Sacral Somatic Dysfunction Flashcards
What elements are in the sacral static testing?
- sacral sulcus
- L5 rotation
- Inferior lateral angle (ILA)
- 4 digit examination
How do you test the sacral sulcus?
1) palpate the PSIS
2) move thumbs medially and inferiorly
3) check for symmetry (deep or shallow)
How do you test L5 rotation?
1) palpate lumbar spine at level of T5
2) check for symmetry (L5 rotation)
How do you test the ILA?
1) palpate with the heel of the hand in the midline down sacrum until it drops anteriorly
2) place one thumb near the thenar eminence to feel the inferior lateral angle of the sacrum
3) place the other thumb roughly symmetrical to the first
4) adjust slightly to find the inferior lateral angle
5) compare each side for posterior/anterior and cephalad/caudal (inferior/superior)
How do you perform the 4 digit evaluation?
1) place the first fingers in the sacral sulci
2) place the thumbs at the ILA
3) evaluate for symmetry
What are the main steps of sacral testing?
1) static testing
2) motion testing
3) diagnosis
What are the 3 types of motion testing?
Lateralization
Active
Passive
What is the test for lateralization?
seated forward bending test
What is the test for active motion?
backward bend test (sphinx)
respiratory motion test
What is the test for passive motion?
lumbosacral spring test
oblique axis passive motion
Describe the seated forward bending test
- tells the side of the dysfunction
- negative in bilateral dysfunction
- unilateral = positive test on side of dysfunction
- torsion = positive test is opposite of the side of the axis (2nd letter of diagnosis)
Give the steps of the seated forward bending test
1) pt seated with both feet flat on the floor
2) physician’s eyes at level of patient’s PSIS’s
3) physicians thumbs are placed on the inferior aspect of the patient’s PSISs and a firm pressure is directed on the PSISs
4) pt instructed to bend forward as far as possible within a pain-free range
5) test is + on side where the thumb (PSIS) moves more cephalad (superior) at the end range of motion; a + test identifies the side of sacroiliac dysfunction, not the specific type of dysfunction
What do the active motions tests look for?
flexion and extension motion
Give the steps of the backward bending test (sphinx)
1) pt lying prone on a treatment table
2) physician stands with dominant eye at level of patient’s sacral sulcus
3) physician’s thumbs placed at sacral sulci, note symmetry
4) pt instructed to backward bend as far as possible within a pain-free range
5) test is + when sacral sulcus appears asymmetrical throughout or the asymmetry gets worse with movement; a positive backward bending test shows the sacrum is unable to flex (extended sacrum)
Give the steps of the respiratory motion test
1) place cephalad hand over the sacrum with thenar and hypothenar eminence at the sacral base and fingertips at the apex
2) place the other hand on top of the cephalad hand pointing in the opposite direction
3) have patient exaggerate inhalation and exhalation
- bilateral sacral base should move posteriorly during inhalation and anteriorly during exhalation
What does the Lumbar spring test define?
flexion/extension
What does the oblique axis passive motion define?
dysfunctional oblique axis
Give the steps of the lumbar spring test
1) patient lying prone on table
2) heel of physician’s hand placed over spinous process of the lumbar spine
3) pressure exerted through the heel of the hand toward the table (extending the lumbar spinal region)
4) test is + when the lumbar spine does not move well into extension; + test shows sacrum is unable to flex (extended sacrum)
Should the lumbar spring and backward bending test be the same?
yes; both are + if sacrum is extended
Give the steps of the oblique axis passive motion test
1) patient prone, physician at side
2) physician places monitoring finger at sacral sulcus and heel of opposite hand on contralateral ILA
3) physician applies anterior pressure with heel of hand at the ILA while monitoring for posterior motion at the opposite sulcus
4) repeat test on opposite sulcus and ILA
Which sacral axis tests respiratory and craniosacral motion?
superior transverse axis (S2 posteriorly)
Which sacral axis tests postural motion?
middle transverse axis (S2 anteriorly)
-dysfunction along this axis will have bilateral findings
Which sacral axis tests innominate rotation?
inferior transverse axis (S3)
How will a dysfunction along the oblique axis present?
deep sacral sulcus on opposite side of the posterior/caudal ILA
How will a dysfunction along a vertical axis present?
deep sacral sulcus on the same side as the posterior/caudal ILA
Define a torsion
- restricted along oblique axis
- may be restricted in flexion or extension
Define unilateral diagnosis
- restricted along a vertical axis
- may be restricted in flexion or extension
Define bilateral diagnosis
- restricted along the middle transverse axis
- may be restricted in flexion or extension
What does it meant if the sacral base is held anteriorly?
flexed or forward tosion
What does it mean if the sacral base is held posteriorly?
extended or backward torsion
How are torsions named?
-first part is named for the rotation of the sacrum (direction it is facing)
-second part is named for axis involved
Ex) Left rotation on a right oblique axis sacral torsion: L/R ST
What are examples of flexed/forward torsions?
Left on Left sacral torsion
Right on Right sacral torsion
What are examples of extended/backward torsions?
Left on Right sacral torsion
Right on Left sacral torsion
Left Rotation on Left Axis ST
Flexed: negative BBT and LS (gets better)
Deep sacral sulcus on the right
Posterior/caudal ILA on the left
SeFBT: positive on the right
Right Rotation on Right Axis ST
Flexed: negative BBT and LS (gets better)
Deep sacral sulcus on the left
Posterior/caudal ILA on the right
SeFBT: positive on the left
Left Rotation on Right Axis ST
Extended: positive BBT and LS
Deep sacral sulcus on the right
Posterior/caudal ILA on the left
SeFBT: positive on the left
Right Rotation on Left Axis ST
Extended: positive BBT and LS
Deep sacral sulcus on left
Posterior/caudal ILA on the right
SeFBT: positive on the right
Where is the base held in a flexed or forward unilateral?
anteriorly
Where is the base held in extended or backward unilateral?
posteriorly
What is the relationship between the deep sacral sulcus and posterior/caudal ILA for a unilateral?
SAME SIDE
Right Sacrum Flexed Unilateral
Flexed: negative BBT and LS
Deep sacral sulcus on the right
Posterior/caudal ILA on the right
SeFBT: positive on the right
Left Sacrum Flexed Unilateral
Flexed: negative BBT and LS
Deep sacral sulcus on the left
Posterior/caudal ILA on the left
SeFBT: positive on the left
Left Sacrum Extended Unilateral
Extended: positive BBT and LS
Deep sacral sulcus on the right
Posterior/caudal ILA on the right
SeFBT: positive on the left
Right Sacrum Extended Unilateral
Extended: positive BBT and LS
Deep sacral sulcus on the left
Posterior/caudal ILA on the left
SeFBT: positive on the right
Bilateral Sacrum Flexed
Bilateral deep sacral sulcus
Bilateral posterior/caudal ILA
SeFBT: negative (no lateralization)
Bilateral Sacrum Extended
Bilateral shallow sacral sulcus
Bilateral anterior/cephalad ILA
SeFBT: negative
What is the relationship of L5 to the sacrum
should be rotated in the opposite direction of the sacrum for balance
What happens if the L5 is not rotated in the opposite direction of the sacrum?
Uncompensated; should be treated before the sacral dysfunction
What does a flexed sacrum indicate about L5?
L5 is neutral (type 1)
What does an extended sacrum indicate about L5?
L5 is flexed/extended (type 2)
Which direction should L5 sidebend in relation to the sacrum?
L5 sidebends toward the oblique axis of torsion
