Renal CIS- Ferrill

Question 1

Seated pelvic diaphragm MFR

Answer 1

1. The child is seated facing either toward or away from the physician.
2. The physician fingers are placed gently just medial to the ischial tuberosities bilaterally.
3. The fingers are brought gently anteriorly and superiorly within the ischiorectal fossa until tension is felt through the pelvic diaphragm. This gentle tension is maintained until a release is felt or tissue motion is restored.

Question 2

Seated diaphragm release

Answer 2

1. The child is seated with the physician behind them and supporting their back with their hip or leg.
2. The physicians fingers anteriorly contact the inferior border of the rib cage and gently hook posteriorly and superiorly to engage the abdominal diaphragmatic fascia. Posteriorly (see bottom picture) the thumbs are engaging the thoracolumbar junction, including the 11-12 ribs and T12-L1.
3. The child is gently encouraged to slump into the fingers while the entire diaphragm is brought into ease or bind, whichever feels more conducive to treatment, until the passive breathing of the child is felt easily. This is balance.
4. This position is held until a release of the mechanical strain or improvement in tissue motion is noted.

Question 3

Normal sacral mechanics:

Answer 3

As the lumbar spine extends the sacrum nutates (biomechanical sacral flexion)
The sacral sulci move anteriorly (deepen)
The ILA’s move posteriorly
As the lumbar spine flexes the sacral base counternutates (biomechanical sacral extension)
The sacral sulci move posteriorly (more shallow)
The ILA’s move anteriorly

Question 4

Posterior sacral dysfunctions

Answer 4

As the lumbar spine extends one or both sides of the sacral base does not move anteriorly
One or both sides of the sacral apex (ILA’s) don’t move posteriorly

Question 5

anterior sacral dysfunctions

Answer 5

As the lumbar spine flexes, one or both sides of the sacral base don’t move posteriorly
One or both sides of the sacral apex (ILA’s) doesn’t move anteriorly

Question 6

Bilateral sacral extension

Answer 6

Both sacral sulci resist anterior motion during lumbar extension/sacral flexion
Both sacral ILA’s resist posterior motion during lumbar extension/sacral flexion

Question 7

Posterior torsions

Answer 7

One sacral sulcus resists anterior motion during lumbar extension/sacral flexion
The contralateral ILA resists posterior motion during lumbar extension/sacral flexion

Question 8

Unilateral sacral extensions

Answer 8

One sacral sulcus resists anterior motion during lumbar extension/sacral flexion
Ipsilateral ILA resists posterior motion during lumbar extension/sacral flexion

Question 9

For all posterior sacral dysfunctions the landmarks are more symmetrical during

Answer 9

lumbar flexion (sacral extension)

Question 10

Bilateral sacral flexion

Answer 10

Both sacral sulci resist posterior motion during lumbar flexion/sacral extension
Both sacral ILA’s resist anterior motion during lumbar flexion/sacral extension

Question 11

Anterior torsions

Answer 11

One sacral sulcus resists posterior motion during lumbar flexion/sacral extension
The contralateral ILA resists anterior motion during lumbar flexion/sacral extension

Question 12

Unilateral sacral flexions

Answer 12

One sacral sulcus resists anterior motion during lumbar extension/sacral flexion
Ipsilateral ILA resists posterior motion during lumbar extension/sacral flexion

Question 13

For all anterior dysfunctions the landmarks are

Answer 13

more symmetrical during lumbar extension (sacral flexion)

Question 14

Seated sacral MET for torsions

Answer 14

Patient sits with crossing the ankle of the affected side (the side of the sacral base that is stuck) over the opposite knee
Physician monitors the affected sacral base with one hand
The other hand is used for counterforce on the ipsilateral knee

Question 15

Seated sacral MET—anterior torsions

Answer 15

While monitoring over the affected sacral base, the physician contacts the lateral aspect of the crossed knee
The patient is asked to slouch (flex lumber spine) until motion is felt at the sacral sulcus
The patient is asked to press down on the physicians counterforce on the knee for 3-5 seconds
Re-engage the barrier by flexing the lumbar spine
Repeat the last two actions 3-5 times or until a release is felt

Question 16

Seated sacral MET-posterior torsions

Answer 16

While monitoring over the affected sacral base, the physician contacts the medial aspect of the crossed knee
The patient is asked to arch their back (extend the lumber spine) until motion is felt at the sacral sulcus
The patient is asked to press up on the physicians counterforce on the knee for 3-5 seconds
Re-engage the barrier by extending the lumbar spine
Repeat the last two actions 3-5 times or until a release is felt