Sacral Somatic Dysfunction Flashcards
LSF/LSE
Left Sacral Flexion/Extension
- Unilateral
RSF/RSE
Right Sacral Flexion/Extension
- Unilateral
BSF/BSE
Bilateral Sacral Flexion/Extension
L/L ST
Left rotation on a Left axis Sacral Torsion
L/R ST
Left rotation on a Right axis Sacral Torsion
R/R ST
Right rotation on a Right axis Sacral Torsion
R/L ST
Right rotation on a Left axis Sacral Torsion
What are the steps to sacral testing?
- Static Testing
2. Motion Testing
What are the Static Tests for sacral testing?
Sacral sulcus
Inferior lateral angle (ILA)
L5 rotation for torsions
Describe the setup for the sacral sulcus static test
Palpate PSIS with thumbs and then move them medially and inferiorly
- Check for symmetry
If the sacral sulcus static test feels deeper on one side compared to the contralateral side, it is considered?
Anterior
If the sacral sulcus static test feels shallower on one side compared to the contralateral side, it is considered?
Posterior
Describe the setup for the Inferior Lateral Angle static test (ILA)
Palpate with heel of hand down midline sacrum until it drops anteriorly
- Place 1 thumb on side of hand to feel ILA and then mirror its placement with the other thumb
- Compare each side for anterior/posterior and superior/inferior
What shape can be used to diagram the physical exam findings of the sacrum?
Home plate
What are the 3 categories of motion testing for sacral testing?
Lateralization
Active motion
Passive motion
What is the lateralization test for sacral motion testing?
Seated Forward Bending Test
What does a (+) Seated Forward Bending Test tell you?
Unilateral - side of dysfunction
Torsion - opposite side of axis
When will a Seated Forward Bending Test be negative?
With a bilateral dysfunction!
Describe the setup for the Seated Forward Bending Test for sacral motion
- Pt seated with feet on the floor and the physician’s eyes level with the PSIS
- Physician’s thumbs are placed on the inferior aspect of the PSIS
– Pt instructed to bend forward
(+) = one of physicians thumbs moves superior!
What are the active motion tests for sacral motion testing?
- Backward Bending (sphinx) Test
2. Respiratory Motion Test
Describe the setup for the Backward Bending (sphinx) Test
Pt lies prone and physician’s thumbs are placed in the sacral sulcus on each side (inferomedial to PSIS)
- Pt instructed to bend backward
(+) = asymmetrical sacral sulci throughout bending
What does a (+) Backward Bending Test indicate?
EXTENDED sacrum
What does a (-) Backward Bending Test indicate?
Flexed sacrum - sacral sulci appear symmetrical during movement
Describe the setup for the Respiratory Motion Test
Pt lies prone and physician places hand over sacrum and other hand on top of 1st hand
- Have patient breathe in and out
- During inhalation = sacrum posterior
- During exhalation = sacrum anterior
What are the passive motion tests for sacral motion testing?
Lumbar Spring Test
Oblique Axis passive motion test
What does the lumbar spring test tell you?
If sacrum is flexed or extended
Describe the setup for the lumbar spring test
Pt lies prone and physician places hand over spinous processes of lumbar spine
- Then presses downward attempting to induce extension
(+) test for a lumbar spring test feels like and indicates?
Feels resistant to compression (extension)
(+) = EXTENDED sacrum
(-) test for a lumbar spring test indicates?
Flexed sacrum
What 2 tests will have the same results?
Backward Bending Test (BBT) AND
Lumbar Spring Test (LS)
What does the Oblique Axis passive motion test tell you?
Used to confirm torsion or not
How is the axis determined with the oblique axis passive motion test?
Side around which there is the GREATEST MOTION
Describe the setup for testing for a left oblique axis using the oblique axis passive motion test
- Doc’s left thumb over LEFT ILA
- Doc’s right thumb is over RIGHT SACRAL BASE
- Applies alternating pressure between thumbs to assess motion
What are the sacral axes?
Superior transverse axis - S2 posteriorly Middle transverse axis - S2 anteriorly Inferior transverse axis - S3 Left and Right oblique axes Vertical Axis
What type of dysfunction will you find around the middle transverse sacral axis?
BILATERAL FINDINGS
- both sacral bases anterior
- both ILAs posterior
- or vice versa
Innominate motion is around which sacral axis?
