Sacrum Flashcards
What two locations of the sacrum are we feeling?
- Sacral sulci
- ILAs
Sacrum TART Eval
Palpate:
1. Quadratus lumborum
2. Erector Spinae m.
3. Piriformis m
4. Hamstrings
Posterior and ________ always occur together.
Inferior
Anterior and _______ always occur together.
Superior
What types of motion does the sacrum perform?
- Flexion: base moves anterior and apex moves posterior
- Extension: base moves posterior and apex moves anterior
What types of flexion SDs can the patient have?
- LSF (left sacral flexion)
- RSF (right sacral flexion)
- BSF (bilateral sacral flexion)
What types of extension SDs can the patient have?
- LSE (left sacral extension)
- RSE (right sacral extension)
- BSE (bilateral sacral extension)
What types of torsions can the patient have?
Two types: forward and backward
Foward:
- Right rotation on a R axis sacral torsion (R/R ST)
- Left rotation of a L axis sacral torision (L/L ST)
Backward
- Left rotation on a right axis sacral torsion (L/R ST)
- Right rotation on a left axis sacral torision (R/L ST)
- LSF (left sacral flexion)
- RSF (right sacral flexion)
- BSF (bilateral sacral flexion)
Describe what you would find.
- LSF= L sacral sulci is anterior; L ILA is posterior.
- RSF= R sacral sulci is anterior; R ILA is posterior.
- BSF= Sacral sulci: anterior; ILAs: posterior
For L/R; the opposite sides should be opposite.
Sacral sulci are anterior; ILA is posterior
- LSE (left sacral extension)
- RSE (right sacral extension)
- BSE (bilateral sacral extension)
Describe what you would see.
- LSE: L sacral sulci is posterior; L ILA is anterior
- RSE: R sacral sulci is posterior; R ILA is anterior
- BSE: both sacral sulci are posterior; both ILA are anterior
sacral sulci are posterior; ILAs are anterior.
Two types of torsion: forward and backward
Foward:
- Right rotation on a R axis sacral torsion(R/R ST)
- Left rotation of a L axis sacral torision (L/L ST)
Backward
- Left rotation on a right axis sacral torsion (L/R ST)
- Right rotation on a left axis sacral torision (R/L ST)
Describe what you would see.
FWDS:
- Right rotation on a R axis sacral torsion(R/R ST): L sacral sulci is anterior; R ILA is posteior
- Left rotation of a L axis sacral torision (L/L ST): R sacral sulci is anterior; L ILA is posterior.
BCKWARDS:
- Left rotation on a right axis sacral torsion (L/R ST): L sacral sulci is posterior; R ILA is posterior.
- Right rotation on a left axis sacral torision (R/L ST): R sacral sulci is posterior; L ILA is anterior
How do I diagnose?
- Conduct lateralization test (will tell you if a L/R sided problem): seated flexion test.
- Conduct: lumbar spring test, backward bending sphinx test, respiratory motion test (will tell if you if F/E)
- Active (sphinx)
- Passive (backward bending sphinx, respiratory motion test)
- 4-point static sacral eval will tell you exactly. what it is.
What laterization test do we perform?
Seated flexion test.
Seated flexion test
- Have pt seated with feet on floor.
- Doc is behind pt at eye level with PSIS.
- Put both thumbs on the patients PSIS and ask the pt to bend foward
- Look to see which goes superior more;
- If R moves 1st -> + on right -> R-sided dysfunction
- If L moves 1st -> + on L -> L sided dysfunction
- If (-) -> no sacral dysfunction or pt has a bilateral dysfunction
What tests will tell us if it is a forward/backward (flexed/extended) SD?
1. Lumbar spring test
2. Backward bending sphinx test
3. Sacral mobility during respiration test
Lumbar Spring Test
- With patient laying prone, push down on the lumbrosacral junction several times.
