Podcast
Questions and Answers
What does a positive iliosacral axis test indicate?
What does a positive iliosacral axis test indicate?
What does a negative seated flexion test with a positive compression test bilaterally suggest?
What does a negative seated flexion test with a positive compression test bilaterally suggest?
What position is the patient in during the Spring Test?
What position is the patient in during the Spring Test?
Prone
What indicates a positive Spring Test?
What indicates a positive Spring Test?
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How should the physician determine the side of the deep sulcus during palpation of the sacral sulci?
How should the physician determine the side of the deep sulcus during palpation of the sacral sulci?
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What is indicated by decreased asymmetry in the sphinx test?
What is indicated by decreased asymmetry in the sphinx test?
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What is the treatment position for unilateral flexion treatment?
What is the treatment position for unilateral flexion treatment?
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What muscle energy technique is used for unilateral extension treatment?
What muscle energy technique is used for unilateral extension treatment?
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What does a positive spring test with backward bending indicate?
What does a positive spring test with backward bending indicate?
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What condition is suggested by a shallow sulcus on the side ipsilateral to a positive flexion test?
What condition is suggested by a shallow sulcus on the side ipsilateral to a positive flexion test?
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What is indicated by the treatment DOWN-UP-DOWN in backward sacral torsion treatment?
What is indicated by the treatment DOWN-UP-DOWN in backward sacral torsion treatment?
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What does Seated Flexion + on Left indicate?
What does Seated Flexion + on Left indicate?
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Describe the method for Lumbar HVLA Lateral Recumbent Type I.
Describe the method for Lumbar HVLA Lateral Recumbent Type I.
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What is the definition of Lumbar HVLA Lateral Recumbent Type II?
What is the definition of Lumbar HVLA Lateral Recumbent Type II?
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What does Articulatory Absolute Contraindications include?
What does Articulatory Absolute Contraindications include?
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Celiac ganglion is located at T5-T9.
Celiac ganglion is located at T5-T9.
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What happens during nutation?
What happens during nutation?
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What is the effect of standing flexion test mechanism?
What is the effect of standing flexion test mechanism?
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How is the standing flexion test performed?
How is the standing flexion test performed?
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Innominate Outflare occurs during hip flexion.
Innominate Outflare occurs during hip flexion.
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The sacrum flexes with __________ and extends with __________.
The sacrum flexes with __________ and extends with __________.
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What is the primary function of the sacrotuberous ligament?
What is the primary function of the sacrotuberous ligament?
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Study Notes
Seated Flexion and HVLA
- Seated flexion tests used to diagnose unilateral flexion, indicated by findings like deep sulcus and posterior ILA on the left.
- HVLA techniques for Type I and Type II use lateral recumbent positioning, influencing how the patient’s limbs are positioned and where the thrust is applied.
Articulatory Contraindications
- Relative contraindications include situations like possible neurologic compromise from repetitive movements in the upper cervical area.
- Absolute contraindications cover lack of consent, fractures, acute inflammation, and serious vascular issues.
Ganglia and Symptomology
- Abdomen-related symptomology linked to celiac (T5-T9), superior mesenteric (T10-T11), and inferior mesenteric (T12-L2) ganglia involvement.
Gait Mechanics
- Pelvic mechanics during gait: Innominates flare in extension and flexion, influencing pelvic stability and interaction with spinal mechanics.
Assessment Techniques
- Innominate assessments involve standing flexion tests, pelvic compression tests, and evaluating ASIS levels for identifying dysfunction.
- Seated flexion and standing flexion tests are critical for diagnosing sacroiliac dysfunction and related issues.
Motion and Axis
- Sacral mobility follows a dynamic cycle of alternating positions, affecting lumbar sidebending due to hip loading.
- Various axes influence sacral motion, including respiratory, sacroiliac, iliac, and oblique axes, crucial for understanding dysfunctions.
MET Techniques
- Muscle Energy Techniques (MET) are applied to address innominate rotations, shears, and pubic shear issues, utilizing patient resistance and counterforces to restore functionality.
