Innominate Treatment (Test 1) Flashcards
Muscle Energy
Inflate of Innominate
- Pt supine- doc stands opposite the dysfunction.
- Patient’s hip and knee are flexed and their foot is placed on the
lateral side of the opposite knee.
- The doc places their cephalad hand on the pt’s ASIS (opposite
side of dysfunction) and their caudal hand is placed on the pt’s
knee.
- Pt’s hip is abducted/externally rotated (FABER position) until a
restrictive barrier is reached.
- Doc instructs the pt to adduct/internally rotate their hip, by pushing their knee into the docs hand while the doc provides equal counterforce for 3-5 secs. The pt is instructed to relax and a new restrictive barrier is engaged. This is performed until no new barriers are met.
Muscle Energy
Out flare of Innominate
- Pt supine. Doc stands opposite the dysfunction.
- Pt’s hip and knee are flexed to 90 degrees. The foot on the
treatment side is placed lateral to the opposite knee.
- The doc places their cephalad hand on the pt’s ASIS (side of
dysfunction) and their caudal hand is placed on the pt’s lateral
knee.
- Pt’s hip is adducted/internally rotated until a restrictive barrier
is reached.
- The pt is instructed to abduct/externally rotate the flexed hip while the doc provides equal counterforce for 3-5 secs. The pt is instructed to relax and the doc engages a new restrictive barrier. This is performed until no new barriers are met.
Muscle Energy
Superior Innominate Shear
- Pt supine with feet off the end of the table.
- Doc stands at foot of the table and grasps the pt’s tibia and
fibula above the ankle. The doc internally rotates and abducts
the pt’s leg.
- Doc leans back to maintain axial traction and instructs the
patient to pull ipsilateral hip toward ipsilateral shoulder for 3-5 secs. The pt is instructed to relax and the doc engages a new restrictive barrier. This is performed until no new barriers are met.
Muscle Energy
Inferior Innominate Shear
- Pt lateral recumbent with dysfunctional side up. Doc sitting on the table behind the pt.
- Doc grasps pt’s ASIS and PSIS on the dysfunctional side. Doc provides a lateral distraction to gap the SI joint, followed by a cephalad force.
- The pt is instructed to inhale and exhale. The doc maintains cephalad force during inspiration and during exhalation the doc increases cephalad force. This is continued until no new barriers are met.
Muscle Energy
Anterior Innominate Rotation
1) Supine Technique:
- Doc standing on side of dysfunction facing the patient.
- Doc passively flexes the pts hip and knee until a restrictive
barrier is reached.
- Pt is instructed to push their knee into the docs hand while the
doc provides an equal counterforce for 3-5 seconds.
- The pt is instructed to relax and the doc flexes the pt’s hip until
a new restrictive barrier is reached. Continue until no new
barriers are met.
- Modification: have the pt fully extend their knee and flex
their leg at the hip.
2) Prone Technique: (Optional)
- Pt prone so the dysfunctional innominate is off the table.
- Doc stands on side of dysfunction facing the pt’s pelvis.
- Doc places one hand on the pt’s sacrum and pelvis to stabilize
them, and uses the other hand to place the pt’s foot against their
thigh.
- Doc flexes the pt’s hip until a restrictive barrier is reached.
- The pt is instructed to push their foot into the doc’s leg while the
doc provides an equal counterforce for 3-5 seconds. The pt is instructed to relax and the doc engages a new barrier. This is performed until no new barriers are met.
Muscle Energy
Posterior Innominate Rotation
1) Supine Technique:
- Pt lies near the side of table so the sacroiliac joint is off the
table. Doc stands on the side of dysfunction, facing pt’s feet
- Doc places cephalad hand over the patient’s opposite ASIS
and uses their caudal hand extends the pt’s hip until a
restrictive barrier is reached.
- Pt is instructed to push their leg towards the ceiling while
the doc provides equal counterforce for 3-5 secs.
- The pt is instructed to relax and the doc flexes the pt’s hip until a new restrictive barrier is reached. Continue until no
new barriers are met.
2) Prone Technique: (optional)
- Doc stands on the opposite side of the dysfunction with cephalad hand on the pts opposite PSIS.
- With caudal hand, doc passively extends the pt’s hip until a restrictive barrier is reached.
