Treatment of Innominate and Pubic Somatic Dysfunction

Question 1

Muscle Energy

Anteriorly Rotated Innominate

Answer 1

Stand on bad side
Pt supine

1. ) Scoot pt so that the ischial tuberosity is off the edge of the table
2. ) flex hip and knee and adduct leg
3. ) place pt knee on your chest
4. ) place cephalad hand on iliac crest and caudal hand on ischial tuberosity
5. ) Muscle energy - pt pushes against your chest

Question 2

Muscle Energy

Posteriorly Rotated Innominate

Answer 2

Stand on bad side
Pt supine

1. ) scoot pt so that one leg is off the table (keep it adducted- close to the table)
2. ) cephalad hand on ASIS of opposite side and caudal hand on knee that is hanging off the table
3. ) muscle energy- ask pt to push knee towards ceiling

Question 3

HVLA

Superior Innominate Shear

Answer 3

Stand at end of table
Pt supine

1. ) Place towel under ILA on dysfunctional side
   2) Abduct, internally rotate leg
2. ) pull until you get to barrier, instruct pt to relax and breate
3. ) short tug on exhale

Question 4

Muscle Energy

Outflare

Answer 4

Stand on bad side
Pt supine

1. ) flex knee and hip
2. ) ADDuct hip
3. ) caudal hand on PSIS (so you can pull it laterally)
4. ) Muscle energy- pt pushes toward you while you pull PSIS laterally

Question 5

Muscle Energy

Inflare

Answer 5

Stand on effected side of table
Pt supine

1. ) flex knee and hip
2. ) ABDfuct and place foot of bad leg on medial knee of good leg (ballerina leg)
3. ) Stabilize opposite hip
4. ) Muscle energy- ask pt to push against you

Question 6

Treatment for bilateral pubic compression

Answer 6

Decompression of Pubes using hip adductors

1. ) Preparatory phase - bend pts knees and spread their feet a little apart, hold their knees together (hug) and ask them to pull apart
2. ) Direct method phase- place your hands in medial aspects of pts knees and ask them to squeeze their legs together while you resist

Question 7

Muscle Energy

Inferior Pubic Shear

Answer 7

Stand on Effected side
pt supine

1. ) Flex hip and knee
2. ) Abduct leg
3. ) place pts knee on your chest
4. ) Cephalad hadn on ASIS/Illiac crest and caudal hand on ischial tuberosity
5. ) Ask pt to push their leg against your chest
6. ) push anterior on ischial tuberocity adn posterior on ililac crest

Question 8

Muscle Energy

Superior Pubic Shear

Answer 8

Stand on effected side
pt supine

1. ) ischial tuberosity and leg off the table
2. ) ABDuct leg by keeping it away from the table
3. ) place cephalad hand on pt opposite hip to stabilize and caudal hand on knee that is off the table
4. ) ask pt to push leg towards ceiling while you resist

Question 9

Indirect Method- Respiratory Force with Traction

Anterior Pubic Shear (posterior Pubic shear on other side)

Answer 9

Stand on effected side
pt supine

1. ) push lateral and posterior on ASIS on effected side- side that is anterior (make an outflare)
2. ) with other hand push the opposite pubic ramus slightly inferior
3. ) ask pt to breathe in and out and feel for spot of balance - hold it there for as long as pt can hold their breath