LAB - Sacral Dx + Tx Flashcards
What points are we pushing on for the sacral exam?
Sacral Sulcus’s
Left and right ILA
how do you find the Sacral Sulcus?
Find the PSIS and go medially a little bit
When you take a Deep breath in (and laying on your stomach), where does your sacrum go?
the ILAs go deep (anatomically anterior), the sulcus goes to the sky (anatomically posterior)
so rocking towards your feet
When you breathe out (and laying on your stomach), where does your sacrum go?
your ILAs go to the sky (anatomically posterior), sacral sulcus goes deep (anatomically anterior)
rocking towards your head
What is Sacral Flexion
what is this most similar to, breathing in or out?
Base tips anteriorly
Apex moves posteriorly
Breathing out
What is Sacral Extension?
what is it most similar to?
Base tips Posteriorly
Apex moves Anteriorly
Breathing in
just think.. “EXTENDING the abdominal cavity for more food”
If both sacral sulcus are moving forwards into flexion, what would you call it?
what about just one?
a bilateral flexion
just one side = unilateral flexion
What are you going to feel with your hands if someone has a bilateral flexion?
You’ll feel the sulcus’s to both be deep
the ILA’s will both be shallow
What are you going to feel with your hands if someone has a unilateral flexion?
one sulcus is going to feel more anterior, the same side ILA is going to feel more posterior
What are you going to feel with your hands if someone has a bilateral Extension?
both sulcus’s are going to be more posterior
both ILA’s are going to feel deep
What are you going to feel with your hands if someone has a unilateral Extension?
one side is going to have the sulcus more posterior, and the same side ILA more anterior
How do we name the torsions?
for the axis that’s NOT MOVING AROUND
and if it’s falling forwards or backwards
you name it for the base part of the axis.
if the axis starts on the right side and cuts to the left.. what do we call it?
right axis
After you find your axis, what are you going to do?
what happens if it’s falling forwards?
backwards torsion?
decide if it’s fallen forwards or backwards
Falling forwards means the opposite sulcus is feeling more anterior, the opposite side ILA is going to feel posterior
base feels more posterior (towards you), and the apex feels farther away (anterior)!
When feeling the sacrum, what’s the difference between a torsion and a unilateral bending?
if you have a right unilateral flexion, you’ll feel a RIGHT posterior ILA
(LEFT ON LEFT).. you’ll feel the right sulcus go anterior, but the LEFT posterior ILA
If it’s a right on right axis, which way did the sacrum
“fall”?
it’s looking right, so it fell forward on a stuck right axis
R on R, explain what it is
L on R, explain what it is
R on L
L on L
the left sacral sulcus is anterior. the right ILA is posterior. (whole sacrum facing right)
right axis, left sulcus is posterior, right ILA is anterior (whole sacrum facing Left)
Left axis, right sacral sulcus posterior, left ILA anterior (whole sacrum facing Right)
Left axis, right sacral sulcus is anterior, left ILA is posterior (whole sacrum facing left)
which side of the sacrum is the problem? how do you know?
Seated Flexion Test
How does the seated flexion test work?
what does a positive test tell you?
what does a negative mean?
It’s just like the standing flexion test
you have them sit and you NEED THEIR FEET ON THE FLOOR.
you come around you hook your thumbs under the PSIS and have them bend forward and touch their toes.
which one moves first and farthest?
that would be a POSITIVE test for that side! –> either unilateral problem or a torsion with the axis on the other side!
negative test may be a BILATERAL dysfunction!
So say doing the seated flexion test you have someone’s right side moves first and farthest.. what could it be?
Right side unilateral flexion or extension
Left axis torsion (either a R on L or L on L)
How does the Lumbar Spring Test work?
+ test?
- test?
what is this testing?
patient is on their stomach
you are springing at the lumbosacral junction
positive = resistance to springing = your sacrum is preferring sitting posterior (backward)
negative = easy spring = normal motion or preference for anterior/forward motion
this tests for if the sacrum is sitting more forward or backward
What is the backward bending/sphinx test?
+ test?
- test?
what is this testing?
you stick your thumbs in the sacral sulci and you see if ones more shallow or deep
then you have the pt bend up in the TV watching position and they either EVEN OUT or GET WORSE
(normally, TV watching will lead to more flexion of the sacrum, so forward)
+ test would be that if they bend their back and the unevenness gets worse.. that would mean it’s POSTERIOR/Backward
- test would be that sacral sulk and Ilas even out during the exam, meaning that it’s ANTERIOR/Forward
this tests for if the sacrum is sitting more forward or backward
How does the sacrum move during respiration?
when you take a deep breath your sacrum goes backwards.. when you breathe out you rock back forwards
Your palm goes on the base of the sacrum, Your fingertips go on the apex of the sacrum
push down a bit and follow the motion.
