • can be associated with pelvic diaphragm dysfx
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52
Q

Left on Left Sacral Torsion

A

neutral sacral mechanics (type 1)

  • sit up, sidebend L –> L obliq axis

monitor:

  • right index finger = anterior
  • left thumb = post-/inferiorly.
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53
Q

•Sacralization of L5

A

L5 fused with sacrum

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54
Q

subjective complaints of anterior innominate

A

ipsilat hamstrin tightess (stretch)

sciatica (piriformis)

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55
Q

Unilateral Sacral Extension

A
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56
Q

Alternate Psoas Evaluation

A

pt prone

grab thigh above knee & extend hip: compare bilat

can get “end feel” of motion –> asses for type 2 SD @ L1/L2

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57
Q

Transverse Axes of the Sacrum

A

Superior Transverse Axis

“Respiratory or cranial” axis; associated with the attachment of the dura at S2

  • inhale = base post, exhal = base ant

Middle Transverse Axis

“Postural” axis for flexion/extension spinal motions

  • lumb-ext = base ant, lumb-flex = base post

Inferior Transverse Axis

Anterior/posterior rotation of the innominates on the sacrum around S3 segment.

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58
Q

pelvic girdle pelvic splanchnics

A

arise off ventral rami S2-S4

PNS to L colon & inferior mesenteric plexus

  • mixes with visceral afferent and SNS

PNS visc-som refelx –> subQ swelling in sacral region

if doesn’t improve with tx –> look for imbalance or visceral origin

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59
Q

Spondylolysis

A

stress fx pars interarticularis: collar on scotty dog

common in adole atheles, esp gym with hyperext

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60
Q

Forward Sacral Rotations
around an Oblique Axis with Gait

A
  • Left rotation of the sacral base around the left oblique axis occurs during the swing phase of the right leg.
  • Right rotation of the sacral base around a right axis occurs during the swing phase of the left leg.
  • If a normal, forward sacral rotation gets “stuck” in that position, it becomes a somatic dysfunction.

Most somatic dysfunctions in the sacrum involve forward torsions about an oblique axis.

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61
Q

Pubic Somatic Dysfunction

A

isolated = rare: usually assoc with innominate SD

respond well to ME: adductor M

consider anterior L5 tender pt (anterior rami) – counterstrain

DDx of pelvic congestion

  • pelvic floor muscles vs. adductors vs visceral
  • OB pt secondary to Relaxin.

Dysuria

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62
Q

Patellofemoral pain syndrome

A

altered tib-fem rotation and increase in valgus (knee add) –> pain

  • rearfoot eversion
  • weak hip abductors/external rotators
63
Q

Important Causes of SI Dysfunction (10)

A

PLS PVC PTSD

Psoas/piriformis

Lumbar/sacral SD/instab

Short leg

Pubic & pelvic floor dysfunction

Viscero-somatic reflexes

Cranial SD

postural imbalance (with or without pelvic side shift)

traumatic sacral SD

spinal stenosis/spondylysis or spondylolistheis

Disc protrusions

64
Q

“Failed Low Back Syndrome”

A

“last resort” for LBP

65
Q
  1. A 12-year-old girl presents to the office complaining of left low back pain. She is left leg dominant and passes frequently with her left leg when playing soccer. The standing flexion test is positive on the left. However, you observe an inferior right ASIS and pubic rami and a right superior PSIS. What is her diagnosis?

A.Right outflare

B.Right anterior innominate

C.Right posterior innominate

D.Left posterior innominate

E.Left pubic compression

A

left post innominate

66
Q

Scissors gait

A

legs add, cross alt in front of other

spastic lower limbs and hip jt add M

compensation motions of trunk and upper extremeties

causes:

  • bilat UMN lesions
  • cerebral palsy
  • adv cerv spondylosis
  • MS
67
Q

Hemiplegic gait

A

due to: cva, SC injury

presentation:

  • affected leg = stiff with less flex of hip/knee
  • leg circumducted, body leans away
  • shoe drag
  • arm = fixed: elbow flexed, hand pronated, fist formed with thumb tucked in
68
Q

Sphinx Test

A

positive = worsening of positional asymm = backwards dysfx

negative = forward dyfx

  • deep sulci become even
69
Q

Bilateral Sacral Extension

A
  • Seated flexion test equivocal
  • False negative test.
  • Spring test POSITIVE, (if equivocal use sphinx test).
  • Bilateral shallow sulci
  • B/L inf ILA equal and not posterior
  • L5 not needed
  • There is a decreased lumbar lordosis.
  • Base of sacrum has moved backward, posterior or extended, equally and bilaterally about a middle transverse axis.
70
Q

