Innominates and Sacral Diagnosis Review and BLT treatments Lab Flashcards
Steps of Balanced Ligamentous Tension
1) position segment in an indirect manner
2) utilize activating force: inherent respiration
- breathing phase with greatest ease
- instruct patient to hold until “air hunger”
3) return to neutral and re-evaluate
BLT: Left Posterior Rotated Innominate
1) patient seated, physician hands on distal tibias
2) Indirectly localize: slowly PUSH UP (ease direction) on ipsilateral leg and simultaneously PULL DOWN on contralateral leg
3) attain balance point
4) instruct pt to rotate trunk towards IPSILATERAL side until ipsilateral leg begins to draw upward with motion
5) attain new balance point
6) instruct patient to inhale deeply and hold for 5-10 seconds
7) release position and reassess
BLT: Right Anterior Rotated Innominate
1) patient seated, physician places hands on distal tibias
2) Indirectly localize: slowly PULL DOWN (ease of motion) on ipsilateral leg and simultaneously PUSH UP on contralateral leg
3) attain balance point
4) instruct pt to rotate trunk towards CONTRALATERAL side until contralateral leg begins to draw upward with motion
5) attain new balance point
6) instruct pt to inhale deeply and hold for 5-10 seconds
7) release position and reassess
How do the left posterior rotated innominate treatment position and right anterior rotated innominate treatment compare?
they are the same
What axis does the sacrum flex and extend on?
transverse axis, sagittal plane
What axis does the sacrum rotate around?
oblique axis, horizontal plane
vertical axis tilted
What will a sacrum stuck in extension look like?
shallow sacral sulcus \+ LS \+ sphinx unilateral extension bilateral extension backward torsion (R/L or L/R)
What will a sacrum stuck in flexion look like?
unilateral flexion
bilateral flexion
forward torsion (R/R or L/L)
What are the motion tests?
- seated flexion test (feet on the floor)
- respiratory motion (active)
- BBT/sphinx test (active)
- lumbar spring (passive)
Which landmarks do you assess for sacral Dx?
L5
Sacral sulcus
ILA
sacral rock test/oblique axis (passive)
What is indicated by an inhalation preference?
sacral extension
What is indicated by an exhalation preference?
sacral flexion
Describe BBT/sphinx test
- pt actively extends lumbar and flexes sacrum
- positive test when sacral bases become more uneven; sacrum prefers extension
Describe lumbar spring test
- pushes lumbar into extension and sacrum into flexion
- positive test when there is resistance to springing; sacrum prefers extension
Describe Oblique Axis Spring
- will have clear preference of rotation motion around an axis
- forward torsion: sacrum rotates to pressure on sacral base
- backward torsion: sacrum rotates to pressure on ILA
Dx: Left Rotation on Left Axis (Forward Torsion)
Lateralization: right side +
Motion testing: flexed
Sacral Sulcus: right deep
ILA: left ILA posterior/inferior
Dx: Right Rotation on Right Axis (Forward Torsion)
Lateralization: left side +
Motion testing: flexed
Sacral Sulcus: left deep
ILA: right ILA posterior/inferior
Dx: Left Rotation on Right Axis (Backward Torsion)
Lateralization: left side +
Motion testing: extended
Sacral Sulcus: left shallow
ILA: right ILA anterior/superior
Dx: Right Rotation on Left Axis (Backward Torsion)
Lateralization: right side +
Motion testing: extended
Sacral Sulcus: right shallow
ILA: left ILA anterior/superior
Dx: Unilateral Flexion (Right)
Lateralization: right +
Motion: flexed
SS: right deep
ILA: right ILA posterior/inferior
Dx: Unilateral Extension (Right)
Lateralization: right +
Motion: extended
SS: right shallow
ILA: right ILA anterior/superior
Dx: Bilateral Flexion
Lateralization: false negative
Motion: flexed
SS: bilateral deep
ILA: bilateral posterior/inferior
Dx: Bilateral Extension
Lateralization: false negative
Motion: extended (false negative on BBT)
SS: bilateral shallow
ILA: bilateral anterior/superior
Lumbar flexion indicates…
sacral extension
Lumbar rotation left indicates…
sacral rotation right
Lumbar sidebend left indicates…
engage sacral left oblique
External rotation of legs gaps…
anterior SI joint, encourages flexion
Internal rotation of legs gaps…
posterior SI joint, encourages extension
Sacral Mechanics for sacral extension SD
Sacral Base shallow (extended) Sacral ILA anterior/superior Direct Barrier: sacral flexion -push base deep (flexed) -move ILA posterior/inferior -lumbar extended (TV position) -legs externally rotated (gap anterior SI)
Sacral Mechanics for sacral flexion SD
Sacral Base deep (flexed) Sacral ILA posterior/inferior Direct Barrier: sacral extension -push base anterior/superior -move ILA anterior/superior -lumbar flexed (supine) -legs internally rotated (gap posterior SI)
Dx: Left rotation on left oblique axis
Sacral Base: flexed
Rotation: left
Axis: left
Treatment: sacral base extended, rotation right, axis left
Torsion Treatment Understanding: L/L diagnosis
Flexion/Extension: sacral sulcus flexed (deep), direct barrier extended, flex lumbar
Rotation: rotated left, direct barrier rotate right, rotate lumbar left
Oblique: left axis, direct barrier left axis, side bend lumbar left
L5 N Rr Sl compensates for L/L
Torsion Treatment Understanding: L/R diagnosis
Flexion/Extension: sacral sulcus extended, direct barrier flexed, extend lumbar
Rotation: rotated left, direct barrier rotate right, rotate lumbar left
Oblique: right axis, direct barrier right axis, side bend lumbar right
L5 F/E Rr Sr compensating for L/R
Sacral BLT Techniques
- traditionally done in supine position
- have pt flex knees then roll toward physician
- place hand on sacrum or on ipsilateral side
Bilateral Sacral Extension BLT
1) use caudal palm to lift both sacral ILAs anterior to point of ligamentous balance
2) use cephalad hand to gap SI joint
3) pt instructed to take deep breath and hold; physician makes minor adjustments to maintain balance
4) repeated until best motion obtained (3x)
Bilateral Sacral Flexion BLT
1) use caudal hand to lift both sacral bases anterior to point of balance
2) use cephalad hand to extend L5, encouraging sacral flexion
3) pt instructed to take deep breath and hold it; physician makes minor adjustment to maintain balance
4) repeat (3x)
L/L BLT
1) physician seated on ipsilateral side as rotation
2) caudal hand use fingers to apply anterior pressure to the right sacral base to the point of balance
3) cephalad hand bridges the ASIS’s to gap SI joints or assist caudal hand pushing sacral base anterior or L5 extension
4) respiratory phases are tested and pt instructed to hold breath
5) repeat
R/L BLT
1) physician seated on ipsilateral side as rotation
2) use palm of caudal hand to apply anterior pressure to the left ILA to the point of balance
3) cephalad hand bridges ASIS to gap SI joints or assist caudal hand by flexing L5
4) respiratory phase
5) repeat
