Sacral Treatment (Test 1) Flashcards
1
Q
Muscle Energy
Bilateral Sacral Flexion
A
- Pt PRONE, physician standing BESIDE pt
- Place Thenar and Hypothenar eminence of CAUDAD hand on ILAs (ie the apex of the sacrum). Cephalad hand goes on top of this hand
- Apply an Anterior & Superior force on the ILAs. As patient inhales, exaggerate sacral extension by applying the anterior force. Resist sacral flexion during exhalation.
- Repeat this process for 3-5
respiratory cycles.
2
Q
Muscle Energy
Bilateral Sacral Flexion
A
- Pt prone in sphinx position, physician standing beside pt
- Place index and middle finger of caudad hand on sacral sulcus. Cephalad hand goes on top of this hand
- As patient inhales, resist sacral extension. As pt exhales, exaggerate sacral flexion by applying an anterior & inferior force
- Repeat this process for 3-5 respiratory cycles.
3
Q
Muscle Energy
Unilateral Sacral Flexion
A
- Pt prone, physician stands on side of dysfunction
- Palpate sacral sulcus/base of the sacrum with cephalad hand.
- The caudad hand abducts (usually about 15°) and internally rotate hip of the affected side to find loosest packed position
- Place heel of caudad hand on ILA of dysfunctional side. Place cephalad hand on top of that hand.
- Exert ANTERIOR/ SUPERIOR force on ILA. As patient inhales, continue downward force on ILA to encourage the sacral extension. As pt exhales, resist motion of sacrum to prevent sacral flexion. Repeat until no new barriers.
4
Q
Muscle Energy
Unilateral Sacral Extension
A
- Pt in prone, sphinx position. Physician standing on side of dysfunction.
- Palpate sacral sulcus/base of the sacrum with cephalic hand
- The caudad hand abducts 15° and internally rotate hip of the affected side to find loosest packed position
- Place hypothenar eminence cephalad on sacral sulcus on side of dysfunction. Place caudad hand on top of that hand
- Exert anterior/inferior force on sacral sulcus. Have pt inhale and exhale. As they inhale, resist sacral extension. Encourage sacral flexion by exerting an anterior force on the sacral sulcus during exhalation.
- Repeat this process for 3-5 respiratory cycles
5
Q
Muscle Energy
Forward Torsion (L on L or R on R)
A
- Pt in modified Sims position with axis side down. Hips and knees are flexed to 90° w/chest down on the table as much as possible and arms hanging over the table
- Physician at side of table, monitoring at L5-S1 interspace.
- Flex the hips & knees until motion is felt at the monitoring hand.
- Pt inhales and exhales deeply 3 times, reaching with their hand, on side opposite the axis, toward the floor after each exhalation (induces additional rotation)
- Rest pt’s knees on your thigh. Caudad hand grasps pt’s heels to flex or extend hips (rare) until L5 is neutral relative to S1
- With caudad hand, lower patient’s legs towards floor by pushing at the feet until reaching sidebending restrictive barrier
- Instruct pt to lift their feet up upwards (ie towards the ceiling) for 3-5 secs, then pt relaxes.
- Move pt into next barrier by pushing feet further towards floor. Repeat ME technique until no new barriers met.
6
Q
Muscle Energy
Backward Torsion (R on L or L or R)
A
- Pt at edge of table in lateral recumbent position with axis side down. Flex top hip & knee to 90°. Pull pt’s lower arm toward physician to produce posterior rotation so that pt’s back gets closer to table and front faces ceiling
- Instruct pt to take 2-3 deep breaths, after each exhalation have the pt reach back with the top arm.
- Physician standing facing the patient, monitoring L5-S1 interspace. Place pt’s top foot on thigh and induce further flexion of top hip & knee until motion is felt at monitoring hand.
- Apply gentle force on pt’s knee towards the floor (adducting top hip), until motion is palpated at L5-S1
- Instruct pt to lift leg up against your hand (upward/towards the ceiling into abduction) for 3-5 secs, then pt relaxes.
- Move pt into next barrier by flexing hip and knee more and pushing knee towards the floor. Repeat ME technique until no new barriers met.
7
Q
HVLA
Bilateral Sacral Flexion
A
- Pt in prone position with physician at side of bed
- Thenar and hypothenar eminences of caudad hand are placed on ILAs just above the apex of the sacrum, with cephalad hand on top (do not
place heel on coccyx)
- Apply an anterior & superior force on ILAs during inhalation to
exaggerate sacral extension. Resist flexion motion during exhalation and then increase anterior/superior force.
- Doc applies a few rounds of ME as described above.
- As patient inhales on last ME cycle, apply a quick anterior & superior HVLA thrust to sacral apex.
8
Q
HVLA
Bilateral Sacral Extension
A
- Pt in prone position with physician at side of bed
- Thenar and hypothenar eminences of cephalad hand are placed on base of sacrum, with caudad hand on top.
- Apply an anterior & inferior force on base during exhalation to
exaggerate sacral flexion. Resist extension motion during inhalation and then increase anterior/inferior force.
- Doc applies a few rounds of ME as described above.
- As patient exhales on last ME cycle, apply a quick anterior & inferior HVLA thrust to sacral base.
9
Q
HVLA
Backward Sacral Torsion
A
- Pt in supine position with physician on side of involved axis (deep sacral sulcus)
- Sidebend pt’s lower extremity and torso away from deep sulcus, creating a “C-shape”
- Pt clasps hands behind neck.
- Physician places thenar eminence of caudad hand on pt’s ASIS on the
side opposite deep sulcus (opposite side physician is standing on)
- Physician places cephalad hand over pt’s opposite shoulder and
through space created by upper arm and forearm, resting dorsum of hand on the manubrium, this will be the rotational lever
- Using cephalad hand, physician induces rotation of upper torso as far as possible into barrier by pulling opposite shoulder towards self, while stabilizing and preventing motion at opposite ASIS with caudad hand.
- Pt is asked to take a deep breath and during exhalation physician applies a rotational thrust of the pt’s upper body with the physician’s cephalad hand on rotation lever, while simultaneously applying a posterior thrust on the opposite ASIS.
