Lec 24 - Pelvis Diag&Treat Summary

Question 1

Pelvis diag can be confounded with

Answer 1

• Lumbar Somatic Dysfunctions (SDs)
• Lower Thoracic SDs
• Lower rib SDs
• You will learn to do the above evaluations and treatments before the 1st year of medical school is over.
• Other confounding factors include: Short leg/pelvic tilt syndrome & Small hemipelvis

Question 2

Side Bending SDs of the L-spine can add confusion to

Answer 2

• Innominate rotation diagnosis (ASIS is higher on the side bent side)
• Upslip diagnosis (iliac crest is higher on the side bent side)

Question 3

Rotation SDs of the L-spine can add confusion to:

Answer 3

Sacral torsion diagnosis (sulcus is deeper on the side opposite of lumbar rotation)

Question 4

Flexion and Extension SDs of the L-spine can add confusion to:

Answer 4

• Sacral torsion diagnosis (can alter the sphinx test)

- Unilateral Sacral flexion and extension diagnosis (can alter the sphinx test)

Question 5

lower rid SDs can affect

Answer 5

…the muscles attached to the ribs and the pelvis:

• Latissimus Dorsi is attached to the bottom four ribs, lumbar spine, sacrum and pelvis
• Quadratus Lumborum is attached to the 12th rib, lumbar spine and pelvis

Question 6

Evaluation and Treatment difficulties of pelvis SD can also arise from

Answer 6

a short leg syndrome or small hemipelvis (rare).

Question 7

Possible SDs of the Innominate Include:

Answer 7

• Muscle Strains: Treated with Strain / Counter strain
• Muscle Imbalances: Treated with Muscle Energy
• Inlfare and Outflare Innominates
• Pubic Dysfunctions (compressions, ↑ or ↓shears)
• Rotations: Anterior Rotation & Posterior Rotation
• Upslip Innominate

Question 8

Possible Sacral SDs include:

Answer 8

• Forward Sacral Torsions: Left on Left (left rotation on a left oblique axis) & Right on Right (right rotation on a right oblique axis)
• Backward Sacral Torsions: Left on Right (left rotation on a right oblique axis) & Right on Left (right rotation on a left oblique axis)
• Unilateral Sacral Flexion (on the right or left)
• Unilateral Sacral Extension (on the right or left)

Question 9

Other SDs not learned here:

Answer 9

Bilateral Sacral Flexion
Bilateral Sacral Extension
Chicago Style of Diagnosis

Question 10

Order of Diagnosis and Treatment:

Answer 10

1) Muscle Strains / Imbalances of the lower extremities
3) Pubic SDs (compression, shears)
2) Innominate Flares
4) Innominate Rotations
5) Up-slip Innominate
6) Sacrum SDs

Question 11

Innominate Diag and Treatment Method

Answer 11

1) Perform a standing flexion test and note which side is positive
2) Patient lies supine. Reseat the pelvis only if necessary: the “line-up”, the “wiggle”, the “hip flop.”
3) Evaluate for muscle imbalances and strain patterns (see section C below).
- -Muscle imbalances (Asymmetry in muscle tightness or length from side to side)
- -Strain patterns (Presence of tender points)
- -Treat strain patterns and/or muscle imbalances if present.
4) Evaluate the innominate for inflares and outflares. Treat the positive standing flexion test side.
5) Treat any pubic compressions if there is a positive standing flexion test.
6) Evaluate for superior or inferior pubic shears. Treat the positive standing flexion test side.
7) Evaluate the position of the ASIS (inferior vs. superior) and the motion of the ASIS (anterior vs. posterior). Then treat if there is an anterior rotation or a posterior rotation of the innominate on the positive standing flexion test side.
8) Repeat the standing flexion test.
- -If NEGATIVE, then you are done with the innominate evaluation.
- -If POSITIVE then you will need to evaluate for an innominate upslip
9) Evaluate for an innominate upslip:
- -In the prone position bilaterally check the: Ischial tuberosity; PSIS; Iliac crest
- -In the supine position: ASIS; Pubic tubercle
- –If three or more are superior on the side of the second positive standing flexion test (one must be the ischial tuberosity) then we have an innominate upslip.
- -Treat the innominate upslip if present.
10) Repeat the standing flexion test.
- -If NEGATIVE, then you are done with the innominate evaluation.
11) If POSITIVE, then there may be something more complicated, like a short leg syndrome, or a small hemipelvis, etc.

Question 12

Sacrum Diagnosis and Treat method

Answer 12

1) Seated Flexion Test / and History of …
2) Evaluate the Sulci & Inferior Lateral Angles (ILAs)
3) Do a Sphinx Test &/orConfirmatory Tests
- -S2 or S4 Tender Point
- -Fascial Drag
- -Spring Test
4) Treat the SD and Re-check
- -Forward or Backward torsions
- -Unilateral Flexion or Extension
5) Seated Flexion Test