Lab 4: Innominate Treatments Only

Question 1

Anterior Innominate Rotation

Supine Technique

Answer 1

Position:

• Patient supine.
• Physician standing on side of dysfunction.

Procedure:

1. Physician passively flexes the patient’s hip and knee until a restrictive barrier is reached.
2. Patient is instructed to push their knee into the physician’s hand while the physician provides an equal counterforce for 3-5 seconds. The patient is instructed to relax and the physician flexes the patient’s hip until a new restrictive barrier is reached. Continue until no new barriers are met.
3. Reassess
4. Modification: have the patient fully extend their knee and flex their leg at the hip.

Question 2

Anterior Innominate Rotation

Prone Technique

Answer 2

Position:

• Patient prone with dysfunctional innominate off the table.
• Physician stands on side of dysfunction.

Procedure:

1. Physician places one hand on the patient’s sacrum and pelvis to stabilize, and uses the other hand to place the patient’s foot against their thigh. Physician passively flexes the patient’s hip until a restrictive barrier is reached. Apply principles of muscle energy.
2. Reasses

Question 3

Posterior Innominate Rotation

Supine Technique

Answer 3

Position:

• Patient supine, lying near the side of table so the SI joint is off the table.
• Physician stands on the side of dysfunction.

Procedure:

1. Physician places cephalad hand over the patient’s contralateral ASIS and uses their caudal hand to extend the patient’s ipsilateral hip off the table until a restrictive barrier is reached.
2. Patient is instructed to push their leg toward the ceiling while the physician provides equal counterforce for 3-5 seconds. The patient is instructed to relax and the physician extends the patient’s hip until a new restrictive barrier is reached. Continue until no new barriers are met.
3. Reassess

Question 4

Posterior Innominate Rotation

Prone Technique

Answer 4

Position:

• Patient prone.
• Physician stands on either side of the dysfunction

Procedure:

1. Physician places cephalad hand on the patient’s PSIS on the dysfunctional side. With caudal hand, physician passively extends the patient’s hip until a restrictive barrier is reached. Apply principles of muscle energy.
2. Reasses

Question 5

Superior Innominate Shear

Answer 5

Position:

• Patient supine with feet off the end of the table.
• Physician stands at foot of the table.

Procedure:

1. Physician grasps the patient’s tibia and fibula above the ankle. The physician internally rotates and abducts the patient’s leg to gap the SI joint.
2. Physician leans back to maintain axial traction and instructs the patient to pull ipsilateral hip toward ipsilateral shoulder for 3-5 seconds. The patient is instructed to relax and the physician provides more traction until a new restrictive barrier is reached. Continue until no new barriers are met.
3. Reassess
4. Modification: May also use respiration. Maintain force on inhalation and increase force on exhalation.

Question 6

Inferior Innominate Shear

Answer 6

Position:

• Patient supine with feet off the end of the table.
• Physician stands at foot of the table.

Procedure:

1. Physician grasps the patient’s tibia and fibula above the ankle. The physician internally rotates and abducts the patient’s leg to gap the SI joint. The patient’s ipsilateral foot is placed on the physician’s thigh.
2. Physician provides cephalad compression of the foot toward the ipsilateral hip. The patient is instructed to push their foot into the physician’s leg for 3-5 seconds. The patient is instructed to relax and the physician provides more compression until a new restrictive barrier is reached. Continue until no new barriers are met.
3. Reassess

Question 7

Inflare of Innominate

Answer 7

Position:

• Patient supine. Patient’s dysfunctional side’s hip and knee are flexed and their foot is placed on the lateral side of the opposite knee.
• Physician stands opposite the dysfunction.

Procedure:

1. The physician places their cephalad hand on the patient’s ASIS (opposite side of dysfunction) and their caudal hand is placed on the patient’s knee (side of dysfunction).
2. Patient’s hip is abducted/externally rotated (FABER position) until a restrictive barrier is reached.
3. Physician instructs the patient to adduct/internally rotate their hip, by pushing their knee into the physician’s hand while the physician provides equal counterforce for 3-5 seconds. The patient is instructed to relax and a new restrictive barrier is engaged. Continue until no new barriers are met.
4. Reassess

Question 8

Outflare of Innominate

Answer 8

Position:

• Patient supine. Patient’s dysfunctional side’s hip and knee are flexed and their foot is placed on the lateral side of the opposite knee.
• Physician stands opposite the dysfunction.

Procedure:

1. The physician places their cephalad hand on the patient’s PSIS (side of dysfunction) and their caudal hand is placed on the patient’s lateral knee (side of dysfunction)
2. Patient’s hip is adducted/internally rotated until a restrictive barrier is reached.
3. The patient is instructed to abduct/externally rotate the flexed hip while the physician provides equal counterforce for 3-5 seconds. The patient is instructed to relax and the physician engages a new restrictive barrier. Continue until no new barriers are met.
4. Reassess

Question 9

Public Dysfunction Shotgun

Answer 9

Position:

• Patient: supine, hips are flexed to 45°and knees are flexed to 90°with feet flat on table
• Physician: standing on side of table

Procedure:

1. While having the patient use isometric contractions alternate between adduction and abduction, holding for 3-5 seconds, repeating 3-5 times
2. Alternative method: start with knees together and progressively get wider between contractions

Question 10

Superior Pubic Shear

Answer 10

Position:

• Patient: Supine
• Doctor: Stand on side of dysfunction

Procedure:

1. Doctor stabilizes opposite ASIS with one hand and holds dysfunctional side’s leg, abduct and slightly extend dysfunctional side off table
2. Using an isometric contraction, have patient flex hip medially and toward ceiling to activate adductor muscles, hold 3-5 seconds, repeat 3-5 times using proper MET

Question 11

Inferior Pubic Shear

Answer 11

Position:

• Patient: Supine
• Doctor: Stand on side of dysfunction

Procedure:

1. Place superior hand on dysfunctional side’s ischial tuberosity to monitor and guide rotation
2. Flex patient’s hip until restrictive barrier adding significant adduction to target pubic dysfunction
3. Using an isometric contraction have patient try to abduct and extend hip for 3-5 seconds, repeat 3-5 times using proper MET