Rotational motions during STANCE Phase

A

ipsi innominate = posterior @ heel strike –> anterior @ toe-off

71
Q

Nutation

A

“nodding”

sacral base anterior –> sacral flexsion (biomech model)

stopped by sacrotuberous lig

72
Q

Transverse Sacral Axes

A
  1. Superior Axis
  • Respiratory
  • Cranial-sacral
  1. Middle Axis
    * Postural or Sacroiliac
  2. Inferior Axis
    * Iliosacral (Innominate rotation on sacrum)
73
Q

Diagnosing the Pelvis for Somatic Dysfunctions

A

never assume LBP/pelvic pain purely musc-skel

  • visc or emotional origin
  • sex hx

OPQRST

74
Q

Lower Extremity Joints during Gait:
Hip

A

initial contact: hip flex, thigh @ 20-25 degrees

rotation:

  • planted: medial rotation
  • free: lateral rotation –> keeps foot parallel to line of mvmt
75
Q

subjective complaints of posterior innominate

A

inguinal/groin pain (rectus femoris)

medial knee pain (sartorius)

76
Q

biochem model of pelvis

A

most commonly used

pelvis links truck with limbs for ambulation

sacrum supports v-column

dysfx = superior –> inferior

77
Q

An evaluation of the sacrum should include an assessment of key associated areas of potential somatic dysfunction, including…

A

cranial base

upper cerv-spine

anterior/posterior ab wall

respir diaphragm

78
Q

OMT for Coccygodynia

A

rectal exam –> localize pain

jt mobil with intra-rectal tech

muyofasical pelvic diagphragm

CS –> SI tenderpts: caudad/medial to PSIS on posterior surf of sacrum

79
Q

Mitchell Model

A

ME to sacral SD

80
Q

sacroiliac jt

A

innominate articulates posteriorly with sacrum @ SI jt

kidney shaped

convex ventrally (anteriorly)

diarthrodial: synovial fl –> great variability

81
Q

Standing Flexion Test

A

iliosacral

  • eye lvl with PSIS
  • thumb that moves farthest is restriction side

postiive –> SIDE of SD: lateralization

82
Q

High Steppage Gait

A

1st pattern

  • toe touches first: paralysis pretib/fib M –> slapping noise with foot after
  • leg raised high: abnorm knee/hip flex

2nd pattern:

  • heel touches first: loss of position –> stomp
  • bilat: ataxia, side-to-side reeling
  • romberg’s sign - dysfx afferent of peripheral N/posterior roots
83
Q

Psoas muscle

A

lumb-spine –> lesser troch

major hip flexor

sparms = flat lumbar lordosis (type II SD @ L1/L2), sacral rot @ oblique axis, pelvic shift

hyperton: sitting-like motions (excessive flexing)

84
Q

•Dx = R on R sacral torsion technique

A

ME:

  • L5 rot R, sacral base post, hip flex
  • pt contract L QL aga resistance –> reciprocal inhib R QL –> R QL relax
  • moniter: L/S jxn –> F mobilizing L5/S1 articulation
85
Q

sacrotub lig attachment for:

A
  • long head bicep femoris
  • piriformis
  • glut-max
86
Q

Subjective complaints of innominate flare

A

pelvic & SI pain

increased M lax on outflared side

inflare –> internal rotation, anterior iliac

outflare –> external rotation, posterior iliac

87
Q

Musculoskeletal Gait Patterns

Gluteus medius lurch

Psoas gait

glut max/extensor lurch

A

Gluteus medius lurch - waddle side to side

Psoas gait - leans over

glut max/extensor lurch - leans backwards

88
Q

Standing

A
  • Width of the base (heel to heel) = 2-4”
  • Feet - slight lateral rotation
  • Only a few muscles usually active

–Erector Spinae

–Triceps surae

–Iliopsoas

  • Forward sway
  • Lateral sway
89
Q

6 Determinants of Gait –
6

A

Minimizing lateral displacement of the Center of Gravity (COG)

stable gait = shift of COG to wt-bearing leg

add of hip & tib-fem angle = reduces lateral displace for balance

90
Q

Swing phase in the pelvis…

A

glut-med contraction –> pulls opp side pelvis fwd @ same time of free limb swing

91
Q

innominate dx: medial malleolus

A

leg length

careful: congeintal short leg/fasical torsions of lower-extrem –> cause leg lengths to appear normal

