Lecture 5: Lumbar, Sacrum, and Innominate HVLA Flashcards
Landmarks of Lumbar, Sacrum, and Innominates
Check Bilaterally:
ASIS
PSIS
Pubic symphysis/tubercles
Medial Malleoli
Iliac Crest
Ischial tuberosity
Superior Innominate Shear HVLA
Inferior Innominate Shear HVLA (Through ASIS)
Inferior Innominate Shear HVLA (Through Lumbosacral Junction)
Anterior Innominate Rotation HVLA
Posterior Innominate Rotation HVLA
Position:
- Patient lateral recumbent, PTP side UP
- Physician stand facing the patient
Hand Position
- Cephalad hand between L5 & S1 spinous process
- Caudal hand: flex patient’s hips and knees until L5 & S1 spinous processes separate
Technique
- Patient straightens bottom leg, places foot of top leg just distal to popliteal fossa of the bottom leg
- Cephalad hand moves to antecubital fossa, forearm on shoulder
- Caudad forearm on the PSIS and iliac crest
- Roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
- High velocity, low amplitude force is delivered with caudad forearm, directed towards the umbilicus
- Recheck innominate findings
Pubic Restriction HVLA
Bilateral Sacral Flexion HVLA
Position
- Patient prone
- Physician beside patient
Hand Position
- Heel of physician’s hand is on the apex of the sacrum.
Set Up
- Monitor each SI joint, abduct the leg until motion is palpated, and internally rotate
Technique
- Have patient breathe in and out several times, each time accentuating inhalation and resisting exhalation to reach the barrier
- As the patient inhales (on the final cycle), apply an anterior/superior HVLA thrust
- Recheck sacral findings
Bilateral Sacral Extension HVLA
L1-L5 Extension or Neutral Dysfunction HVLA with Long Lever and Rotational Emphasis
R on L Axis Sacral Torsion HVLA
Position
- Patient supine with hands clasped together behind neck
- Physician on side of involved axis
Set Up
- Sidebend patient’s lower extremity and torso away, creating a “C-shape”
Hand Position
- Thenar eminence of caudal hand on patient’s ASIS on side opposite the axis
- Cephalad hand grasping the patient’s lateral distal bicep
Technique
- Using cephalad hand, physician induces rotation of upper torso as far as possible into barrier by pulling opposite elbow towards self, while stabilizing and preventing motion at opposite ASIS with caudal hand.
- During exhalation, apply a rotational thrust of the patient’s upper body while simultaneously stabilizing the opposite ASIS.
- Recheck sacral findings.
Type 2 Lumbar Lateral Recumbent HVLA
Position
- Patient lateral recumbent, PTP side UP
- Physician facing patient
Hand Position
- Monitor spinous process of dysfunction and below with caudal hand.
Technique
- Grasp patient’s bottom arm, and pull anterior to rotate to the dysfunctional segment and caudally to engage sidebending. Switch monitoring hands.
- Flex hips and knees until motion is felt at monitoring hand.
- For Extended dysfunctions, leave bottom leg slightly bent, with superior leg crossed over the bottom.
- For Flexed dysfunctions, patient straightens bottom leg and places top foot into bottom leg’s popliteal space.
- Caudal forearm contacts posterior aspect of the patient’s pelvis spanning from the SI joint to the greater trochanter.
- Cephalad arm contacts patient’s anterior shoulder.
- With the caudal forearm, roll pelvis anteriorly to engage the restrictive barrier. Patient is instructed to inhale deeply.
- At the end of exhalation, exert a rotational thrust through the barrier by rotating the patient’s pelvis forward and towards the table.
- Recheck lumbar findings.
Type 1 Lumbar Lateral Recumbent HVLA
What structures are evaluated in a sacral TART exam?
Piriformis
Erector Spinae Ms.
SI joint
What structures are evaluated in an innominate TART exam?
Quadriceps (anterior rotation)
Hamstrings (posterior rotation)
Quadratus lumborum (superior shear)
SI joint
