Week 1

Question 1

What are the 4 major external rotators?

Answer 1

Piriformis, Obturator (internus and externus), Gemellus (Superior and Inferior), and Quadratus femoris

Question 2

The only external rotator that connects directly to the sacrum is the ___, and it can act as an abductor when the hip is ___, or acts as an external rotator when the hip is ___

Also, some people (10-12%) have the __ nerve piercing the piriformis, so if contraction occurs is can possibly cause sciatica

** This is a MAJOR generator of pain and you can get a calyx via the sciatic nerve rubbing up against the piriformis muscle

Answer 2

Piriformis, flexed, extended

Sciatic nerve

Question 3

While sitting in a chair, your inominate undergoes ___ pelvic tilt and is accompanied with increased ___ (Kyphosis or lordosis?)

If one were to experience an anterior pelvic tilt, they would be accompanied with an increased ___

Answer 3

Posterior, kyphosis

Lordosis

Question 4

** The 1st ligament responsible for back pain is the ___ ligament

Answer 4

Iliolumbar ligament

Question 5

Name the muscle based on its description for the 2 major hip flexors

1) From ala of ilea to the lesser trochanter of the femur
2) From the 5th lumbar vertebrae to the lesser trochanter of the femur

Answer 5

Iliacus

Psoas

Question 6

These questions relate to the gait cycle, also know the pictures from slide 26 in the innominate lecture

During the right heel strike, the right innominate has rotated in a ___ direction and the left innominate has rotated in an ___ direction.

During this time, the anterior surface of the sacrum is rotated to the __ and the superior surface is ___, while the spine is straight but rotated to the ___

During the right mid-stance, the right leg is straight and the innominate is rotating ___. The sacrum has rotated to the __ and is side bent __, while the lumbar spine has side bent __ and rotated ___.

During the left heel strike, the left innominate begins __ rotation, after toe-off, the right innominate begins __ rotation.

The sacrum is level, but with the anterior surface rotated to the __. The spine, although straight, is also rotated to the __ as in the lower trunk.

At the left leg stance, the left innominate is high and the left leg straight. The sacrum has rotated to the __ and side-bent ___, while the lumbar spine has side-bent __ and rotated __

Answer 6

Posterior, anterior

Left, level, left

Anterior, right, left, right, left

Anterior, posterior

Right, right

Left, right, left, right

Question 7

A + flexion test, whether it is seated or standing, is when the ___ comes up (cephalad) as the person flexed from the waist.

Therefore, the dysfunction is on the __ side that came up (elevated) first and farthest and also the SI will lock prematurely on the dysfunctional side

These are ___ tests (dynamic or static?)

Answer 7

PSIS

Same

Dynamic

Question 8

Rotation dysfunctions

An anterior innominate rotation means the ASIS is __PSIS is __ and medial malleolus is ___ aka long (since think about it, the ASIS is rotated down so it makes you have a longer leg)

An posterior innominate rotation means the ASIS is __PSIS is __ and medial malleolus is ___ aka short (since think about it, the ASIS is rotated up so it makes you have a shorter leg)

** Pubic tubercles equal for both

Answer 8

Inferior, superior, inferior

Superior, Inferior, Superior

Question 9

Shear dysfunctions

A superior shear consists of the ASIS, PSIS, and medial malleolus all being ___ on the affected side causing the leg to be __ on that side

An inferior shear has the ASIS, PSIS, and medial malleolus all being __ on the affected side leading to the leg being __ on that side

** Pubic tubercles equal for both

Answer 9

Superior, shorter

Inferior, longer

Question 10

***** Tight hamstrings and gluts lead to a __ tilt

Tight iliopsoas muscles can lead to an ___ tilt

Weak rectus abdomins muscles can lead to a ___ tilt

Weak erector spinae muscles can lead to an ___ tilt

A standing flexion test may lead to a false positive or negative sign for an innominate SD, due to the fact that there can be unequal ___ lengths so one must treat the hamstrings first and then reassess.

Answer 10

Posterior

Anterior

Posterior

Anteior

Hamstring

Question 11

Innominate ___s are when the ASIS is more medial on one side compared to the other

So for inflares and outflares, the ASIS heights are ___, PSIS heights are ____, the Malleoli heights are ___ and for an inflare innominate the ASIS to midline distance is ___ on the side of dysfunction and an outflare innominate has the ASIS to midline distance ___ on the side of dysfunction

** ^ Pubic tubercles equal for fares

If a standing flexion and compression test is found positive on the right, and the pubes are found superior on the right, it would be considered pubic __ with up slip on the __ side

** ^ In other words, a right superior pubic shear (instead of a right inferior pubic shear)

Answer 11

Flares

Equal, equal, equal, shorter, longer

Shear, right (Name it for the side the dysfunction is felt on)

Question 12

The major flexor of the hip is the ___ muslce and it pulls the pelvis ___

The major extensor of the hip is the ___ group and the ___ muscle and it pulls the pelvis __

What are the three major hip adductors and they stabilize and pull the hip ___

What are the three major hip abductors and they stabilize and pull the hip ___

Which group all attaches to the pubic ramus and the medial and/or posterior femur?