92
Q

Seated Flexion Test:
Lateralizing Special Test

A
  • Positive test indicates a sacro-ilial somatic dysfunction.
  • It distinguishes the side of dysfunction with the dysfunctional side moving furthest.
  • In the seated position the ilia are initially “locked” in place by the ischial tuberosities.
  • As the patient bends forward the restricted sacral side brings the ipsilateral PSIS and ilium “further” then the contralateral side.
93
Q

pelvis lig: true and accessory

A

true:

  • Anterior sacroilliac ligaments
  • Interosseous sacroiliac ligaments
  • Posterior sacroiliac ligaments

accessory:

  • Sacrotuberous
  • Sacrospinous
  • Iliolumbar
94
Q

Piriformis Muscle

A

arterior sacrum –> greater trochanter

fx:

  • ext-rot of hip
  • int-rot if hip flex to 90

hyperton = ext-rot LE, SI dysfx, LBP, butt pain

95
Q

If one sacral sulci deeper

A

can mean sacrum is rotated to opposite side on oblique axis.

ILA Palpation: check for ILA that is

more posterior and/or inferior = OBLIQUE AXIS DYSFUNCTION!

96
Q

Oblique Axes of the Sacrum

A

named for superior pole of sacrum they pass thru

gait

  • left stance leg/right swing: L oblique axis –> sacral base moves anterior on R, ILA moves post/inf on L
97
Q

Check L5 Transverse Processes for Rotation

A
  • This differentiates sacral rotation from sacral torsions.
  • If sacrum is rotated opposite to L5 then you have a torsion.
  • If sacrum is rotated in the same direction as L5 then you have a rotation.
98
Q

sacral development

A

5 segments:

lateral –> body: 2 years

sacral seg sep by IV disc until 25-30

99
Q

Multifidus muscle trigger points

can refer pain to

A

lower abdomen

and groin.

100
Q

Backwards Sacral Dysfunction

A
  • In this situation, the sacral base has moved posteriorly up the short arm of the SIJ o the side of the oblique axis.
  • The anterior part of the sacrum is facing left, although it’s from the left part of the sacral base moving posteriorly.
  • This is associated with a Type 2 L5 somatic dysfunction, and is commonly caused by a flexion and sidebending type of injury to the L/S junction that drives the sacral base posteriorly.
101
Q

Rotational motions during Swing phase

A

pelvis = 4 degrees to stance side with spine = swing side: go opposite directions

102
Q

QUADRICEPS and gait

A

before heel strike: concentrically

after heel strike –> foot flat: eccentrically

foot flat –> mid-stance: concentric: contraction of knee extensors to absorb shor and keep knee from buckling until it reaches full extension

103
Q

Counternutation

A

sacral base moves posteriorly

Motion is checked by posterior SI ligaments

104
Q

Naming Backwards Sacral Dysfunction on an Oblique Axis

A
  • Right on Left Sacral Torsion
  • Left on Right Sacral Torsion
  • Right on Left Sacral Rotation
  • Left on Right Sacral Rotation
  • “L”s and “R”s go together for forward sacral dysfx
  • “L”s and “R”s are opposite for backward sacral dysfx
105
Q

Q – angle

A

angle b/w femur and tibia

increased in women: wider hips

106
Q

•Dx = L on R sacral torsion

A

ME:

  • L5 rot L, lower leg extended = sacral base anterior
  • pt contract L QL –> R QL recip-inhib
107
Q

Sacral Mechanics Rule: torsion

A

torsion:

  • oblique axis = same side as L5 SB
108
Q

seated flexion test

A
  • Patient is seated with feet on floor.
  • D.O. monitors PSISs as patient

bends forward

  • Positive test if one PSIS moves further
  • Positive test = side of SIJ dysfunction
  • OR-

= if oblique axis dysfunction,

will be positive on side opposite oblique axis

109
Q
A

Thomas Test- psoas spasm

increased distance b/w knee and table = positive

110
Q

Patient with LBP

A

never assume purely musc-skel

111
Q

Swing Phase – Mid-swing

A

mostly momentum

knee extension added

112
Q

axes of sacrum

A
  1. Superior transverse axis
  2. Middle transverse axis
  3. Inferior transverse axis
  4. Left oblique axis
  5. Right oblique axis
113
Q

Forward Sacral Somatic Dysfunctions on Oblique Axis

A
  • Left rotation of the sacral base on a left oblique axis with L5 rotated left = Left on Left forward sacral rotation
  • Right rotation of the sacral base on a right oblique axis with L5 rotated right = Right on Right forward sacral rotation
  • Biomechanical Rule: If the sacrum and L5 rotate in the same direction we name the somatic dysfunction as a sacral rotation.

•

114
Q
  1. A 23-year-old male presents to the office complaining of low back and right posterior thigh pain. The pain started after he drove home from College in Ohio. You diagnose a right anterior innominate. What are your findings and which muscle may be contributing to his pain?

