Sacral Somatic Dysfunction Flashcards
Goal of manipulation?
restore symmetry to gait function and vertebral motion
Pelvic girdle parasympathetic?
S1-S4 (uterus, prostate, genitalia, descending colon, sigmoid, and rectum)
motor and sensory (sciatica)
Sacral base anterior?
antaomical flexion, forward bending
SBS is in extension (nutation)
Sacral base posterior?
Anatomical extension, backward bending
SBS is in flexion (counternutation)
Postural sacral motion?
occurs when the patient is seated or standing
Inherent sacral motion?
occurs when the sbs in the head flexes and extends (sacral motion)
Dynamic sacral motion?
occurs during walking
Superior transverse axis?
respiratory motion and inherent motion
horizontal axis posterior to the point of attachment at the level of s2
Respiration movement?
inhale spine elongates- sacral base posterior
exhale spine recoils- sacral base anterior
movement during inherent motion of CRI?
cranial flexion- sacral base posterior-counternutates
cranial extension- sacral base anterior/nutates
Middle transverse axis?
postural motion
horizontal axis located at the anterior convexity of upper and lower limbs of sacroliliac joint
Seated sacral motion?
when seated/flexion of torso- sacral base moves anterior
when seated/extension of torso- sacral base moves posterior
standing sacral motion?
the sacral base moves posterior when standing and bending over/flexing torso
Inferior transverse axis?
innominates rotate about, ilia on the sacrum
horizontal axis that passes through the inferior articular surface of the sacrum
Other axis of movement?
left oblique axis, right oblique axis, vertical axis
these axes come into play during ambulation
name oblique axis?
for the superior end
Sacral base?
uppermost posterior part of the sacrum
just medial to PSIS
identify the one that is anterior
Inferior lateral angle?
palpate lateral to the base of the coccyx
identify the side that is more posterior and/or inferior
Diagnose sacral SD?
Asymmetry of paired sacral landmarks
Asymmetry of range of motion of sacroiliac joint
Tissue texture changes
4 steps to make the somatic dysfunction diagnosis?
Perform seated flexion test
Palpate the sacral landmarks
Motion tests
Palpate L5
Seated flexion test?
place thumbs under PSIS
patient flexes forward with feet on the floor
side with last superior movement is side of sacroliliac restriction (pos side)
Confirm seated flexion test?
ASIS compression test
ASIS compression test?
positive test, restriction of posteriormedial pressure indicates SI restriction on ipsilateral side
Is there an oblique axis?
A positive seated flexion test/ASIS compression test typically indicates the sacral oblique axis is on the opposite side
ex) a positive right seated flexion/ASIS compression test indicates a left oblique axis
Describe the 2 possible motions around an oblique axis?
Forward on a right axis
left anterior sacral base and right posterior/inferior ILA (inferior lateral angle)
right sacral rotation on right oblique axis
rotation is opposite the anterior sacral base
R/R or right on right
Backward on a right axis
right anterior sacral base and posterior/inferior base on the left
left rotation on a right oblique axis
L/R or left on right
What does lumbar findings (L5) tell you about sacral rotation and sacral oblique axis?
If L5 is rotated, sacrum rotates in opposite direction on an oblique axis
If L5 is sidebent to one side, a sacral oblique is typically enlarged on the same side
Does not involve an oblique axis?
unilateral flexion/ extension
bilateral flexion/ extension
Evaluate range of motion of sacroiliac joint?
seated flexion test and/or ASIS compression test
Backward bending test
lumbosacral springing test
Palplate the static sacral landmarks?
Sacral base, named for anterior side
Inferior lateral angle, names for side that is more posterior/ inferior
Tests that evaluate the sacral base/ lumbosacral junction to flex?
Lumbar spring test, Backward bending test
If sacrum is already flexed?
then there is no problem flexing it more, get a negative test
Forward sacral torsion, forward sacral rotation, unilateral flexion, bilateral flexion
If the sacrum is extended?
then it cannot flex more and you get a positive test
backward sacral torsion, backward sacral rotation, unilateral extension, bilateral extension
Lumbar spring test?
Pos=resistance to springing, sacral extension or backward rotation on oblique axis
neg= ease of spring, sacral flexion or forward rotation/torsion
Backward bending test?
pos=increased sacral base asymmetry, sacral extension or backward rotation on oblique axis
neg= decreased sacral base asymmetry, sacral flexions or forward rotation or torsion
Therefore a negative test or spring indicates?
unilateral or bilateral sacral flexion, R on R/ L on L
Therefore a positive test or no spring?
unilateral or bilateral sacral extension, R on L/ Lon R
Determine the axis?
Opposite side of positive seated flexion/ ASIS compression test
Opposite side of tight piriformis muscle
tests to determine motion restriction
L5 rotation is opposite the sacrum?
Sacral torsion
L5 rotation is same side as sacrum?
Sacral rotation
Treatment of sacral rotation vs torsion?
same
Unilateral Sacral flexion?
Base anterior and ILA posterior/inferior on same side of positive flexion/ASIS
Cause- hard landing on foot or ischial tuberosity
may be accompanied bu superior innominate shear or posterior innominate rotation
Unilateral sacral extension?
Base anterior and ILA p/i on opposite side of positive seated flexion/ASIS
cause- strong leg tug
may be accompanied by inferior innominate shear or anterior innominate rotation
If low back pain not have positive seated flexion or ASIS compression and sacral landmarks are symmetrical?
check to see if lumbar curve is reduced/ exaggerated
motion test the sacrum
use the spring and backward bending test (pos indiactes bilateral sacral extension)
Positive seated flexion test/ASIS compression test?
palpate sacral base and ILA
Negative seated flexion test/ ASIS compression test?
check pelvis or lumbar spine
Base anterior, ILA opposite?
Do motion test Extension restrict= forward rotation flexion restrict= backward rotation Test L5 rotation Opp sacrum= sacral torsion Same sacrum= sacral rotation
Base anterior, ILA same side?
Seated flexion test + same side= unilateral flexion
Seated flexion test + opp side= unilateral extension
Neg spring test indicates?
That the sacrum can move into flexion and its restricted in extension, therefore backward rotation