Answer 12

Iliopsoas (Iliacus and Psoas Major), anterior

Hamstrings (mostly the biceps femoris, semitendinosus and semimembranosus) and gluteus maximus, posterior

Adductor Magnus, Brevis, and Longus, medially

Gluteus medius, minimus, and tensor fascia lata, laterally

Adductor group

Question 12

Pubic compression and gapping have a ____ standing flexion test and a ___ pelvic compression test bilaterally

Pubic ___ often present as bilateral tenderness of each pubic rami as well as centrally over the symphysis and possible bulging symphyseal cartilage

Pubic ___ often occurs after childbirth, pelvic fractures, or trauma to the pelvis and can be very painful with larger than expected gapping of symphyseal cartilage

Answer 12

Negative, Positive

Compression

Gapping

Question 14

___ is when S1 and S2 do NOT fuse and ___ is when L5 fuses to the sacrum

Answer 14

Lumbarization, sacralization

Question 15

The lateral sacral crest, formed by the fusion of the sacral transverse processes, end in a curve inferiorly called the ___

Answer 15

Inferolateral angle (ILA)

Question 16

The sacral ___ is a defect near the apex (remember that is the bottom) where the lamina failed to close and this is where sacral epidural nerve blocks are performed

Answer 16

Hiatus

Question 17

The sacrum has __ vertebrae fused into a single bone and the coccyx has __ vertebrae, some fused and some not fused

Answer 17

5, 4

Question 18

The sacrum is suspended between the innominates by 3 true ligaments (technically it’s just 1 with three subgroups) and 3 accessory ligaments.

Name all 6

**True ligaments attach bone to bone, and accessory ligaments attaches to another ligament, tendon, or fascia

Answer 18

True: Sacroiliac ligament (the three subgroups are the anterior, posterior, and interosseous sacroiliac ligament)

Accessory: Sacrotuberous, Sacrospinous, Iliolumbar

Question 19

The __ ligament attaches from S3 to the pre-auricular surface of the ilium

The __ ligament has massive bands that attach from the medial sacral crest to the iliac tuberosities

The __ ligament connects the PSIS to S3 and S4

Answer 19

Anterior/ventral sacroiliac L.

Interosseous sacroiliac L.

Posterior/dorsal sacroiliac L.

Question 20

** Possible test questions

The sacrotuberous ligament attaches from the sacrum to the __ tuberosity

The sacrospinous ligament attaches from the sacrum to the ____ spine

The sacrotuberous and sacrospinous ligaments stabilize ___ motion, preventing ___ - ___ rotation around the __ axis

The iliolumbar ligament attaches the 4th and 5th lumbar vertebra to the ___ crest

The iliolumbar ligament stabilizes __ motion, restricting ___ motion of ___ and ___

** Don’t confuse iliac and ischial**

Answer 20

Ischial

Ischial

Anterior, posterior - superior, transverse

Iliac

Posterior, anterior, L4/L5

Question 21

The primary intrinsic muscles of the pelvic diaphragm are __ and __

The secondary muscles, considered to have partial attachment to the true pelvis is rectus abdominis, transversus abdominis, internal and external oblique, quadratus lumborum, rector spinae, and multifidus

Answer 21

Levator ani group (pubococcygeus, puborectalis, and iliococcygeus)

And

Coccygeus

Question 22

The cranial dural attachment is the __, __, and __

*** The sacral dural attachment is __

Answer 22

Foramen magnum, C1, C2

S2

Question 23

___ closure is due to holding an object by pressure on the sides created by muscles, ligaments, and fascia surrounding the SI joint

__ closure is “stacking” aka the use of a roman arch as a self supporting structure such as the sacrum that acts as the keystone arch that is wedged between the ilium

*** KNOW THE PICS FROM THE INTRO TO SACRUM LECTURE, SLIDE 41

Answer 23

Force

Form

Question 24

The transverse axes of motion for sacral axes has a superior, middle, and inferior axis.

