Lecture 3: Sacrum

Question 1

What are the important landmarks to palpate for to diagnose the sacrum?

Answer 1

Sacral sulcus
L5 rotation
ILA

Question 2

Static testing for landmarks:
How do you evaluate the sacral sulcus?
How do you evaluate the ILA?

Answer 2

• medial and inferior to PSIS, assess if deep/anterior or shallow/posterior
• palpate the midline until sacrum drops, ILA approximately where the thenar eminence is (then look for it on the other side using the other hand)

Question 3

How do you perform a seated forward bending test (SeFBT) for lateralization?

Answer 3

• Patient seated with feet on floor
• eyes level to PSIS with thumbs on inferior PSIS
• ask pt to bend forward
• positive side moves the most superiorly, can be even = bilateral SD

Question 4

How do you perform a sphinx test/BBT and what is a positive result?

Answer 4

• Prone patient
• Dominant eye at sacral sulci level and put thumbs on sacral sulci
• Patient rests up on elbows

Positive if there is no asymmetry improvement/worsengs = sacrum does not move and is stuck in extension

Question 5

How do you perform a respiratory motion test?

How do you interpret the result?

Answer 5

• cephalad heel at base, caudad on top in opposite direction
• Pt inhales and exhales
• decide if sacrum exaggerates inhalation (moves posteriorly/extension) or exhalation (moves anteriorly/flexion)

Question 6

How do you perform a lumbar spring test and what is a positive and negative result?

Answer 6

• Prone patient
• heel of hand on L5 spinous process and check for springing

Positive: No spring = sacrum is stuck in extension
Negative: springs = sacrum is flexed

Question 7

How do you perform an oblique axis passive motion test?

Answer 7

• Prone patient
• Ipsilateral finger on ipsilateral sacral sulcus, contralateral heel on contralateral ILA
• push heel down to see if sacral sulcus moves
• Repeat on other side

Tests oblique axes of motion

Question 8

What are the sacral axes?

Answer 8

superior transverse axis
middle transverse axis
inferior transverse axis
left oblique axis
vertical axis 
right oblique axis

*obliques named after the side of the sacral base they cross

Question 9

What characterizes a torsion SD?

What characterizes a unilateral SD

What characterizes a bilateral SD?

Answer 9

• only see saws/restricted on the oblique axis
• only see saws in the same side/restricted on the vertical axis
• see saws on the same side horizontally/restricted on the middle axis

Question 10

What torsion diagnoses means the sacrum is flexed/forward?

What torsion diagnoses means the sacrum is extended/backward?

Answer 10

• L/L or R/R STs

- L/R or R/L STs

Question 11

What unilateral diagnoses means the sacrum is flexed/forward?

What unilateral diagnoses means the sacrum is extended/backward?

Answer 11

• LUSF, RUSF

- LUSE, RUSE

Question 12

What type of diagnoses warrants an L5 evaluation?

Answer 12

Sacral torsions

Question 13

What does a compensated L5 mean?

Answer 13

-should be rotated opposite direction of the sacrum and sidebends toward oblique axis of torsion

Question 14

What do you do if L5 is uncompensated?

Answer 14

-treat the L5 before the sacrum

Question 15

If the sacrum is flexed, what does that indicate for L5?

If the sacrum is extended, what does that indicate for L5?

Answer 15

• Neutral (type 1 like)

- F/E (Type 2 like)

Question 16

Where is L/L and R/R torsions lateralized?

Where is R/L and L/R torsions lateralized?

Answer 16

• opposite of the rotation

- side of the rotation

Question 17

Where are unilaterals lateralized?

Answer 17

-side of see-saw