When breathing in, go towards the feet. when breathing out, follow to the head
you feel what’s easier.
if they “like” to go to the feet during inhalation, that means they’re stuck posterior or stuck in inhalation.
if they “like” to go to the head, that means they’re stuck in exhalation or stuck anteriorly.
What does Lumbar spring, sphinx test, and respiratory motion tell you?
if it’s forwards or backwards.
i.e. stuck in flexion or stuck in extension
If you had a left sided one from your seated test and you said it was sitting more forward through the 3 forward/backward tests.
what are the 2 options?
That would mean it narrows it down to
Left side unilateral flexion, or a forward torsion (Right on Right)
Say we have it narrowed down to two things..
Left side unilateral flexion or a forward torsion (Right on Right)
what do you do to check?
4 point static sacral eval
2 ways:
1. stick both thumbs in sacral sulci and see which is more deep or shallow then do the same thing for the ILAs
- make the “4 points” with your hands to check all 4 at the same time
compare the 2 sacral sulci together and 2 Ila’s together.
so the ILAs are the best way to check which is which!
Say we have it narrowed down to two things..
Left side unilateral flexion or a forward torsion (Right on Right)
how do you tell the difference between these both?
If you’re looking at the sulcus, the left sulcus feels anterior.. the only difference now is the ILA’s.
If it’s a R on R, you know that your right ILA will be posterior
If your left ILA is posterior.. you know that doesn’t make sense with the axis!
What does the Sacroiliac Rocking Oblique Axis Test do?
confirms a torsion.
if you think you have a torsion, this just helps you check to make sure.
you’re trying to twist the sacrum into the motion you think it’s going around. then you switch and you should feel that it’s not moving as much
What’s the first thing you have to do when treating someone’s sacrum?
if it’s stuck in flexion, what do you need to do?
what about stuck in extension?
Gap the SI Joint
you need to open up the back of the joint so you can push it back to where it belongs
you need to open up the front of the joint so you can push it back to where it belongs
If someone is stuck in extension, how do you gap the SI joint?
if someone is stuck in flexion, how do you gap the SI joint to let it move?
Externally rotate to open up the front side of the joint
Internally rotate
Left Unilateral extension.
how do you treat it with Unilaterally Extended Sacrum ME/ART?
since it’s extended, you are going to abduct and you need to externally rotate.. then you just leave it there.
now that sacral sulci is out towards you.
you put your palm on top and engage that that’s sticking out.
articulatory you just spring.
ME you use respiration… when they breathe in it’s coming out so you RESIST THAT, but follow it into Inhalation (since inhaling pushes it forward)
3-5x
recheck
If you have a left unilateral flexion, how are you going to treat it with ME
You’re always pushing down on something, but since the left sulcus is anterior, you’d just be pushing it farther.
so since it’s flexed, you internally rotate and abduct the leg
the ILA on the left side is going to be more posterior, so you push on it.
remember that during inhalation, the ILAs are moving more anterior, so you’re going to follow it with inhalation, and resist exhalation!!!
What happens if you have a bilaterally extended sacrum? how do you treat it?
Externally rotate BOTH LEGS and abduct BOTH LEGS because this is BILATERAL!
You are going to put your hand on the center of the base of the sacrum and resist inhalation and follow it during exhalation.
3-5x
What happens if you have a bilaterally flexed sacrum? how do you treat it?
IR both legs and abduct both legs
Both ILAs are going to be posterior, so you put your hands on both ILAs, follow it during inhalation and resist during exhalation!
3-5x
recheck
If you have a forward sacral torsion (ex L on L) , how are you going to fix that? (ME or ART)
Right sulcus is anterior, left ILA is going to be posterior.
ANY TORSION.. THE AXIS SIDE GOES DOWN.
for L on L, have the person be on their left side (lateral recumbent)
FORWARD TORSION = FORWARD SIDE OF BODY ON TABLE Their arms go in a modified sims position (chest on the table)
since it’s L on L or R on R, 2 L’s or 2 R’s.. think 2 Legs!!
take both legs and bend at the knees and hips until you get to that L5/S1 joint and get the knees off the table and have them rest them on your legs (you can see)
monitor at the L5/S1 joint.
push their legs to the ground and have them push them back up to the ceiling for ME or push them down for ART
return them to neutral!
If you have a backwards sacral torsion.. how do you fix that?
(ex L on R)
Left sulcus is posterior
lay on the side of the axis (right in this example)
BACKWARDS TORSION so BACK on the table for a modified sims position.
only 1 letter is the same so only ONE LEG!
move the top leg and monitor at the L5/S1 junction, move the hip till you feel the motion and you push that one leg (at the knee) down for ART!
ME you have them pull up, 3-5s, farther down, 3-5s, you know the drill