The superior transverse axis is __ motion as well as ___ flexion/extension. It occurs at the articular process of __ and at the attachment of the __

The middle transverse axis is referred to as ___ or ___ aka the axis for flexion/extension in sitting and standing. This occurs at the level of the S2 __

The inferior transverse axis is the ___ axis that is important for rotation of the ilium on the sacrum

Answer 24

Respiratory, SBS (also called inherent motion), S2, dura

Postural or sacroiliac, body

Iliosacral

Question 25

The oblique axes of motion is where ___/___ motion occurs and has a right and left oblique axis

The right oblique axis runs from superiorly __ to inferiorly ___

The left oblique axis runs from superiorly __ to inferiorly ___

Answer 25

Dynamic/torsional

Right, left

Left, right

** Named for the cephalad side

Question 26

During respiratory motion, which remember, is around the ___ axis, the sacral base (the top) moves __ during inhalation while the sacral apex moves __ and this leads to a ___ lumbar lordosis

During exhalation, the sacral base moves __ while the sacral apex moves ___ and this leads to a __ lumbar lordosis

Answer 26

Superior transverse axis

Posterior, anterior, Decreased

Anteriorly, Posteriorly, increase

Question 27

????????????????????????????????????????????????????????????????????????

During postural motion, which remember is around the __ axis, if you flex forward aka forward bending then the sacral base moves __ and the sacral apex moves ___

Extension aka backward bending causes the sacral base to move __ and apex to move __

**Don’t confuse this with slouching during sitting, which causes a ___ pelvic tilt vs sitting up straight with lumbar extension that causes a ___ pelvic tilt

Answer 27

Middle transverse axis,

Anterior, posterior

Posterior, anterior

Posterior, anterior

Question 28

Inherent motion (aka SBS motion) occurs around the ___ axis and is the main hinge around which cranial motion occurs

The terms to describe this motion is nutation and counternutation

Nutation means nodding ___ (in relation to the sacrum) and this causes the sacral base to move ___ and the sacral apex to move ___. ** It occurs with craniosacral/SBS ___ **

Counternutation causes the sacral base to move ___ and the sacral apex to move ___ and occurs with craniosacral/SBS ___

Answer 28

Superior transverse axis

Anterior, posterior, extension

Posterior, anterior, flexion

Question 29

Dynamic motion, which occurs while walking, is around the __ axis and during this motion the innominates are constantly rotating in opposite directions to one another aka one rotates anterior and the other posterior

Answer 29

Oblique

Question 30

There are 4 major pelvic ligaments we talk about. Name the ligament based on its location

1) From ilia to the 5th lumbar vertebra
2) From the sacrum to the spine of the ischium
3) From the sacrum to the ischial tuberosity
4) Covers most of the sacroiliac joint and is both anterior and posterior

** KNOW THE PICTURES FOR ALL THE LIGAMENTS (Starts at slide 24 in Pre-lecture)

**Also, the sacrospinous and sacrotuberous ligaments divide the greater and lesser ___

Answer 30

1) Iliolumbar ligament
2) Sacrospinus ligament
3) Sacrotuberous ligament
4) Sacroiliac ligament

Sciatic foramens

Question 30

The pubic symphysis is a ___ joint, with a disc called the interpubic disc

Answer 30

Fibrocartilagenous joint

Question 31

The seated flexion test is monitored at the ____ aspect of the ___.

The test looks at which PSIS moves first/and or the furthest in the cephalad direction and the ___ (contralateral side or ipsilateral side) that does so indicates the positive side

** In other words, this test determines the side of laterality, but if it is a bilateral SD, you wouldn’t get a positive test

Answer 31

Inferior, PSIS

Ipsilateral side (same side)

Question 32

In the lumbar spring test, the patient is prone and a springing force is applied ____ into the ___-___ junction (aka the sacral base)

If you get a normal spring, the test is ___, which indicates no dysfunction OR ___ torsion or ___ dysfunction

If you get a hard end feel, the test is ___, which indicates a ___ torsion or ____

Answer 32

Anteriorly, lumbo-sacral

Negative, anterior, flexion

^ **AKA either no dysfunction, OR the base of the sacrum is sitting forwards/anterior aka more deep so that gives you a spring feeling

Positive, Posterior, extension

^ **AKA the base of the sacrum is sitting backwards/posterior aka more shallow so that gives you the hard end feel

Question 33

The sphinx test aka backward bending test increases lumbar ___ and therefore brings the sacrum into the ___ position

This test is used for confirmation of the ___ test

If the sacral sulci are noted to become more symmetric, the result is ___ torsion or unilateral ____ dysfunction

If the sacral sulci are noted to become more asymmetric, the result is ___ torsion or unilateral ___ dysfunction

Answer 33

Lordosis, flexion

Lumbar spring

Anterior, flexion

Posterior, extension

Question 35

For a 4 point passive evaluation, you contact the sacral sulci with a monitoring finger and the opposite ILA with the heel of the hand.

You then apply an ___ pressure with the heel of the hand at the ILA and monitor for ___ motion at the opposite sulcus.