- The pt is instructed to pull their leg down towards the table while the doc provides equal counterforce for 3-5 secs.
- The pt is instructed to relax and the doc flexes the pt’s hip until a new restrictive barrier is reached. Continue until no new barriers are met.
Muscle Energy
Pubic Restrictions
These treatments are done in an alternating fashion to treat both a fixed compression and fixed gapping of pubic symphysis
1) Fixed COMPRESSION:
- Pt supine. Doc stands on either side of table.
- Pt’s hips are flexed to 45 degrees and knees are flexed to 90 degrees with feet flat on table.
Doc abducts the pt’s knees and places forearm between pt’s
knees.
- Pt is instructed to pull both knees medially (adductions of hips)
against the docs elbow and palm while the doc provides equal
counterforce for 3-5 seconds. The pt is instructed to relax.
2) Fixed GAPPING of pubic symphysis:
- Pt supine. Doc either side of table.
- Pt’s hips are flexed to 45 degrees and knees flexed to 90 degrees
with feet flat on table
- The knee closest to the doc is placed on their abdomen while
grasping the lateral aspect of the other knee with both hands.
- Pt is instructed to abduct their knees while the doc provides
equal counterforce for 3-5 seconds. The pt is instructed to relax.
**After one cycle of treatment, the each barrier is further engages and step repeated until no new barriers are met.
HVLA
Superior Innominate Shear
- Pt supine with feet off the end of the table.
- Doc stands at foot of the table and grasps the pt’s tibia and
fibula above the ankle. The doc internally rotates and abducts the pt’s leg. (This close packs the joint to allow the LE to be a lever to work upon the innominate)
- Doc leans back to maintain axial traction and instructs the pt to inhale and exhale slowly 2-3 cycles, gently increasing axial traction on each exhalation.
- Doc then applies an axial “leg tug” thrust to the lower extremity.
- This treatment can also be added at the end of performing ME for dysfunction.
HVLA
Inferior Innominate Shear
- Pt lateral recumbent with dysfunctional side up. Doc sitting on the table behind the pt.
- Doc grasps pt’s ASIS and PSIS on the dysfunctional side. Doc provides a lateral distraction to gap the SI joint, followed by a cephalad force.
- The pt is instructed to inhale and exhale slowly for 2-3 cycles.
- Doc maintains cephalad force during inspiration and during
exhalation the doc increases cephalad force.
- After 2-3 cycles of respiration, doc applies a cephalad force
through the ASIS and PSIS contacts.
HVLA
Anterior Innominate Rotation
- Pt lateral recumbent. Dysfunction side up. Doc standing at side of table facing pt.
- Pt’s hips and knees are flexed until motion is palpated at L5/S1 interspace. Pt’s top leg is dropped off side of table. The pt’s foot should not touch the floor.
- Doc places caudal forearm in a line between the pt’s PSIS and trochanter and their cephalad hand on the pts top shoulder.
- Doc induces axial rotation by pushing the shoulder posteriorly
and rolling the pelvis anteriorly until barrier is engaged.
- Pt is instructed to inhale and exhale. On exhalation the doc
provides a thrust along the shaft of the femur.
HVLA
Posterior Innominate Rotation
- Pt lateral recumbent, dysfunctional side up. Doc at side of table facing pt.
- Doc places cephalad hand at L5/S1 and uses caudal hand to flex pts hips and knees until motion is felt at monitoring hand. Pt is instructed to straighten bottom leg and hook the top foot in the popliteal fossa of bottom leg.
- Doc places cephalad hand on pt’s elbow and rests forearm on their shoulder.
- Doc places hypothenar eminence of caudal hand on PSIS or places caudal forearm on PSIS and posterior iliac crest
- Doc induces an axial rotation by pushing the pt’s top shoulder posteriorly and rolling the pelvis anteriorly until barrier is engaged.
- Pt is instructed to inhale and exhale, upon exhalation the doc provides a thrust towards the pt’s umbilicus (inducing anterior rotation).
HVLA
Pubic Restrictions
- Perform ME for pubic restriction alternating the two techniques until no new barriers are met.
- Doc then gradually increases abduction of both hips simultaneously (frog leg posture).
- Doc instructs the pt to inhale and exhale and applies a thrust toward abduction at end of exhalation.
