Sacral torsion treatments

Question 1

What is the treatment hierarchy for the lumbar and pelvic regions?

Answer 1

Pubic subluxations, rotated innominates, lumbar dysfunction, sacral torsions, pelvis flares

Question 2

What are the three phases of the slump test?

Answer 2

Performing the actual slump, with a straight back, extending the leg, dorsiflexing the foot and adding tension to the spinal cord.

Question 3

What type of pathology are we looking for in the slump phase of the slump test?

Answer 3

Disc pathology

Question 4

What type of pathology are we looking for in the extended leg phase of the slump test?

Answer 4

Hamstring tightness

Question 5

What type of pathology are we looking for in the dorsiflexion and rounded spine section of the slump test?

Answer 5

Sciatic nerve tension

Question 6

How is the straight leg/well leg test applied?

Answer 6

Beginning on the symptomatic leg, flex the hip until the lumbar spine begins to flex. If this increases symptoms, lower the leg until the symptoms subside, then passively dorsiflex the foot.

Question 7

If symptoms occur during the leg flexion portion of the SLWL test, what type of pathology is present?

Answer 7

Disc pathology

Question 8

If symptoms occur only during the dorsiflexion portion of the SLWL test, what type of pathology is present?

Answer 8

Sciatic nerve tension

Question 9

Which portion of the SLWL test is done on the well leg?

Answer 9

Only the lifting of the leg portion. It looks for disc pathology.

Question 10

Sacral nutation

Answer 10

Flexion of the sacrum, the base moves forward.

Question 11

Sacral counternutation

Answer 11

Extension of the sacrum, the base moves backward

Question 12

Trendelenberg test application

Answer 12

Patient is asked to stand on one foot, typically with the other leg behind. Therapist looks for symmetry in the angles

Question 13

Trendelenberg’s test tests for what?

Answer 13

Weakness in the glute med on the weight-bearing side.

Question 14

Positive sign of the Trendelenberg test

Answer 14

Some bending away from the weight bearing side

Question 15

Kinesiology of the Trendelenberg test

Answer 15

Closed chain adduction occurs because the glute med is too weak to hold the position. The acaetabulum rolls and glides inferior and lateral.

Question 16

Muscles which can cause an anteriorly rotated innominate

Answer 16

Tight rectus femoris and weak hamstrings

Question 17

Muscles which can cause a posteriorly rotated innominate

Answer 17

Tight hamstrings and weak rectus femoris

Question 18

Muscles which can cause an inflare

Answer 18

Tight iliacus and weak glute med, min and TFL

Question 19

Muscles which can cause an outflare

Answer 19

Tight glute med, min and TFL and a weak iliacus

Question 20

Muscles which can cause a pubic subluxation

Answer 20

Tight adductors cause an inferior subluxation, weak adductors cause a superior subluxation

Question 21

Describe a SIM

Answer 21

The patient resists the therapist with mild to moderate effort. There is no takeup in between. Each session lasts 3-5 seconds.

Question 22

Application of a SIM for a superior pubic subluxation

Answer 22

Patient supine with the affected leg off of the table. Therapist stabilizes opposite ASIS and inside the affected knee. Patient effort is to move affected leg up and over their body.

Question 23

Application of a SIM for an inferior pubic subluxation

Answer 23

Patient supine with hip flexed to at least 90 degrees. Therapist stabilizes this position. Patient effort is to push the knee up and over the shoulder of the therapist.

Question 24

Application of a SIM for a pelvic inflare

Answer 24

Patient supine and in FABER position. Therapist immobilizes both ASIS as well as placing an arm down the femur. Patient effort is to push their knee into the therapist’s elbow.

Question 25

Application of a SIM for a pelvic outflare

Answer 25

Patient supine with the foot on the problem side place over the other knee. The therapist hooks their hand under the same side PSIS and their other hand pushes the knee. Patient effort is abduction.

Question 26

Application of a SIM for posteriorly rotated innominate

Answer 26

Patient prone with affected side knee flexed to 90 degrees. Therapist places one hand under the knee and the other on the same side PSIS. Patient effort is to bring down the knee.

Question 27

Application of a SIM for anteriorly rotated innominate

Answer 27

Patient die-lying with treatment side up. The bottom leg is straight and the top leg is bent. Therapist stabilizes at the knee with their hip, on the ASIS and ischial tuberosity. Patient effort is to contract into the leg.

Question 28

If a SIM treated the issue, what exercise should be assigned?

Answer 28

Planks

Question 29

How is an multifidi tested?

Answer 29

Watch for compensatory motion during the seated flexion test, feel the TPs of lumbar vertebrae. Check lumbar rotation and side bending.

Question 30

How is piriformis tested?

Answer 30

For A and P, the patient is prone on the table and medial rotation is examined. Watch for the innominate lifting off of the table.

Question 31

How can we bias for the piriformis during passive tests

Answer 31

Place the patient supine with the knee and hip at 90 degrees, then rotate the foot in.

Question 32

How is psoas tested?

Answer 32

Test hip extension with the fingers on the lumbar vertebrae. When the psoas starts pulling, the SPs of the lumbar vertebrae may start turning.

Question 33

Application of an IIT for piriformis

Answer 33

Patient in recovery position. Palpate the sacrum and extend the hip until the sacrum starts to move. Bring knee to 90 degrees of flexion and rest the hand inside the knee. Patient effort is to push the knee into the hand. Take-up is to twist the spine.

Question 34

Application of IIT for multifidi

Answer 34

Patient side-lying with treatment side up. Flex both hips and knees to at least 90 degrees for pre-stretching. Patient effort is booty pop and take up is rotation towards the back.