The axis you are using is based on the sacral sulci, so for example if you are monitoring the right sacral sulci and applying the force to the left ILA, your axis would be the ___ oblique axis

** This technique is used to diagnose a ___ dysfunction by determining which oblique axis has more ease of motion

Answer 35

Anterior, Posterior

Right

Sacral torsion

Question 36

Similar to the four digit passive evaluation, the ____ is simply contacting each sacral sulci and ILA and feeling which one is more deep/shallow (for sulci) and which one is more anterior/superior or posterior/inferior (for ILAs)

** So for this you are contacting the sulci and ILA of the same side

Answer 36

Four digit contact (also called static symmetry of sacrum in our OSCE)

Question 37

In the respiratory motion test of the sacrum, you are testing the sacral mobility as referred to the ___ of the sacrum.

You place your first hand’s thenar/hypothenar eminence on the ___ of the sacrum and your fingertips at the ___ of the sacrum and your other hand is placed ontop in the opposite direction

During inhalation, the sacral base moves ___ and during exhalation the sacral base moves ___

If the base does not move posteriorly aka you have a restriction during inhalation, then it could indicate bilateral sacral ___

If the base does not move anteriorly aka you have a restriction during exhalation, then it could indicate bilateral sacral ___

In unilateral flexion and extension, and sacral torsion, the respiratory motion is classified as ___, but not fully restricted

Answer 37

Base

Base, apex

Posterior, Anterior

Flexion

Extension

Asymmetric

Question 38

In the side bending passive evaluation of the sacrum, you contact the inferior aspect of the ____ with the heel of the hand and load and spring on both sides

When you push in the ___ direction on the right ILA, you are inducing ___ side-bending and vice-versa

If there is a hard end feel for example while pushing on the right ILA, that means the sacrum does not like to side bend to the left aka it is restricted to left side bending so you would be side bent ___

This test is used to diagnose a ____ dysfunction aka unilateral sacral flexion or extension

Answer 38

ILA

Cephalad, left

Right (because remember, you name the dysfunction for where it likes to live)

Unilateral

Question 39

For a bilateral sacral flexion test name the results

1) Seated flexion/compression
2) Lumbar lordosis
3) Sacral sulcus
4) ILAs
5) Lumbar spring test
6) Respiratory motion
7) Side bending passive evaluation
8) 4 point passive evaluation

Answer 39

1) Negative (False negative)
2) Increased
3) Deep bilaterally
4) Posterior bilaterally
5) Negative
6) Restricted to inhalation phase (aka stuck in exhalation so it would be classified as an exhalation SD)
7) No restriction
8) No restriction

Question 40

For a bilateral sacral extension test name the results

1) Seated flexion/compression
2) Lumbar lordosis
3) Sacral sulcus
4) ILAs
5) Lumbar spring test
6) Respiratory motion
7) Side bending passive evaluation
8) 4 point passive evaluation

Answer 40

1) Negative (false negative)
2) Decreased
3) Shallow bilaterally
4) Anterior bilaterally
5) Positive
6) Restricted to exhalation phase (aka it is stuck in inhalation)
7) No restriction
8) No restriction

Question 41

For a unilateral sacral flexion test name the results

1) Seated flexion/compression
2) Sacral sulcus
3) ILAs
4) Lumbar spring test
5) Respiratory motion
6) Side bending passive evaluation
7) 4 point passive evaluation

Answer 41

1) Positive on involved side (so if it’s a right unliateral sacral flexion SD, then when the patient bends forward your right thumb on the PSIS will move first and furthest)

**^ When we refer to flexion for this test, it’s technically rotating around the superior-inferior axis

2) Deep on involved side (right SD means your right sacal sulci is deep)
3) Posterior and inferior on involved side (right SD means your right ILA is Posterior and inferior)
4) Negative
5) Asymmetry
6) Restricted towards SB to uninvolved side (aka it it’s a right unilateral sacral flexion, you would be stuck SB to the right)

**^ SB on an anterior-posterior axis

7) No restrictions

Question 42

For a unilateral sacral extension test name the results

1) Seated flexion/compression
2) Sacral sulcus
3) ILAs
4) Lumbar spring test
5) Respiratory motion
6) Side bending passive evaluation
7) 4 point passive evaluation

Answer 42

1) Positive of involved side
2) Shallow on involved side
3) Anterior and superior on involved side
4) Positive
5) Asymmetry
6) Restricted towards SB to involved side
7) No restriction

Question 43

For a forward sacral torsion test name the results

1) Seated flexion
2) Pelvic compression
3) Sacral sulcus
4) ILAs
5) Lumbar spring test
6) Respiratory motion
7) Side bending passive evaluation
8) 4 point passive evaluation

R on R means right ___ on a right ___ and vice-versa for L on L

Answer 43

** All () will be explained using a R on R forward sacral torsion SD

1) Positive side opposite of axis (Left sacral sulci moves first and furthest forward aka left side positive)
2) Positive on side of axis (positive on right side)
3) Deep on the uninvolved axis side (left sacral sulci deep)
4) Posterior on side opposite deep sacral sulcus (aka posterior on uninvolved axis side so your right ILA is posterior)
5) Negative (since part of the sacrum is held forward since it is a forward torsion)
6) Asymmetry
7) No restriction
8) Restricted to posterior rotation around involved axis (So you would be restricted to posterior rotation around the right oblique axis aka the left sacral sulci can not move posterior since it is stuck in a deep aka anterior position - Even though we dont refer to the sulci as anterior)….

