Lab 5: Sacrum Treatments Only

Question 1

Bilateral Sacral Flexion

Answer 1

1. Monitor SI joint, then abduct the leg until
   motion is palpated.
2. Internally rotate the lower extremities.
3. Place heel of right hand across the apex of the sacrum.
4. Either:
   
   1. ART: Apply a springing motion with the heel of your hand in an anterior/superior direction until motion improves.
   2. ME: With the heel of your hand apply ananterior/superior force to engage the RB.
5. Have the patient breathe deeply and encourage the anterior/superior motion associated with inhalation and resist posterior inferior motion associated with exhalation.
6. Recheck

Question 2

Bilateral Sacral Extension

Answer 2

1. Monitor SI joint, then abduct the leg until
   motion is palpated.
2. Externally rotate the lower extremities.
3. Instruct patient to assume prone TV watching position
4. Place heel of hand across the base of the sacrum.
5. Either:
   
   1. ART: Apply a springing motion with the heel of your hand in an anterior/inferior direction until motion improves.
   2. ME: With the heel of your hand apply anterior/inferior force to engage the RB.
6. Have the patient breathe deeply and encourage the anterior/inferior motion associated with exhalation and resist posterior inferior motion associated with exhalation.
7. Recheck

Question 3

Unilateral Sacral Flexion

Answer 3

1. Monitor SI joint, then abduct the leg until
   motion is palpated
2. Internally rotate the leg on affected side
3. Place heel of right hand on ILA of affected side
4. Either:
   
   1. ART: Apply a springing motion with the heel of your hand in an anterior/superior direction until motion improves.
   2. ME: With the heel of your hand apply ananterior/superior force to engage the RB.
5. Have the patient breathe deeply and encourage the anterior/superior motion associated with inhalation and resist posterior inferior motion associated with exhalation
6. Recheck

Question 4

Unilateral Sacral Extension

Answer 4

1. Monitor SI joint, then abduct the leg until
   motion is palpated
2. Externally rotate the leg on affected side.
3. Instruct patient to assume prone TV watching position
4. Place heel of hand across the base of the sacrum on affected side.
5. Either:
   
   1. ART: Apply a springing motion with the heel of your hand in an anterior/inferior direction until motion improves.
   2. ME: With the heel of your hand apply anterior/inferior force to engage the RB.
6. Have the patient breathe deeply and encourage the anterior/inferior motion associated with exhalation and resist posterior inferior motion associated with exhalation
7. Recheck

Question 5

Forward Torsion

Answer 5

Patient Position: Modified Sims position with axis side down. Hips and knees are flexed to 90° with chest down on the table as much as possible and arms hanging over the table.

Physician: Side of table, monitoring at L5-S1 interspace.

Steps:

1. Flex the hips & knees until motion is felt at the monitoring hand.
2. Patient inhales and exhales deeply 3 times, reaching with their hand, on side opposite the axis, toward the floor after each exhalation (induces additional rotation).
3. Rest patient’s knees on your thigh (if doc seated). Caudad hand grasps pt’s heels to flex or extend hips (rare) until L5 is neutral relative to S1.
4. With caudad hand, lower patient’s legs towards floor by pushing at the feet until reaching sidebending restrictive barrier.
5. Instruct pt to lift their feet up upwards (ie towards the ceiling) for 3-5 secs, then patient relaxes.
6. Move patient into next barrier by pushing feet further towards floor.
7. Repeat ME technique until no new barriers met.
8. Recheck

Question 6

Backward Torsion

Answer 6

Paient position: Edge of table in lateral recumbent position with axis side down. Flex top hip & knee to 90°. Pull patient’s lower arm toward physician to produce posterior rotation so that pt’s back gets closer to table and front faces ceiling.

Steps:

1. Instruct patient to take 2-3 deep breaths, after each exhalation have the patient reach back with the top arm.
2. Physician standing facing the patient, monitoring L5-S1 interspace. Place patient’s top foot on doc’s thigh and induce further flexion of top hip & knee until motion is felt at monitoring hand.
3. Apply gentle force on pt’s knee towards the floor (adducting top hip), until motion is palpated at L5-S1.
4. Instruct patient to lift knee up against your hand (upward/towards the ceiling into abduction) for 3-5 secs, then patient relaxes.
5. Move patient into next barrier by flexing hip and knee more and pushing knee towards the floor.
6. Repeat ME technique until no new barriers met.
7. Recheck