A.Right positive Seated Flexion Test, left PSIS high, right ASIS high and right pubic rami high and piriformis.

B.Right positive Seated Flexion Test, right PSIS high, right ASIS high and right pubic rami high and quadratus lumborum.

C.Left positive Standing Flexion Test, right PSIS high, right ASIS high and right pubic rami high and quadratus lumborum.

D.Right positive Standing Flexion Test, right PSIS high, right ASIS low and right pubic rami low and hamstring.

E.Right positive Standing Flexion Test, left PSIS high, right ASIS high and right pubic rami high and hamstring.

A

A.Right positive Standing Flexion Test, right PSIS high, right ASIS low and right pubic rami low and hamstring.

115
Q

quadatus femoris hypertonicity refers to…

A

hip

116
Q

Inversion ankle sprain

A

Predisposing factors:

  1. Longer total foot contact time (more time in stance phase)
  2. More laterally directed pressure (causing inversion)

Findings after LAS (ligament ankle sprain):

  1. later inversion (prolonged pronation - eversion)
  2. Metatarsophalangeal joint extension ROM greater
117
Q

Sacro-ilitis (Ankylosing Spondylitis)

A

inflam SIJ: bilat

negative for rheumatoid factor

genetic: HLA-B27
males: disease moves up spine, female = begin anywhere without pattern

bamboo spine (fusion) as disease progresses - the outer fibers of annulous fibrosis ossify and the vertebra become more square

118
Q

Right on Left Sacral Torsion

A

backwards sacral torsion

  • patient flex trunk fwd (type II @ L5) , sidebend left –> L obliq axis

monitor

  • right ILA = post-/inferiorly.
119
Q

With unilateral flexion or extension the seated flexion test is _______ on the side which is “stuck” in flexion or extension

A

positive

SD: side of positive seated flexion

120
Q

•Lumbarization of S1

A

S1 detached from sacral base

121
Q

eccentric versus concentric

A

concentric = shortening of M

eccentric = lengthening of M

122
Q

Lumbosacral Instability

A

spondylo-lysis/listhesis, congenital abnorm, spinral stenosis

  • hypomobile side: pain only with opp hypermob –> congestion
    • ex: L SIJ hypo = R SIJ pain but not R SD
    • mob painful SIJ –> not relieve pain

closure of SIJ: M inbalace of LE and thoracolumbar

  • iliolumbar lig = tender
    • sacral base unlvl
    • innominate dysfx: pelvic side shift
    • lower lumbar som dysfx
123
Q

Sacrum-

A

•keystone of the pelvic arch transmitting body weight down into the legs via the acetabulum.

124
Q

The primary muscles of the pelvis

A

intrinsic muscles of the pelvic diaphragm.

levator ani (iliococcygeus, pubococcygeus, puborectalis)

coccygeus muscles

125
Q

Short Leg Syndrome or Postural Imbalance

A

compensation: convex @ side of low sacral base

SI discomfort, exacerbated by walk/run with TTC & tenderness

pattern:

  • short: fwd torsion (anterior), deep sacral sulcus, anterior innominate rot
    • upper sacrum slides down upper SIJ –> attempt to lengthen
  • long: pelvic shift
126
Q

What do we know?

A

What do we know?

-Deep sulcus and post/inf

ILA are opposite so we have

an oblique axis

-The sacrum has rotated

towards the left; L5 to the right

-Torsion

Dx: L on L sacral torsion

127
Q

Reflex Causes of SI Dysfunction

A

PNS pregang in lateral horn S2-S4

128
Q

L5 and Sacral Diagnosis

A

Physiological Sacral Diagnosis: L on L or R on R

  • L5 follows neutral mechanics type 1 ex. L5NSLRR.
  • THE LEFT SIDEBENDING AT L5 WILL INDUCE THE AXIS OF MOTION FOR THE SACRUM HENCE A LEFT AXIS.
  • (L ROTATION ON L AXIS)

NON-PYSIOLOGICAL SACRAL DIAGNOSIS: L ON R OR R ON L

  • L5 follows non-neutral mechanics type 2 ex. L5FSLRL
  • side bending will induce the left axis of motion for the sacrum.
  • (Right rotation on a Left axis.)
129
Q

Pubic Symphysis-Gapping

A

child birth

fx/trauma

degree can be seen on radiograph

tx:

  • SI jt
  • core M
  • SI belt
130
Q

Lower Extremity Joints during Gait:
Knee

A

terminal swing: quad straighten leg for heel strike

initial ontact: knee flexed 5 deg (vastuses, rec-fem not involved), IT band for stab