Rotation, axis

Question 44

** L5 is rotated the ___ direction as your oblique axis aka if you have a right rotation on a right oblique axis then L5 is rotated ___ and if you have a left rotation on a left oblique axis then L5 is rotate ___

Answer 44

Opposite, left, right

Question 45

For a backward sacral torsion test name the results

1) Seated flexion
2) Pelvic compression
3) Sacral sulcus
4) ILAs
5) Lumbar spring test
6) Respiratory motion
7) Side bending passive evaluation
8) 4 point passive evaluation

R on L means right ___ on a left ___ and vice-versa for L on R

Answer 45

** All () will be explained using a L on R forward sacral torsion SD

1) Positive side opposite of involved axis (Left sacral sulci moves first and furthest backward)
2) Positive on side of axis (positive on right side)
3) Shallow on the uninvolved axis side (left sacral sulci shallow)
4) Anterior on side opposite shallow sacral sulcus (aka anterior on opposite axis so your right ILA is anterior)
5) Positive (since part of the sacrum is extended back toward us since it is a backward torsion)
6) Asymmetry
7) No restriction
8) Restricted to anterior rotation around involved axis (So you would be restricted to anterior rotation around the right oblique axis aka the left sacral sulci can not move anterior since it is stuck in a shallow aka posterior position - Even though we dont refer to the sulci as posterior)….

Question 46

When evaluating the innominate, it is important to re-set the hips prior to ___ evaluation by having the patient lay supine, bend knees, place feet flat on table, lift hips off table and place them back down and then extend knees back to a flat supine position

Answer 46

Supine

Question 47

For the standing flexion test you want to contact the _____ aspect of the PSIS with the thumbs and a positive test means that the ___ is dysfunctional in relation to the ___

** You are testing for ___-___ motion and the side of laterality if present

** Also remember, you must asses straight leg testing to evaluate for asymmetrical hamstring tension because asymmetrical tension will give a false ___ standing flexion test

Answer 47

Inferior, Ileum, Sacrum

Ilio-sacral

Positive

Question 48

For the trendelenburg test, the patient lifts one foot and bends at the knee and stands on the other foot (weight bearing side)

The ____ should contract on the weight bearing side and this will elevate the pelvis on the unsupported side

If the gluteus medius is weak on the side of the stance leg, the pelvis on the unsupported side drops

**So this is an example:

Patient lifts up left leg and stands (puts weight) on right leg. His right gluteus medius should contract, and therefore hold up the left PSIS. If his gluts are weak on the right side, they don’t contract strongly and can no longer hold up the left PSIS, so the left pelvis drops and this is a positive sign for weak RIGHT gluts

So one more time to conclude, if patient lifts left foot, and left hip drops, it is ___ gluteus medius/ superior gluteal nerve pathology

Answer 48

Gluteus medius

Right

Question 49

The ___ test has the patient lie supine and pull their knees to the chest. One leg is then lowered to the table to test the flexibility of hip ___ and a positive test is the inability to fully ___ at the hip

**Indicates hip flexor contraction aka psoas tension

Answer 49

Thomas

Flexors

Extend

Question 50

____ test has the patient lie lateral recumbent with hips and knees flexed. The doctor actively abducts the top leg and lowers it to the table.

If the patient can not adduct, it indicates ___ contracture

Answer 50

Obers test

IT band

Question 51

In the pelvic/ASIS compression test (also called Pelvic rocking) the doctor contacts the ASIS bilaterally and induces a force through the ASIS towards the table in a ___ and ___ direction and notes a hard end feel on the side of dysfunction

AKA if you have a PTP or restriction of motion on the right ASIS, the SI joint is dysfunctional on the ___ side

** This does not discriminate between ilosacral and sacroilial motion

Answer 51

Posterior, medial

Right

Question 52

When looking for various innominate SDs, one must measure the ASIS heights, ASIS to midline distance (which measures the distance from the ASIS to the ___), PSIS heights, Malleoli heights/length (by contacting the inferior aspect of the ____ malleoli bilaterally, and the pubic tubercles

Answer 52

Xyphoid, medial

Question 53

For the seated flexion test to evaluate sacrum dysfunctions, you are assessing __-__ motion

For the standing flexion test to evaluate innominate dysfunctions, you are assessing ___-___ motion

