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FMLT > Sacrum > Flashcards

Sacrum Flashcards

1
Q

Assessment of Sacrum includes

A
  1. position of sacral base and superior body with weight shift. Efficient state = sacrum remains level w/ WS or motions of the LE, incl SLS.
  2. PA assessment at base, middle, and caudal segments.
  3. Caudal and cranial glide w/ respect to innominates during LTR. In efficient state, the sacrum remains level during this motion.
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2
Q

What FMs are used in mobilization of sacrum

A

Cranial and caudal glide: bilateral hip rotation

PA mobilization: Active LTR, bil knee extension, hip rotation, upper trunk extension, LE abduction

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3
Q

Corresponding hip and innominate motion for PD

A

Hip: abducts, internally rotates, extends
Innominate: abducts, inflare, depresses, internally rotates, anterior torsion

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4
Q

Corresponding hip and innominate motion for AD:

A

Hip: Adducts, flexes, externally rotates
Innominate: adducts, outflare, depresses, posterior torsion,

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5
Q

In order to not treat the sacrum or innominates through a “dirty lever arm”, we have to

A

Assess hip if treating innominate or sacrum through hip, and spine if treating either of these in seated position, treating dysfunctions.

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6
Q

During the swing test, in an efficient state, the innominate moves with the

A

Hip

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7
Q

During swing test, in an efficient state, the sacrum moves with the

A

Spine

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8
Q

Evaluation of the innominates includes:

A
  1. position of PSIS and iliac crest with weight shift. Efficient state = innominates remain level w/ WS or motions of the LE, incl SLS.
  2. Leg swing
  3. HISL
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9
Q

What would be an “efficient” finding on the swing test

A

Movement is smooth and end range is reached without abrupt stopping
Sacral motion should be independent from iliac motion
Innominate moves before sacrum moves

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10
Q

Normal ranges of motion for HISL

A

Hip: 0 - 110 degrees
Innominate: 110 degrees to 130 degrees
sacrum: 130 degrees to 150
L5= 150 +

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11
Q

When we assess hip flexion/ impingement dysfunctions, we look at:

A
  1. FADIR and IR/ER to assess for impingement
  2. Posterior tissue restriction and neural tension by flexing hip and extending knee
  3. Glute max restriction along interface with hamstring.
  4. inferior glide and posterior hip restrictions
  5. innominate ER mobility–assess iliacus, mobilize innominate into external rotation
  6. Play of inguinal and iliopsoas tendon, ability to travel smoothly through inguinal canal
  7. Depression of the pubic ramus (tx and then retrain in new range)
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12
Q

Mobilizing a hip into inferior glide

A

Wind hip up in 3 dimensions with abd/add and IR/ER; add lateral distraction with strap around pelvis. Add contract relax.

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13
Q

How do we treat an upslip/elevation of the innominate in supine

A

In supine with sacrum blocked, long axis traction with CR. Wind up barrier with ER/IR and treat by resisting unilateral pelvic elevation (hip hike).
Upslip more common than depression.

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14
Q

Elevation and depression of innominate can be performed

A

in supine long axis

In prone with LTR; elevation on one side with rotation indicates dysfunction on that side

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15
Q

How do we treat an upslip/elevation of the innominate in prone

A

localize restriction and mobilize with LTR, resistance to LTR

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16
Q

When assessing hip rotation, what is an efficient finding, and what is an inefficient finding?

A 
Efficient= hips stay in same relative position with pelvic shear. 
Inefficient = hip shears anteriorly w/ IR and posteriorly with ER
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17
Q

When performing hip on axis mobilization to IR what special set up is needed

A

foam roll under anterior aspect of hip to avoid anterior translation of femoral head

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18
Q

What is an efficient and inefficient finding when assessing innominate IR?

A

Efficient: PSIS moves away from sacrum for 30 degrees of IR, then sacrum comes along.
Inefficient: both sacrum and innominate move laterally at the same time.

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19
Q

What is an efficient and inefficient finding when assessing innominate ER?

A

Efficient: Innominate compresses at sacrum and then translates anteriorly.
Inefficient: Compression w/o anterior translation, with early lumbar spine motion.

20
Q

Which is treated first: Innominate IR or ER?

A

Innominate IR (gapping) is treated first as it will create distraction at the surface of the joint.

21
Q

Treatment for mobilizing innominate into IR

A

Address anterior soft tissue restrictions including iliacus.
1. Prone, localize direction of restriction in gapping at PSIS, trace w/ IR/ER of hip and apply force and potentially percussion.
2. Sidelying, one hand at PSIS, other at ASIS
Follow both with NMR of resisted ER at end range IR of hip.

22
Q

What is often the most dysfunctional component of innominate ER?

A

Anterior shear of the innomminate after compression into sacrum; treat in prone

23
Q

When assessing Innominate flexion, you must also examine what movement?

A

PA motion of pubic ramus with FADIR position; treat before treating innominate flexion.