131
Q

torsion

A

sacrum rotating opposite of L5

type 1 mechanics

132
Q

Bilateral Sacral Flexion

A
  • Seated flexion test equivocal
  • A false negative test
  • Spring test negative
  • Bilateral deep sulci
  • Post/inf ILA equal (posterior)
  • L5 not needed
  • There is an increased lumbar lordosis
  • Base of sacrum has moved anterior, equally and bilaterally about a middle transverse axis.
133
Q

6 Determinants of Gait: 1-3

A

GOAL: reduce vertical displacement

  1. Pelvic Rotation: post –> ant = enlong leg
  2. Downward pelvic tilt
  3. Knee flexion of the STANCE leg (error in DSD)

first- pelvic rotation – elevates the extremities of the arc

second and third – pelvic tilt and knee flexion – depress its summit.

134
Q

pelvis functionally consists of

A

–the left innominate

–the right innominate

–the sacrum

135
Q

Swing Phase - Acceleration

A

knee flexes simul due to momentum –> dorsiflex ankle –> shortens free limb

136
Q

center of gravity

A

smooth undulating - low amplitude

anterior to 2nd sacral vert - 1.8 in vert displacement, 1.75 in horizaontal displacement

highest @ 25% and 75% gait cycle, midpt = lowest (dbl-wt-bearing)

137
Q

Leg length & Innominate Rotation

A

post-innominate = short leg

ant-innominate = long leg

structural short leg –> body compensates ipsi via anterior innominate rotation to lengthen

138
Q

Unilateral Sacral Flexion

A

seated flexion test is positive on the same side which is “stuck” in flexion

139
Q

Patients with pelvic diaphragm restrictions or dysfunctions may present with…

A

LBP

UTI

dysmenorrhea

dyspareunia (painful sex)

constipation

hemorrhoids

140
Q

Backwards Sacral Torsion: M affected

A

QL and piriformis on same

side become hypertonic

and dysfunctional

141
Q

what do we know?

A

-Deep sulcus and post/inf

ILA are opposite so we have

an oblique axis

-The sacrum has rotated

towards the left; L5 to the right

-Torsion

Dx: L on R sacral torsion

L5 FRrSr because backwards dysfx

follows type 2 mechanics

142
Q

subtalar jt

A

proper fx = critical to efficient gait

2/3 eversion (pronation) –> 1/3 inversion (inversion)

motion @ jt = 5-7 degrees: cavus = 3-4, flat = 16

143
Q

who does pubic dysfx be a source of pelvic floor tension?

A

restriction of UG diaphragm –> UG fx –> congestion of prostate/uterus

144
Q

tight hamstring leads to…

A

sacral base unleveling and posterior innominate

145
Q

Introduction to Gait

A
  • Average step length = 15”
  • Cadence of 90-120 steps per minute
146
Q

Psoas Syndrome

A

type 2 SD F L1/L2

  • ipsi lumbar SB, contralat rot

sacral SD = same side as SB

pelvic shift, piriformis, sciatic irritation = opp of spasm

chronic: fwd sacral torsion –> engage oliq axis with lumbar SB
acute: L1/L2 F, L5 E (type 2) –> bwd sacral torsion

147
Q

Muscular Action during SWING Phase

A
148
Q

Floor contact as foot progresses: gait

A
149
Q

Anterior Innominate Rotation

A

named for side with POSITIVE standing flex test

  • ASIS on affected side is Inferior
  • PSIS on affected side is Superior
  • Pubic tubercle inferior on affected side
  • Ischial tuberosity superior
  • Motion about an inferior transverse axis
150
Q

Innominate Flares

A

flare = ASIS more medial on one side vs other

measure from xyphoid/umbilicus –> each ASIS

named for side of postiive standing flex test

151
Q

why are strong pelvic ligaments are needed?

A

balance pelvis during wt-brear

without:

  • base = tip forward –> stress –> lumb/sac imbalance –> low bavk pain/ jt degen
152
Q

•Organic causes of psoas hypertonicity

A

FAD CUPS

  • Femoral bursitis
  • Arthritis of the hip
  • Diverticulosis*

Cancer of the descending or sigmoid colon

Ureteral calculi*

Prostatitis*

Salpingitis*

153
Q

Spring Test

A

spring lumbo-sac jxn with hell of hand

ease = NEGATIVE

resistance = POSITIVE - bwkwards sacral dyfx

154
Q

Swing Phase Deceleration

A

quad contract –> extension for desired length & pos of foot for hell strike

extensors of hip/flex of knee –> contract eccentrically @ end of swing phase –> decel fwd mvmt

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