sacral muscle energy - lab 5

Question 1

unilateral sacral flexion

Answer 1

1. Patient is prone with arms hanging off the sides of the table.
2. Doctor is standing at the same side of the table as the dysfunction.
3. The heel of the caudal hand is on the ILA with the fingers in the sacral sulcus.
4. Abduct and internally rotate the ipsilateral hip until motion is felt at the sacral sulcus and the joint loosens.
5. Apply a constant force toward the table and cephalad.
6. The patient is asked to inhale and hold his breath pressure is applied on the ILA.
7. Patient exhales as pressure is maintained.
8. Repeat (may need 5-7 times).
9. Return to neutral and recheck.
   - May apply a thrust on the ILA at the end of the last expiratory phase

Question 2

B. Unilateral Sacral Extension

Answer 2

1. Patient in the Sphinx position (propped up with elbows supporting upper body).
2. Doctor at opposite side of the table.
3. Abduct and internally rotate the ipsilateral hip until motion is felt at the sacral sulcus and the joint loosens.
4. Hypothenar eminence of cephalad hand is placed on the posterior sacral sulcus, the caudad hand is placed on top.
5. Force is applied anterior on the sulcus.
6. Apply a constant force toward the table.
7. The patient is asked to inhale and exhale forcefully while pressure is applied on the sacral sulci.
8. Patient inhales as pressure is maintained.
9. Repeat (may be 5-7 times)
   10. Return to neutral and recheck

Question 3

C. Forward Sacral Torsion

Answer 3

1. Patient is in the Sim’s position axis side down
2. Face the patient seated with knee supporting pts knees.
3. Monitor the lumbosacral junction (LSJ).
4. Flex the knees until motion is felt at the LSJ and L5 is neutral relative to S1
5. Ask the patient to inhale and reach toward the floor. You can push the shoulder toward the table.
6. Lean against the knees, using them as a fulcrum and drop the legs off the table until motion is felt.
7. The patient is asked to raise the ankles against resistance 3-5 seconds.
8. Relax for 2 seconds.
9. Engage a new barrier and repeat.
   10. Return to neutral and recheck.

Question 4

D. Backward Sacral Torsion

Answer 4

1. Patient is in the lateral recumbent position with knees flexed axis side down.
2. Stand at the side of the table facing the patient.
3. Monitor the LSJ.
4. Flex the knees and patient straightens the lower leg until there’s motion at the LSJ.
5. Pull the lower arm until motion is felt at the LSJ.
6. Lower the upper leg (using the knees as a fulcrum) below the table until motion is felt at the LSJ.
7. Ask the patient to push the ankle toward the ceiling against resistance.
8. Relax for 2 seconds.
9. Engage the new barrier and repeat.
10. Return to neutral and recheck.

Question 5

E. Bilaterally Flexed Sacrum

Answer 5

1. Patient prone.
2. Doctor on side of patient.
3. Thenar and Hypothenar eminences of caudad hand on ILA’s bilaterally.
4. Cephalad hand reinforces.
5. Force is applied anterior on ILAs.
6. Patient inhales deeply.
7. Sacral extension is exaggerated during inhalation and resisted during exhalation.
8. Repeat (may need 7-10 times).

Question 6

F. Bilaterally Extended Sacrum

Answer 6

1. Patient prone in sphinx position.
2. Doctor on side of patient.
3. Index and middle fingers placed in sulci bilaterally.
4. Other hand reinforces bottom hand.
5. Continuous pressure is applied anterior.
6. Patient inhales and exhales deeply.
7. Flexion is exaggerated during exhalation and extension is resisted during inhalation.
8. Repeat 7- 10 times.

Question 7

G. General Sacral Torsion

Answer 7

1. Patient is prone with knees bent.
2. Stand at the foot of the table supporting the knees exerting a lateral force on the legs.
3. Ask the patient to push the ankles medially against resistance.
4. Relax for 2 seconds.
5. Engage the new barrier and repeat 3 times.
6. Return to neutral and recheck.

Question 8

H. Ischial Tuberosity Spread

H. Ischial Tuberosity Spread

Answer 8

1. Patient is prone with knees bent.
2. Kneel on the table supporting the knees with doctor’s knees; thumbs on the medial aspect of the ischial tuberosities pushing laterally; elbows exerting a lateral force on legs causing internal rotation.
3. Patient is instructed to cough forcibly.
4. Spread the ischial tuberosities as well as the legs while the patient coughs.
5. Repeat and recheck.