Pathophysiology of Dysfunction
- Dysfunction manifests through altered gait patterns, pelvic loading disturbances, and compromised muscle function in relation to the lumbar spine.
Sacral Diagnosis Protocol
- A systematic approach to sacral diagnosis includes AGR screening, standing flexion tests, various palpation techniques, and specific compression tests, guiding treatment focus.
Structural Relationships
- Anatomical structures such as ligaments (sacrotuberous, sacrospinous, iliolumbar) play key roles in pelvic stability and are often first to respond to sacral dysfunction.
Diagnostic Testing
- Spring test assesses sacral motion efficiency, with positive results indicating posterior sacral positioning and related dysfunctions. Negative spring tests suggest ease of motion, indicating potential anterior sacral dysfunction.
Important Concepts
- Ferguson's angle (25-35 degrees) influences lumbar strain, while understanding the sacral sulcus and inferior lateral angles aids in palpation and diagnosis of sacral conditions.### Sphynx Test and Related Dysfunction
- Sphynx Test: Dynamic examination of sacral landmarks in a prone patient who raises onto elbows; assesses sacral motion during lumbar extension and sacral flexion.
- Decreased Asymmetry: Indicates flexion-type dysfunction, where sacral base prefers anterior motion.
- Increased/Unchanged Asymmetry: Suggests extension-type dysfunction, with sacral base favoring posterior motion.
Unilateral Dysfunction Findings
- Right Unilateral Flexion: Positive seated flexion test on the right; backward bending improves findings; spring test negative; deep sulcus and posterior ILA on the right.
- Right Unilateral Extension: Positive seated flexion test on the right; backward bending worsens findings; spring test positive; deep sulcus on the left and deep ILA on the right.
- Left Unilateral Extension: Positive seated flexion test on the left; backward bending worsens findings; spring test positive; deep sulcus on the right and deep ILA on the left.
Treatment Techniques
- Unilateral Flexion Treatment: Prone position; abduct ipsilateral leg; inwardly rotate leg; apply anterior springing force on inferior lateral angle during inhalation.
- Unilateral Extension Treatment: Prone position; abduct ipsilateral leg; externally rotate leg and instruct extension of the lumbar spine; apply anterior springing force on the sacral base during exhalation.
Bilateral Sacral Conditions
- Bilateral Sacral Flexion: Deep bilateral sulci, increased lordosis; negative spring test; backward bending improves findings.
- Bilateral Sacral Extension: Shallow bilateral sulci, decreased lordosis; positive spring test; backward bending worsens findings.
Treatment for Bilateral Conditions
- Bilateral Sacral Flexion Treatment: Prone position; abduct both legs; monitor ILAs; induce cephalad and anterior force during deep inhalation.
- Bilateral Sacral Extension Treatment: Sphinx position; abduct both legs; apply cephalad and anterior force over the base during exhalation.
Torsion Dysfunctions
- Forward Sacral Torsion (X on X): Positive seated flexion test on the ipsilateral side; spring test negative; backward bending improves findings; L5 rotated opposite.
- Backward Sacral Torsion (X on Y): Positive seated flexion test on the ipsilateral side; spring test positive; backward bending worsens findings; sulcus shallow on the side ipsilateral to flexion test.
Treatment for Torsion
- Forward Sacral Torsion Treatment I: Patient lies on the dysfunction side; flex knees and hips, rotate shoulders upward, and apply upward force on ankles during isometric contraction.
- Forward Sacral Torsion Treatment II: Patient in Sim’s position; follow similar steps as Treatment I, applying downward force on ankles.
- Backward Sacral Torsion Treatment: Patient lies axis side; flex knees and hips; rotate shoulders upward; apply downward force on knee/ankle during isometric contraction.
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Description
Test your knowledge on various sacral assessment techniques. This quiz covers critical elements such as the iliosacral axis test, seated flexion test, and Spring Test. Understand how the outcomes of these tests indicate patient conditions and how to perform them correctly.