Inferior transverse axis - S3
Describe the dysfunction that will be found around either a Left Oblique or Right Oblique axis
It will have an anterior sacral sulcus on the OPPOSITE side of the posterior ILA
OR
Posterior sacral sulcus on the OPPOSITE side of the anterior ILA
Describe the dysfunction that will be found around the vertical axis
It will have an anterior sacral sulcus on the SAME side as the posterior ILA
OR
Posterior sacral sulcus on the SAME side as the anterior ILA
Unilateral sacral dysfunctions are restricted around what axis?
Vertical axis
Bilateral sacral dysfunctions are restricted around what axis?
Middle transverse axis
Torsion sacral dysfunctions are restricted around what axis?
Oblique axis
Unilateral sacral dysfunctions are restricted around the vertical axis. If there is an anterior sacral sulcus, where will the posterior ILA be?
SAME SIDE
Describe RSF
Right sacrum flexed
- Anterior Right sacral sulcus
- Posterior Right ILA
With a RSF, what are the results of the seated forward bend test and the BBT/LS tests?
(+) seated forward bend on the RIGHT
(-) BBT/LS
Describe LSF
Left sacrum flexed
- Anterior Left sacral sulcus
- Posterior Left IlA
With a LSF, what are the results of the seated forward bend test and the BBT/LS tests?
(+) seated forward bend on the LEFT
(-) BBT/LS
Describe LSE
Left sacrum extended
- Posterior Left sacral sulcus
- Anterior Left ILA
With a LSE, what are the results of the seated forward bend test and the BBT/LS tests?
(+) seated forward bend on the LEFT
(+) BBT/LS
Describe RSE
Right sacrum extended
- Posterior Right sacral sulcus
- Anterior Right ILA
With a RSE, what are the results of the seated forward bend test and the BBT/LS?
(+) seated forward bend on the RIGHt
(+) BBT/LS
Bilateral sacral dysfunctions are restricted around the middle transverse axis. How do the sacral sulci present?
EQUAL
With bilateral sacral dysfunctions, what is the result of the seated forward bend test?
NEGATIVE
Describe BSF
Bilateral sacral flexed
- Both sacral sulci anterior
- Both ILA posterior
Describe BSE
Bilateral sacral extended
- Both sacral sulci posterior
- Both ILA anterior
What is the static test specific for testing for torsion dysfunctions?
L5 rotation
What is the motion test specific for testing for torsion dysfunctions?
Oblique axis passive motion test
Describe L/L ST
Left rotation on Left axis sacral torsion
- Anterior Right sacral sulcus and Posterior Left sacral sulcus
- Posterior Left ILA and Anterior Right ILA
With L/L ST, what are the results of the seated forward bend test and BBT/LS tests?
(+) seated forward bend on RIGHT (OPPOSITE OF AXIS)
(-) BBT/LS
Describe R/R ST
Right rotation on Right axis sacral torsion
- Anterior Left sacral sulcus and Posterior right sacral sulcus
- Posterior Right ILA and Anterior Left ILA
With R/R ST, what are the results of the seated forward bend test and BBT/LS?
(+) seated forward bend on LEFT (OPPOSITE OF AXIS)
(-) BBT/LS
Describe L/R ST
Left rotation on Right axis sacral torsion
- Posterior Left sacral sulcus and Anterior Right sacral sulcus
- Anterior Right ILA and posterior Left ILA
With L/R ST, what are the results of the seated forward bend test and BBT/LS?
(+) seated forward bend test on the LEFT
(+) BBT/LS
Describe R/L ST
Right rotation on Left axis sacral torsion
- Posterior Right sacral sulcus and Anterior Left sacral sulcus
- Anterior Left ILA and posterior Right ILA
With R/L ST, what are the results of the seated forward bend test and BBT/LS?
(+) seated forward bend test on the RIGHT
(+) BBT/LS
L5 should be rotated ____ to the way the sacrum is rotated
OPPOSITE
Which way does L5 sidebend?
TOWARDS OBLIQUE AXIS of torsion
If L5 is not rotated opposite of the sacrum, it is considered?
Uncompensated
L/L and R/R ST… is L5 flexed or extended or neutral?
Neutral
L/R and R/L ST… is L5 flexed or extended or neutral?
Flexed/Extended
L/L and R/R ST is considered flexed or extended?
Flexed
L/R and R/L ST is considered flexed or extended?
Extended
Ex. R/R ST. Describe L5.
R/R ST = flexed
L5 = Neutral; Rotated LEFT; Sidebent RIGHT
Ex. R/L ST. Describe L5.
R/L ST = extended
L5 = F/E; Rotated LEFT; Sidebent LEFT