Answer 53

Sacro-ileal

Ilio-sacral

Question 54

It is important to note that the ____ test DOES NOT differentiate between ilio-sacral or sacro-ilial motion… It simply tells you what ___ is dysfunctional

That is determined via the ___ test for ilio-sacral

And the ___ test for sacro-ileal

Answer 54

Pelvic compression, SI joint

Standing flexion

Seated flexion

Question 55

Muscle Energy treatment of bilateral sacral flexion, means that the sacrum is restricted to the inhalation phase (aka stuck in exhalation)

The doc places their thenar and hypothenar eminence on the ____ (apex of sacrum) and then, you apply an ___ and ___ force during ____ and resist sacral flexion during ___

Answer 55

ILAs

Anterior and superior

Inhalation, exhalation

Question 56

Muscle Energy treatment of bilateral sacral extension, means that the sacrum is restricted to the exhalation phase (aka stuck in inhalation)

The doc places their thenar and hypothenar eminence on the ____ (base of sacrum)

Therefore, you apply an ___ and ___ force during ____ and resist sacral extension during ___

For this test, you want to place the patient into a ___ position in order to assist with increasing lumbar lordosis and therefore already starting the patient off with a slightly flexed sacrum

Answer 56

Sacral sucli

Anterior and Inferior, exhalation, inhalation

Sphinx

Question 57

Muscle Energy treatment of unilateral sacral flexion first requires that the doctor ___ducts the hip about 15 degrees and ____ rotates the hip in order to find the affected side’s loosest packed position

Next, place heel of hand on ___ of SD side, and then apply an ____ and ____ force when the patient ___ in order to encourage sacral extension and resist motion of the sacrum when the patient ___ in order to prevent sacral flexion

Answer 57

Abduct, Internally

ILA

Anterior and superior, inhales, exhales

Question 58

Muscle Energy treatment of unilateral sacral extension first requires that the doctor places the patient in a __ position to start the sacrum off in a flexed position, and then the doc ___ducts about 15 degrees and ____ rotates the hip in order to find the affected side’s loosest packed position

Next, place heel of hand on the ___ of SD side, and then apply an ____ and ____ force when the patient ___ in order to encourage sacral flexion and resist motion of the sacrum when the patient ___ in order to prevent sacral extension

Answer 58

Sphinx, abducts, internally

Sacral sulci

Anterior and inferior, exhales, inhales

Question 59

Muscle Energy treatment of forward torsion (L on L or R on R) has the patient lie in a ___ position with axis side ___

You monitor at the __-___ interspace and then flex the patients hips and knees until motion is felt at the monitoring hand (aka ___ is neutral relative to ___)

In order to induce even more rotation through the lumbar spine to the sacrum, when the patient inhales and exhales deeply 3 times, you ask them to reach with their hand, on the ____ side of the axis, towards the floor after each exhalation

Then you rotate the patients hips by pushing the feet towards the floor until a side bending ___ barrier is palpated at L5-S1 and the patient then lifts their feet upwards (against resistance), and then you push their feet further down

Answer 59

Modified sims, down

L5-S1, L5, S1

Opposite

Restrictive

Question 60

Muscle Energy treatment of backward torsion (R on L or L on R) has the patient lie in a ___ position with axis side ___

You monitor at the __-___ interspace and then pull the patients lower arm towards yourself to produce ___ rotation

Then you ___ the patients top hip by pushing the knee towards the floor until a motion is palpated at L5-S1 and the patient then lifts their leg upwards (against resistance). Then you induce FURTHER ___ of top hip and knee and once again then you push their knee further down until no new barrier is felt

Answer 60

Lateral recumbent, down

L5-S1, Posterior

adduct, Flexion

Question 61

HVLA treatment of bilateral sacral flexion, means that the sacrum is restricted to the inhalation phase (aka stuck in exhalation)

You have the patient lie in a ___ position first

Therefore, you apply an ___ and ___ force during ____ to exaggerate sacral extension and resist sacral flexion during ___

After a few rounds of increasing the force, during the ___ phase on the last ME cycle, apply a quick anterior and superior HVLA thrust to the sacral ___

Answer 61

Prone

Anterior and superior, inhalation, exhalation

Inhalation, apex

Question 62

HVLA treatment of bilateral sacral extension, means that the sacrum is restricted to the exhalation phase (aka stuck in inhalation)

You have the patient lie in a ___ position

Therefore, you apply an ___ and ___ force during ____ to exaggerate sacral flexion and resist sacral extension during ___

After a few rounds of increasing the force, during the ___ phase on the last ME cycle, apply a quick anterior and inferior HVLA thrust to the sacral ___

Answer 62

Prone
^** Don’t get confused, for ME of an extension, you would have patient lie in prone with sphinx

