Sacral Somatic Dysfunction

Question 1

Goal of manipulation?

Answer 1

restore symmetry to gait function and vertebral motion

Question 2

Pelvic girdle parasympathetic?

Answer 2

S1-S4 (uterus, prostate, genitalia, descending colon, sigmoid, and rectum)
motor and sensory (sciatica)

Question 3

Sacral base anterior?

Answer 3

antaomical flexion, forward bending

SBS is in extension (nutation)

Question 4

Sacral base posterior?

Answer 4

Anatomical extension, backward bending

SBS is in flexion (counternutation)

Question 5

Postural sacral motion?

Answer 5

occurs when the patient is seated or standing

Question 6

Inherent sacral motion?

Answer 6

occurs when the sbs in the head flexes and extends (sacral motion)

Question 7

Dynamic sacral motion?

Answer 7

occurs during walking

Question 8

Superior transverse axis?

Answer 8

respiratory motion and inherent motion

horizontal axis posterior to the point of attachment at the level of s2

Question 9

Respiration movement?

Answer 9

inhale spine elongates- sacral base posterior

exhale spine recoils- sacral base anterior

Question 10

movement during inherent motion of CRI?

Answer 10

cranial flexion- sacral base posterior-counternutates

cranial extension- sacral base anterior/nutates

Question 11

Middle transverse axis?

Answer 11

postural motion

horizontal axis located at the anterior convexity of upper and lower limbs of sacroliliac joint

Question 12

Seated sacral motion?

Answer 12

when seated/flexion of torso- sacral base moves anterior

when seated/extension of torso- sacral base moves posterior

Question 13

standing sacral motion?

Answer 13

the sacral base moves posterior when standing and bending over/flexing torso

Question 14

Inferior transverse axis?

Answer 14

innominates rotate about, ilia on the sacrum

horizontal axis that passes through the inferior articular surface of the sacrum

Question 15

Other axis of movement?

Answer 15

left oblique axis, right oblique axis, vertical axis

these axes come into play during ambulation

Question 16

name oblique axis?

Answer 16

for the superior end

Question 17

Sacral base?

Answer 17

uppermost posterior part of the sacrum
just medial to PSIS
identify the one that is anterior

Question 18

Inferior lateral angle?

Answer 18

palpate lateral to the base of the coccyx

identify the side that is more posterior and/or inferior

Question 19

Diagnose sacral SD?

Answer 19

Asymmetry of paired sacral landmarks
Asymmetry of range of motion of sacroiliac joint
Tissue texture changes

Question 20

4 steps to make the somatic dysfunction diagnosis?

Answer 20

Perform seated flexion test
Palpate the sacral landmarks
Motion tests
Palpate L5

Question 21

Seated flexion test?

Answer 21

place thumbs under PSIS
patient flexes forward with feet on the floor
side with last superior movement is side of sacroliliac restriction (pos side)

Question 22

Confirm seated flexion test?

Answer 22

ASIS compression test

Question 23

ASIS compression test?

Answer 23

positive test, restriction of posteriormedial pressure indicates SI restriction on ipsilateral side

Question 24

Is there an oblique axis?

Answer 24

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

Question 25

Describe the 2 possible motions around an oblique axis?

Answer 25

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

Question 26

What does lumbar findings (L5) tell you about sacral rotation and sacral oblique axis?

Answer 26

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

Question 27

Does not involve an oblique axis?

Answer 27

unilateral flexion/ extension | bilateral flexion/ extension

Question 28

Evaluate range of motion of sacroiliac joint?

Answer 28

seated flexion test and/or ASIS compression test Backward bending test lumbosacral springing test

Question 29

Palplate the static sacral landmarks?

Answer 29

Sacral base, named for anterior side Inferior lateral angle, names for side that is more posterior/ inferior

Question 30

Tests that evaluate the sacral base/ lumbosacral junction to flex?

Answer 30

Lumbar spring test, Backward bending test

Question 31

If sacrum is already flexed?

Answer 31

then there is no problem flexing it more, get a negative test Forward sacral torsion, forward sacral rotation, unilateral flexion, bilateral flexion

Question 32

If the sacrum is extended?

Answer 32

then it cannot flex more and you get a positive test | backward sacral torsion, backward sacral rotation, unilateral extension, bilateral extension

Question 33

Lumbar spring test?

Answer 33

Pos=resistance to springing, sacral extension or backward rotation on oblique axis neg= ease of spring, sacral flexion or forward rotation/torsion

Question 34

Backward bending test?

Answer 34

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

Question 35

Therefore a negative test or spring indicates?

Answer 35

unilateral or bilateral sacral flexion, R on R/ L on L

Question 36

Therefore a positive test or no spring?

Answer 36

unilateral or bilateral sacral extension, R on L/ Lon R

Question 37

Determine the axis?

Answer 37

Opposite side of positive seated flexion/ ASIS compression test Opposite side of tight piriformis muscle tests to determine motion restriction

Question 38

L5 rotation is opposite the sacrum?

Answer 38

Sacral torsion

Question 39

L5 rotation is same side as sacrum?

Answer 39

Sacral rotation

Question 40

Treatment of sacral rotation vs torsion?

Answer 40

same

Question 41

Unilateral Sacral flexion?

Answer 41

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

Question 42

Unilateral sacral extension?

Answer 42

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

Question 43

If low back pain not have positive seated flexion or ASIS compression and sacral landmarks are symmetrical?

Answer 43

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)

Question 44

Positive seated flexion test/ASIS compression test?

Answer 44

palpate sacral base and ILA

Question 45

Negative seated flexion test/ ASIS compression test?

Answer 45

check pelvis or lumbar spine

Question 46

Base anterior, ILA opposite?

Answer 46

``` Do motion test Extension restrict= forward rotation flexion restrict= backward rotation Test L5 rotation Opp sacrum= sacral torsion Same sacrum= sacral rotation ```

Question 47

Base anterior, ILA same side?

Answer 47

Seated flexion test + same side= unilateral flexion | Seated flexion test + opp side= unilateral extension

Question 48

Neg spring test indicates?

Answer 48

That the sacrum can move into flexion and its restricted in extension, therefore backward rotation