Sacral Dx and Tx Flashcards
1
Q
If my patient has a Bilateral Flexion what would be findings be?
A
- seated flexion/pelvic compression= NEG
- lumbar lordosis= increased
- sacral sulcus= deep bilaterally
- ILA= posterior bilaterally
- lumbar spring test= NEG
- respiratory motion= restricted to inhalation
- side bending passive and 4 point passive= no restriction
2
Q
If my patient had a Bilateral Extension what would my findings be?
A
- seated flexion/pelvic compression= NEG
- lumbar lordosis= decerased (flat)
- sacral sulcus= shallow bilaterally
- ILA= anterior bilaterally
- lumbar spring= POS
- respiratory motion= restricted to exhalation
- side bending passive and 4 point passive= no restriction
3
Q
If my patient had a Right Unilateral Sacral Flexion what would my findings be?
A
- seated flexion/pelvic compression= POS R
- sacral sulcus= deep on R
- ILA= posterior and inferior on R
- lumbar spring= NEG
- SB passive= resricted to SB L (likes to be SB R)
- 4 point passive= no restriction
4
Q
If my patient had a Left unilateral flexion what would my findings be?
A
- seated flexion/pelvic compression= positive on L
- sacral sulcus= deep on L
- ILA= posterior and inferior on L
- Lumbar spring= NEG
- SB passive= restriced to SB R (like to be SB L)
- 4 point passive= no restrictions
5
Q
If my patient had a R Unilateral Extension what would my findings be?
A
- seated flexion/pelvic compression= POS on R
- sacral sulcus= shallow on R
- ILA= anterior and superior on R
- lumbar spring= POS
- SB passive= restricted toward SB R (likes to be SB L)
- 4 point passive= no restriction
6
Q
If my patient had a Left Unilateral Extension what would my findings be?
A
- seated flexion/pelvic compression= POS on L
- sacral sulcus= shallow on L
- ILA= anterior and superior on L
- Lumbar spring= POS
- SB passive= restricted to SB L (likes to be SB R)
- 4 point passive= no restriction
7
Q
If my patient had a R on R Foward Torsion what would my findings be?
A
- seated flexion= POS on L
- pelvic compression= POS on R
- sacral sulcus= deep on the L
- ILA= posterior on R
- lumbar spring= NEG
- 4 point passive= restricted to rotating left around right oblique axis, hard end feel on R ILA
8
Q
If my patient had a Left on Left Foward Torsion what would my findings be?
A
- seated flexion= POS on R
- pelvic compression= POS on L
- sacral sulcus= deep on the R
- ILA= posterior on L
- lumbar spring= NEG
- 4 point passive= restricted to rotating right around left oblique axis, hard end feel on L ILA
9
Q
If my patient had a Right on Left Backward Torsion what would my findings be?
A
- seated flexion= POS on R
- pelvic compression= POS on L
- sacral sulcus= deep on L
- ILA= posterior on R
- lumbar spring= POS
- 4 point passive= restricted to left rotation around left oblique axis, hard end feel on L ILA (hard end feel R sulcus!)
10
Q
If my patient had a Left on Right Backward Torsion what would my findings be?
A
- seated flexion= POS on L
- pelvic compression= POS on R
- sacral sulcus= deep on R
- ILA= posterior on L
- Lumbar spring= POS
- 4 point passive= restricted to right rotation around right oblique axis, hard end feel on R ILA (hard end feel on L sulcus!)
11
Q
What is important to remember about pelvic/ASIS compression test?
A
- press down posterior medially on ASIS
- side of hard end feel= POS side
- does NOT discriminate between iliosacral and sacrolilial motion
- indicates SI joint dysfunction on side of restricted motion
12
Q
Lumbar spring test
A
- pt prone
- springing force applied anteriorly into lumbosacral junction with heel of hand
- NEGATIVE= normal spring
- POSITIVE= no spring, increased resistance to pressure
13
Q
What is sphinx test used for?
A
- backward bending test *confirm lumbar spring test
- backward bending increase lumbar lordosis and brings scarum into flexed position
- If sulci more symmetric= Anterior torsion/unilateral flexion
- If sulci more asymmetric= Posterior torsion/unilateral extension
14
Q
What is 4 point passive test used for?