Anterior and inferior, exhalation, inhalation

Exhalation , base

Question 63

HVLA treatment of a backward sacral torsion (we don’t treat forward sacral torsions) has the doc stand on the patients side on the ___ axis and then you sidebend the lower extremity and torso AWAY from the ___ side (aka the ___ sacral sulcus) - so you make a C-shape

Then contact ASIS on ___ side of deep sulcus (aka the uninvolved side) and when you are in the proper contact position, the patient takes a deep breath and during the ___ phase, the doc applies a rotation thrust of the patients upper body, while simultaneously applying a ___ thrust on the opposite ASIS

Answer 63

Involved, involved, deep

Opposite, exhalation, posterior

Question 64

In flexion, the sacral base moves ___ and in extension the sacral base moves ___

Answer 64

Forward/anterior

Backward/posterior

Question 65

The ___ barrier is the end point of passive motion (doc does motion for you)

The ___ barrier is the limit of active motion (patient does motion themselves)

A __ barrier is when the physiological barrier has been reduced

When we have motion into the restrictive barrier, the quality of motion is called a ___, and if motion is into freedom the quality of motion is called ___

Answer 65

Anatomic
Physiologic
Restrictive

BIND, EASE

Question 66

A form of OMT where patients muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed counterforce is called ___

This is a ___ (direct on indirect?) and ___ (Active or passive?)

Who first described ME in 1958 and then published after his death?

Answer 66

Muscle Energy-Defined

Direct (aka we engage the restriction barrier), Active (patient’s cooperation is required)

Fred Mitchell Sr. D.O

Question 67

For muscle energy, using the patients muscle energy as an activating force, you apply a counteractive force and this maintains an ____ contraction aka no movement in the ___ phase

Answer 67

Isometric, active

Question 68

To perform muscle energy, you must first make the diagnosis, then you position the body part with the SD into it’s restrictive barrier, because remember, this is a ___ technique.

Next, the patient provides a light to moderate force ___ from the restriction/barrier and the doctor provides an equal counterforce to achieve ___ contraction for __-__ seconds and then you both relax

After post isometric relaxation, doctor repositions body part further into the NEW restriction barrier.

Repeat this step 3-5 times or until no new restriction barrier is met

Answer 68

Direct

Away

Isometric, 3-5

Question 69

___s detect skeletal muscle tension and send in to the CNS. They are located between muscle and tendon insertion

They are stretched whenever muscles ___

Answer 69

Golgi Tendon Organs

Contract

Question 70

In the golgi tendon reflex, sensory neurons (group ___ afferents) send info the gray matter of spinal cord where they synapse with ____ interneurons

These interneurons synapse with large ___ motor neurons in the anterior gray horn and inhibit messages to the same muscle where the 1b afferents originated

This causes a reflex ___ of the muscle since there is an inhibitory message

Answer 70

1b, Inhibitory

Alpha

Relaxation

Question 71

Post-isometric relaxation is important for ME (Muscle Energy) because it allows the neuromuscular bundle to be in a ___ state immediately after contraction, allowing ____ stretching to occur without reflex opposition

Also, muscle contraction stretches the golgi tendon organ and ultimately causes reflex ___

Answer 71

Refractory, passive

Relaxation

Question 72

Reciprocal inhibition is when a shortened muscle is lengthened in other words, you need reciprocal inhibition so then when a muscle contracts, an opposing muscle does not simultaneously work against it

This occurs due to gentle contractions in the ___ muscle, which causes reflex relaxation of the ___ muscle via an inhibitory interneuron causing the alpha-motor neuron of the antagonist muscle to be inhibited and therefore relaxed

Answer 72

Agonist, antagonist

Question 73

HVLA is a ___ (direct or indirect) technique and a ___ (active or passive) technique

Answer 73

Direct, passive

Question 74

Vertebral segments are referred to as above and below, as well as the disc between the two

Aka if we talk about T4 segment, we mean T4 as it articulates with T5, and the disc in between

Localization is at the __ between the 2 vertebra

Answer 74

Facets

Question 75

When applying a thrust in HVLA, it must be applied after the setup is locked against the ___

Answer 75

Restrictive barrier

Question 76

When a sudden thrust is applied during HVLA, it activates the golgi tendon organ and therefore strongly ___ muscle activity and therefore sudden relaxation occurs

**This allows muscle tensions to equalize and thus normalizing imbalanced afferent inputs

Answer 76

Inhibits

Question 77

ME treatment of an inflare innominate SD requires the doctor to place the patients hip into ____ and ____ rotation (aka the FABER position) until a RB is met

^**In other words, hips and knee of SD side is flexed and foot is placed on lateral side of opposite knee

The doctors cephlad hand is on the patients ASIS, which is on the ___ side of the SD and their caudad hand is paced on the patients ___ knee

The patient ____ and ___ rotates their hip to cause an isometric contraction

Answer 77

Abduction, external

Opposite, medial

Adducts, internally

Question 78

ME treatment of an outflare innominate SD requires the doctor to place the patients hip into ____ and ____ rotation until a RB is met