- Positive test: resistance to springing; sacrum is extended (likes to move posterior)
- Negative test: ease of springing; sacrum is flexed (likes to move anterior)
Backward bending sphinx test
- Patient lays down prone
- Put thumbs on the sacral sulci and note which one is deeper.
- Tell pt to get in TV watching position and see what thumbs do.
- test: inequity between L/R increases; sacrum is sitting backwards (posteriorly) extended SD
- test: sacral sulci even out; sacrum is sitting forward or anterior; pt has a flexed SD.
- test: inequity between L/R increases; sacrum is sitting backwards (posteriorly) extended SD
Sacral Mobility During Respiration
- Cup the sacrum
- Push on it.
- Ask pt to breath deeply in and out.
- Follow with hands.
- Sacrum is extended if: it doesnt like to go forward when pt breathes out, but likes to go back when pt breathes in/
* Sacrum is flexed if: it likes to drop when exhales but does not like to up when inhales.
- Sacrum is extended if: it doesnt like to go forward when pt breathes out, but likes to go back when pt breathes in/
How do you decide which corner is the problem?
4 point sacral evaluation test
4 point sacral evaluation test
Used to diagnose sacral torsion dysfunction
- Pt is on stomach
- Put 2 index fingers on the sacral sulcus
- Put 2 thumbs on the ILA.
- Apply pressure
Unilateral Sacral Extended MET/ART
ON SIDE WITH THE PROBLEM:
- Pt is prone; Externally rotate and abduct the leg.
- Take palm, but it on part that is sticking out (if L extended, put palm on L sacral sulcus)
- ART: spring back and forth
- MET: have patient breath in and out deeply;
- Inhalation (breathe in)- resist
- Exhalation (breathe out) - push
Unilateral Sacral FLEXED MET/ART
ON SIDE OF DYSFUNCTION:
- Pt is prone; Internally rotate and abduct the leg
- Place palm on ILA that is sticking out (whatever side you have dysfunction on)
- ART: spring until motion improves
MET: have patient breathe deeply;
- Inhalation (breathes in): push
- Exhales (breathes out): resist
Bilateral Extended Sacrum MET/ART
- Tell patient to get in TV watching position
- Abduct and externally rotate legs.
- Put hand over base of the sacrum
- Tell pt to breathe deeply in and out.
- ART: spring
- MET:
- When patient inhales, resist.
- When patient exhales, push down.
- Repeat 3-5 times or until no new barriers.
Bilateral Flexion Sacrum MET/ART
- Pt. is prone
- Internally rotate and abduct both legs.
- Put hand in between ILAs
- Tell pt to breathe deeply in and out.
- ART: spring
- MET:
- When patient inhales, push.
- When patient exhales, resist
- Repeat 3-5 times or until no new barriers.
Forward torsions MET or ART.
(L on L or R on R)
- Patients lays on side with axis side down.
- Pt puts chest toward the table
- Move BOTH thighs off the table at 90 degrees and monitor at S1.
- Drop BOTH legs off of the table
- ART: spring legs down
- MET: push down while telling patient to push up for 3-5. seconds. relax for 1-2 seconds. go to next barrier and repeat 3-5 times.
- RETURN THE PATIENT TO NEUTRAL.
- FEET SHOULD NOT TOUCH THE FLOOR
Backward sacral torsion
L on R
R on L
- Patients lays on side with axis side down.
- Pt puts back toward the table
- Move ONE thigh off the table at 90 degrees and monitor at S1.
- Drop ONE leg off of the table
- ART: spring legs down
- MET: push down on knee while telling patient to push up for 3-5. seconds. relax for 1-2 seconds. go to next barrier and repeat 3-5 times.
- RETURN THE PATIENT TO NEUTRAL.
- DO NOT PUT FEET ON TABLE
what do you see in
L unilateral flexion
R unilateral flexion
Bilateral unilateral flexion
what do you see in
L unilateral extension
R unilateral extension
Bilateral unilateral extension
What do you see in
Forward torsions
What do you see in
backward torsions
