L19-20: Innominates I-II Flashcards
Articulations at the pelvis
- ) Sacroiliac joint
- ) Pubic symphysis
- ) Femoral heads with acetabulum
How to detect short leg syndrome?
- If after OMM treatment, pt is evaluated in standing position and iliac crests and greater trochanters are both lower on same side, possible patient will need to be evaluated for short leg syndrome
What is a small hemipelvis?
- Pelvis is shorter on one side, very rare. Detected when pts are sitting
Landmarks of pelvis
- Iliac crests
- ASIS
- AIIS
- Pubic symphysis/tubercles
- PSIS
- IT
Name motions of the innominate on the sacrum
- ) Inflare (medial) / outflare (lateral)
- ) Anterior and posterior rotation
- ) Superior and inferior translatory motion
Describe how movement of thigh, causes lumbar spine movement
- Innominate follows thigh, thigh follows innominate
- Innominate follows sacrum, sacrum follows innominate
- Sacrum follows lumbar spine, lumbar spine follows sacrum
- L-spine follows sacrum, which follows innominates, which follows femur
Describe innominate motion during walking cycle
- Right foot out places right innominate in posteriorly rotated position
- Right innominate moves posterior to anterior as right heel strikes ground
- Left foot out places left innominate in posteriorly rotated position
- Left innominate moves posterior to anterior as left heel strikes ground
Describe translatory movement of innominates when standing on each leg
- When on left leg, left innominate is translated superiorly
- When on right leg, right innominate is translated superiorly
Describe innominate motion with respiration
- ) Inhalation: diaphragm moves inferior, L-spine flexes, sacrum extends, outflare of innominates
- ) Exhalation: diaphragm moves superior, L-spine extends, sacrum flexes, inflare of innominates
What conditions could treating the innominates address?
- Pain: LBP, hip pain, knee pain
- Gait problems
- Running problems
- Postural stress in neck, head, knees, feet etc.
Name innominate somatic dysfunctions
- ) Hip musculature strain patterns/tender points
- ) Hip musculature asymmetry in length/tightness
- ) Pubic SDs: compression, shears
- ) Iliosacral SDs: flare, rotations, shears
Tests to diagnose inflared/outflared innominate
- ) Inflared innominate = Standing flexion test + on side with ASIS closest to midline
- ) Outflared innominate = Standing flexion test + on side with ASIS further away from midline
Pt has standing flexion test positive on left side. ASIS on left is further from midline than ASIS on right. What could be wrong with the innominate?
- Outflared left innominate
How to treat an inflared innominate?
- Treat with muscle energy using figure 4 position.
- If inflare on left, place left ankle over left knee. Physician’s hand over right ASIS and left knee. Muscle energy by having pt push against hand on knee, keep traction on ASIS
How to treat an outflared innominate?
- Treat with muscle energy using modified piriformis stretch position. If right outflare, place right hip at 90 degrees, grasp medial right PSIS, other hand on right knee. Physician adducts right femur to barrier (but keep pressure downwards to prevent over rotation of pelvis), maintain lateral traction to PSIS. Muscle energy by having pt abduct.
How to diagnose pubic symphysis somatic dysfunction?
- History: Pelvic pain, groin pain, hip pain or/and LBP
- Physical: Positive standing flexion test, Assume pubic compression (bones closer together than they should be) if there is standing flexion test positive and pt isn’t pregnant, Palpate pubic tubercle on side of + STFT for tissue texture changes and/or tenderness
Treatment for pubic symphysis compressions? What muscles are you using to treat?
1.) Isolytic/isometric technique treats compression (always done, unless pregnant). This may also treat pubic shears
**Not done in pregnant pt
Muscles used: adductors of hip
Treatment for superior pubic shear? What muscles are you using to treat?
- Hang leg that corresponds to pubic bone that is sheared superiorly off table
- Hold ASIS on opposite side to stabilize and have pt use hand to hold themselves on table
- Physician exerts downward force on knee, pt asked to bring knee towards opposite shoulder
Muscles used: adductors of hip
Treatment for inferior pubic shear? What muscles are you using to treat?
- Flex hip that corresponds to pubic bone that is sheared inferiorly. Physician on table sitting. Place hand over SI joint, flex hip until motion felt there. Other hand is cupping the IT, driving it more superiorly til motion is felt
- Pt extends hip – drives leg toward physician – do muscle energy. After relaxation, flex hip and drive IT superiorly – til 4th barrier.
Muscles used: extensors of hip
How to diagnose innominate rotations?
- ) History: LBP, hip pain
- ) Physical (test, landmark, test): STFT+, ASIS position (whether superior or inferior on side of +STFT), ASIS motion test (if ASIS inferior, motion easier inferiorly)
Pt has STFT+ on left, left ASIS is superior and motion of tissue over left ASIS resists anteriorly (goes posteriorly). Diagnosis?
- Posterior rotation of left innominate
For innominate rotations, what are the correlations between ASIS position and tissue motion over ASIS?
- keep vowels together
- Anterior (think moving down and forward) motion goes with inferior position
- Posterior (think moving up and backwards) motion goes with superior position
What could be occurring if ASIS position and tissue motion over ASIS do not correlate?
- Something else, such as upslipped innominate, lumbar sidebending, etc.
How to treat innominate rotations? Muscles used for anterior? For posterior?
- ME for anterior / posterior rotations. Anterior is same as inferiorly sheared pubic bone without hand on and driving IT. Muscles used: extensors of the hip.
- Posterior is same as superiorly sheared pubic bone except direction of isometric contraction is towards same shoulder. Muscles used: flexors of the hip.
- OR HVLA for anterior / posterior rotations. Anterior (leg in air): leg raised 30 degree and slightly abducted. Posterior (leg in plane): slight abduction. Both with dorsiflexion of foot and internal rotation.
