Lab 4: Sacral Dx & Tx HVLA/BLT

Question 1

Reassessment of the sacrum should include all diagnostic tests w/ emphasis on what for bilateral dysf, unilater dysf, and torsions?

Answer 1

Bilateral: sphinx test, lumbar spring test, and respiratory motion

Unilateral: sidebending evaluation

Torsions: 4-point passive evaluation

Question 2

What is the sacral HVLA for Bilateral Sacral Flexion?

Answer 2

• Pt is prone and doc is at side of table
• Monitor the SI joint, then ABduct/IR the leg until motion is felt. Using caudad hand on ILA just above sacral apex w/ cephalad hand on top
• Apply an anterior/superior force on ILA’s during inhalation and resist during exhalation and then increase anterior/superior force, doing this a few times
• As pt inhales on last ME cycle, apply a quick anterior/superior HVLA thurst to sacral apex

Question 3

What is the sacral HVLA for Bilateral Sacral Extension?

Answer 3

• Pt is prone and doc is at side of table
• Monitor the SI joint, while ABduct and ER the leg until motion felt. Cephalad hand on the sacral base w/ caudad hand on top
• Apply anterior/inferior force on sacral base during exhalation and resist during inhalation, then increase anterior inferior force, do this for a few rounds of ME
• As patient exhales on last ME cycle, apply a quick anterior/inferior HVLA thrust to sacral base

Question 4

What is the sacral HVLA for a Backward Sacral Torsion?

Answer 4

• Pt is supine and doc is on side of involved axis (deep sacral sulci)
• Sidebend pt’s LE and torso AWAY from deep sulcus –> creating a “C-shape”+ pt clasps hands behind neck
• Doc places thenar eminence of caudad hand on pt’s ASIS on side opposite deep sulcus (opposite side physican standing on)
• Place cephalad hand over pt’s opposite shoulder and thru space created by upper arm and forearm, resting dorsum of hand on the manubrium, this is rotational lever
• Using cephalad hand, physician induces rotation of upper torso as far as possible into barrier by pulling opposite shoulder towards self, while stabilizing and preventing motion at opposite ASIS
• Pt is asked to take a deep breath and during exhalation doc applies a rotational thrust of pt’s upper body, while simutaneously applying a posterior thrust on the opposite ASIS

Question 5

What is the sacral BLT for Bilateral Sacral Extension?

Answer 5

• Pt is supine and doc at side of the table
• Lifts the sacral apex anterior to the point of ligamentous balance, while pt is instructed to “take a very deep breath and hold it as long as possible.” The doc makes minor adjustments to maintain balance.
• Repeated until the best motion is obtained (average is 3x)

Question 6

What is the sacral BLT for Bilateral Sacral Flexion?

Answer 6

• Pt is supine and doc at side of the table
• Lift the sacral base anterior to the point of balanced ligamentous tension. Pt’s respiratory phases are tested and he/she is instructed to hold the breath as long as possivle in the phase that provides the best ligamentous balance
• Repeat until the best motion obtained (average 3x)

Question 7

What is the supine sacral BLT for Forward Sacral Torsion?

Answer 7

• Pt is supine and doc on ipsilateral side of table as the sacral base rotation
• Apply anterior pressure to the base on the side of the deep sulci to the point of balanced ligamentous tension
• Cephalad hand may either bridge the ASIS’s to gap the SI joints or may be placed under the sacrum to reinforce the lifting fingers
• Respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the most balanced phase
• Repeat until best motion is obtained

Question 8

What is the seated sacral BLT for Forward Sacral Torsions?

Answer 8

• Pt is seated and doc is seated behind the patient
• Monitor the sulci and induce extension from above until the posterior sacral base is palpated as moving anterior to balance w/ the other side
• Rotate the pt thru their upper body in direction of sacral rotation
• Sidebending MAY be induced to the contralateral side as the rotation
• Activating Force: have pt hold exhalation until air hunger
• Upon inhalation, recheck and repeat as needed until TART is significantly reduced.

Question 9

What is the supine sacral BLT for Backward Sacral Torsion?

Answer 9

• Pt is supine w/ doc on ipsilateral side of table as the sacral base rotation
• Anterior pressure to the side of the deep ILA, encouragin rotation around the involved oblique axis to the point of BLT
• Doc’s other hand may either bridge the ASIS’s to gap the SI joints or may be placed under the sacrum to reinforce the lifting fingers
• Respiratory phases are tested and the pt is instructed to hold his/her breath as long as possible in the phase that provides the best BLT. Doc makes minor adjustments to maintain BLT
• Repeat until best motion is obtained

Question 10

What is the seated sacral BLT for Backward Sacral Torsions?

Answer 10

• Pt is seated and doc behind the patient opposite the side of the involved oblique axis
• Monitor the sacral sulci and induce flexion from above in the seated pt until the anterior sacral base is palpated as moving posterior to balance w/ the other side
• Rotate the pt through their upper body in the direction of the sacral rotation. Sidebending MAY be induced to the contralateral side as the rotation
• Activating force: have the pt hold inhalation until air hunger
• Upon exhalation, recheck and repeat as needed until TART is signifcantly reduced