^**In other words, hips and knee of SD side is flexed and foot is placed on lateral side of opposite knee

The doctors cephlad hand is on the patients ASIS, which is on the ___ side of the SD and their caudad hand is paced on the patients ___ knee

The patient ____ and ___ rotates their hip to cause an isometric contraction

Answer 78

Adduction, internal

Same, lateral

Abducts, externally

Question 79

ME treatment of a superior innominate shear SD requires the doctor to place the patients in the ___ position, and then move the leg into ____ and ____ rotation

The doc then leans back to maintain axial traction and instructs the patient to pull their ipsilateral hip (same hip you are pulling on) towards their ipsilateral shoulder

^** You could also have the patient inhale and exhale, and you would increase your tractional force during ___

Answer 79

Supine, Abduction, internal

Exhalation

Question 80

ME treatment of an inferior innominate shear SD requires the doctor to place the patients in the ___ position (with SD side facing ___), and then contact the ___ on the SD side

You then provide a ___ distraction to gap the SI joint aka move the ASIS and PSIS towards the ceiling, and then apply a ___ force

You use respiratory assist for this technique, so when the patient ___ you resist motion, and when they ___ you increase your force

Answer 80

Lateral recumbent, up (towards ceiling), ASIS and PSIS

Lateral, cephalad (towards head)

Inhale, exhale

Question 81

ME treatment for anterior innominate rotation can be done in a supine OR prone technique.

For supine, the doc passively ____ the hip and knee until a RB is met. *You can also have patient with knee fully extended, as long as you flex their hip. Patient pushes their knee into docs hand while doc provides equal counterforce

For prone the ____ (dysfunctional or normal?) innominate is off the table. Then you ___ their hip until a RB is met and the patient pushes their foot into your leg to provide a counterforce

Answer 81

Flexes

Dysfunctional, flex

Question 82

ME treatment for posterior innominate rotation can be done in a supine OR prone technique.

For supine the ____ (dysfunctional or normal?) innominate is off the table. Then you ___ their hip until a RB is met and the patient pushes their leg towards the ceiling

For prone, the doc contacts opposite PSIS (but PSIS on the side of the SD) and passively ___ the patients hip until RB is met. The patient then pulls their leg down to create a counterforce

Answer 82

Dysfunctional, extend

Extends

Question 83

ME treatment for pubic restrictions are also called the ___ technique (fixes both gapping and compression problems)

To fix a ___ problem, the doc places hands in between abducted knees and has the patient adduct hips until no new RB is met

To fix a ___ problem, doctor instructs patient to abduct knees while do keeps the knees in an adducted position

Answer 83

Shotgun

Compression

Gapping

Question 84

HVLA for superior and inferior innominate shear does the same stuff as ME, except a quick tug on the leg (superior) or cephalad force through ASIS and PSIS (interior) is applied at the end of ___

^ For the superior shear SD, just know that the reason why we abduct and internally rotate is to pack the joint to allow the lower extremity to be a ___ to work upon the innominate

Answer 84

Exhalation

Lever

Question 85

HVLA for an anterior innominate rotation has the patient placed in a ___ position (SD side up).

The hips and knees are ___ until motion is palpated at ___ interspace and then the ___ leg is dropped off the side of the table

Next, the doc contacts the area between the PSIS and trochanter with their caudal forearm and top shoulder with the cephalad hand. ___ rotation is induced by pushing the top shoulder ____ and rolling the pelvis ____ until a RB is met

Patient inhales and exhales and on ___ the doc provides a thrust along the shaft of the ___

Answer 85

Lateral recumbent

Flexed, L5-S1, top

Axial, posterior, anterior

Exhalation, femur

Question 86

HVLA for an posterior innominate rotation has the patient placed in a ___ position (SD side up).

The hips and knees are ___ until motion is palpated at ___ interspace and then the ___ leg is straightened and the top foot is hooked to the bottom leg in the ___

Next, the doc contacts the PSIS with hand or PSIS/posterior iliac crest with forearm with their caudal arm and top shoulder with the cephalad hand. ___ rotation is induced by pushing the top shoulder ____ and rolling the pelvis ____ until a RB is met

Patient inhales and exhales and on ___ the doc provides a thrust towards the patients ___

Answer 86

Lateral recumbent

Flexed, L5-S1, bottom, popliteal fossa (of the bottom leg)

Axial, posteriorly, anteriorly

Exhale, umbilicus

Question 87

HVLA for pubic restrictions use the ME technique for both compression and gapping and then the doc gradually increases ___ of both hips simultaneously and during exhalation applies a thrust towards ____

^** So you do this for both compression and gapping in hopes that it resets the pubic symphysis

Answer 87

Abduction, abduction