A
- finger monitoring at sacral sulcus and heel of hand on opposite side ILA
- apply anterior pressure on L ILA and monitor posterior motion at R sulcus
- apply anterior pressure on R ILA and monitor for posterior motion at L sulcus
- looking for restriction around oblique axes
- used to dx torsion
15
Q
Respiratory motion of sacrum
A
- if restricted to inhalation (sacral base moves posterior)= bilateral flexion
- if restricted to exhalation (sacral base moves anterior)= bilateral extension
**all unilaterals will have asymmetric respiratory motion, not fully restricted
16
Q
After all treatments you have to do what?
A
REASSESS!!
- bilateral dysfunction= sphinc test, lumbar spring, respiratory motion
- unilateral dysfunction= sidebending
- torsion= 4 point passive
- all do static symmetry
17
Q
If a patient had Bilateral Sacral Flexion how would you treat them?
A
- pt prone
- place caudad hand on ILAs (sacrum apex)
- cephalad hand on top of caudad
- apply anterior/superior force on ILAs
- exaggerate force during inhale and resist anterior motion during exhale
- 3-5 respiratory cycles or until no new barriers
- HVLA= after a few rounds of ME as patient INHALES on last cycle apply quick anterior/superior thrust to sacral apex
18
Q
If a patient had a Bilateral Sacral Extension how would you treat them?
A
- pt prone/ sphinx position
- index/middle finger caudad hand on sacral sulcus (base of sacrum)
- cephalad hand on top
- pt inhales resist posterior motion, exaggerate motion during exhale by applying anterior and inferior force
- repeat 3-5 breath cycles or until no new barriers
- HVLA= apply a few round of ME and as patient EXHALES on last cycle apply quick anterior/inferior thrust to sacral base
19
Q
How would you treat a patient with a Right Unilateral Sacral Flexion?
A
- pt prone, doc on R side
- palpate sacral sulcus/base with cephalad hand
- caudad hand abduct and internally rotate R hip
- place heel caudad hand on ILA on R and cephalad hand on top
- apply anterior/superior force on ILA
- as patient inhales exaggerate force and as pt exhales resist anterior motion
- repeat until no new barriers
20
Q
How would you treat a patient with a Left Unilateral Sacral Extension?
A
- pt prone, IN SPHINX, doc on L side
- palpate sacral sulcus/base with cephalad hand and caudad hand abduct and internally rotate hip of L leg
- place cephalad hand on L sacral sulcus and caudad hand on top
- apply anterior/inferior force on sulcus
- patient inhale resist motion, as exhale exaggerate motion
- repeat 3-5 cycles or until no new barriers
21
Q
How would you treat a patient with a L on L Foward Torsion?
A
- pt modified SIMS with (axial side) L side down
- hips and knees flex 90 with chest down on table arms hanging off
- monitor L5/S1 flex hips/knees until motion felt
- pt inhales and exhales deeply 3 times induce axial rotation
- rest pt knees on your thigh caudad hand grasp pts heels to flex until L5 neutral relative to S1
- caudad hand lower pt legs toward floor by pushing at feet
- pt lift feet upwards toward ceiling for 3-5 sec against your counterforce
- pt relax and doc engage new barrier pushing feel further to floor
- repeat until no new barriers
22
Q
How would you treat and R on L Backward Torsion with ME?
A
- pt at edge of table lateral recumbant with (axis side down) L side down
- flex top hip and knee to 90 and pull lower arm to induce posterior rotation so pt back closer to table
- monitor at L5/S1 and place top foot further into flexion until motion felt
- apply gentle force on pts knee toward floor (adducting top hip)until motion felt at L5/S1
- pt lift knee against your counterforce (toward ceiling) 3-5 sec then relax
- move pt into next barrier by pushing knee toward floor and repeat until no new barriers met
23
Q
How would you treat a L on R Backward Torsion with HVLA?
A
- pt supine with doc on side of involved axis (deep sulcus), R side
- sidebend pt LE and torso away from R creating C shape
- pt clasp hands behind neck
- doc place caudad hand on L ASIS
- plce cephalad hand over opposite shoulder and through space resting dorsum of hand on manubrium (this is rotational lever)
- using cephalad hand induce rotation of upper torso into barrier by pulling opposite shoulder toward itself and preventing motion at ASIS
- pt take a deep breath and on exhale apply axial rotation thrust of pt upper body with cephalad hand on rotation level and applying posterior thrust simultaniously on opposite ASIS
