Lab 6: Sacrum and BLT Treatments

Question 1

Bilateral Sacral Extension

Answer 1

Position:

• Patient: supine
• Physician: side of table

Treatment:

1. Use the caudal palm to lifts both sacral ILAs anterior to the point of ligamentous balance.
2. Use cephalad hand to gap SI joint.
3. Patient is instructed, “Take a very deep breath and hold it as long as possible.”
4. The physician makes minor adjustments to maintain ligamentous balance.
5. Repeated until the best motion is obtained (average is 3 times).
6. Recheck

Question 2

Bilateral Sacral Flexion

Answer 2

Position:

• Patient: supine
• Physician: side of table

Treatment:

1. Use the caudal palm to lifts both sacral bases anterior to the point of ligamentous balance
2. Use cephalad hand to extend L5, encourging sacral flexion.
3. Patient is instructed, “Take a very deep breath and hold it as long as possible.”
4. The physician makes minor adjustments to maintain ligamentous balance.
5. Repeated until the best motion is obtained (average is 3 times).
6. Recheck

Question 3

Forward Sacral Torsion

Answer 3

Position:

• Patient: supine
• Physician: ipsilateral side of table as the sacral base rotation

Treatment:

1. Caudal hand: Use the fingers to apply anterior pressure to the deep sacral base to the point of balanced ligamentous tension.
2. Cephalad hand: bridge the ASIS’s to gap the SI joints OR assist caudal hand pushing the sacral base anterior or L5 extension.
3. The respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the phase that provides the best ligamentous balance.
4. Step 3 is repeated until the best possible motion is obtained.

Question 4

Backwards Sacral Torsion

Answer 4

Position:

• Patient: supine
• Physician: ipsilateral side of table as the sacral base rotation

Treatment:

1. Caudal hand: Use palm to apply anterior pressure to the anterior ILA to the point of balanced ligamentous tension.
2. Cephalad hand: bridge the ASIS’s to gap the SI joints or assist by flexing L5.
3. The respiratory phases are tested and the patient is instructed to hold his/her breath as long as possible in the phase that provides the best ligamentous balance.
4. Step 3 is repeated until the best possible motion is obtained.

Question 5

Posterior Innominate Rotation

Answer 5

Position:

• Patient: seated
• Doctor: seated in front of the patient

Hand Position: holds distal tibias

Technique:

1. Slowly push up on ipsilateral leg and simultaneously pull down on the contralateral leg.
2. Attain the balance point.
3. Instruct patient to rotate trunk towards ipsilateral side until the ipsilateral leg begins to draw upward with the motion.
4. Attain the new balance point.
5. Instruct the patient to inhale deeply and hold for 5-10 seconds.
6. Release position & reassess.

Question 6

Anterior Innominate Rotation

Answer 6

Position:

• Patient: seated
• Doctor: seated in front of the patient

Hand Position: holds distal tibias

Technique:

1. Slowly pull down up on ipsilateral leg and simultaneously push down on the contralateral leg.
2. Attain the balance point.
3. Instruct patient to rotate trunk towards contralateral side until the contralateral leg begins to draw upward with the motion.
4. Attain the new balance point.
5. Instruct the patient to inhale deeply and hold for 5-10 seconds.
6. Release position & reassess.