24
Q

Steps to treating innominate flexion

A
  1. Fixate sacrum with fingers, sacral wedge, or other block.
  2. Localize restriction and place pressure on ASIS to assist FM of innominate flexion. Can also use both hands, on on ASIS and one on ischial tuberosity.
  3. To increase flexion ROM, begin with resisted hip extension and apply traction to LE during contraction. If therapist is using both hands to mobilize, pt can provide self-resistance with hands behind thigh or can place heel on therapist’s shoulder and do CR that way.
25
Q

Ways to assess innominate ab- and adduction include:

A
  1. Standing with pelvic shear.
  2. Lateral leg swing (pt abducts and adducts the hip both in front of and behind the body)
  3. Sitting with hands under ischial tuberosity, evaluating weight bearing, width and impact of trunk flexion
26
Q

Prior to tx of innominate abduction, what must be cleared?

A

Hip abduction; First perform STM to femoral head and improve play of ITB, then mobilize hip inferiorly.

27
Q

What is typically the dysfunction contributing to limited innominate abduction?

A

ITB dysfunction and limited inferior glide of the hip.

28
Q

Positioning for hip abduction (inferior glide of hip) and innominate abduction mobilization

A

Sidelying, affected hip up, strap around greater trochanter, resisted adduction; to mobilize innominate, shift hand to iliac crest, CR to adduction of the hip.

29
Q

How to treat innominate abduction in supine with combined hip flexion.

A

Pt in “happy baby” position

  1. Assess soft tissue at medial aspect of ischial tuberosity; mobilize
  2. Use ‘butterfly hand” to assess each end feel.
  3. Treat with pt holding contralateral LE in flexion and resisting adduction of thigh being treated.
30
Q

treatment of Hip and innominate abduction in supine with hip in neutral flexion (Set up, mobilization, NMR)

A

Block the opposite leg in hip flexion and IR, then take the treatment leg out into abduction.
NMR: resist flexion and IR of non-tx hip and extension/abduction of treated hip.

31
Q

Quadruped positioning for tx to improve innominate abduction

A

localize restriction through lumbar flexion and extension and add sidesitting. Sustain pressure and have pt shift back onto heels

32
Q

Positioning to treat adduction of the hip

A
  1. Tx side up, bottom leg maximally flexed
  2. Pt at the end of the table
  3. Strap under the proximal aspect of the hip, CR to abductors
33
Q

What to assess when assessing adduction of the hip and innominate with strap

A
  1. Assess hip distraction by lifting up on strap
  2. Assess end feel of hip adduction
  3. Assess ability of superior aspect of innominate for its ability to distract from superior aspect of sacrum.
34
Q

Progression for treating limited innominate extension

A
  1. evaluate leg swing and forward bending (both innominates should move at the same time and rate–in dysfunction, one will begin to move early).
  2. Evaluate and treat knee flexion, rectus and psoas, and mobilize femoral nerve by STM in norwegian position (prone quad stretch position)
  3. Tx hip extension in prone or thomas position
  4. tx innominate extension
35
Q

Normal extension mobility sequencing occurs

A

in 10 degree increments from hip to innominate to sacrum to lumbar spine.

36
Q

Position for treating to improve innominate extension:

A

Sidelying is preferred, with force at innominate at PSIS, or an perform in prone. mobilize w/ resisted hip flexion.

37
Q

home program to improve innominate and hip extension

A
  1. High stepping lunge at wall most functional
  2. sidelying hip isometric (PD or just hip ext at wall, bottom leg flexed to protect spine)
  3. Unilateral or bilateral bridging.
38
Q

Define nutation

A

Describes the sacrum’s motion in relationship to the innominates.
Describes a motion in which the base of the sacrum moves forward and the inferior apect moves posterior.

39
Q

Form closure at the SIJ includes what motions of the sacrum, and what are the functional implications of form closure?

A

Nutation–in this state, there is a smaller articulation and much more ligamentous support, which causes more stability at the joint as it is better able to transmit force (close pack position).

40
Q

Force closure of the SIJ includes what position of the Sacrum, and what are the functional implications of force closure?

A

Counter nutation. The joint surface is larger, and there is less ligamentous tension, resulting in greater SIJ mobility; in this position, only mm contraction can stabilize the joint.

41
Q

What happens to the hip rotators when nutation is lost?

A

They become inhibited on the side of dysfunction of sacral nutation

42
Q

How do we assess sacral nutation

A
  1. Hands on PSIS with weight shift; in efficient state, sacrum will nutate when side is loaded.
  2. LPM through dowel to ID ACE, deficient diagonals.
  3. Pt self-resistance through dowel at wall (staggered stance)
43
Q

Positioning to treat to improve sacral nutation:

A

Prone, with half foam rolls under ASIS to block anterior rotation (extension) of the innominates). Mobilize with CR to knee extension.

44
Q

Evaluation of the pelvic floor contraction

A
  1. Palpate medial to the ischial tuberosity and have pt contract and look for lifting away of PF
  2. test by approximation through abdominal contents with contraction.
45
Q

How do we facilitate PF contraction

A
  1. irradiation from adduction, ER of hip.

2. Soft tissue approximation and have pt push fingers out.

46
Q

Home program for pts with deficient nutation include

A
  1. Assess whether or not SI belt is appropriate for this pt by pre/post testing LPM
  2. Self- mobilization into extension of sacrum, beginning in sidelying, hooking foot on edge of table, then push up to side sit and ant and posterior tilt
  3. high step lunge with resistance
  4. Resisted hip rotation.

FMLT (4 decks)

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