Sacrum.self.Study.guide

7/28/2019 Sacrum.self.Study.guide

http://slidepdf.com/reader/full/sacrumselfstudyguide 1/24

A Self Study Review of

Sacrum Diagnosis andMuscle Energy

Mary Goldman D.O.



Standing Flexion Test;

Seated Flexion Test• Standing: “+” (positive) if pelvis and/or sacrum

somatic dysfunction (SD)

• Seated: “+” if sacrum SD

• False “–” if bilateral flexion/extension of pelvis

• If both “+” on same side, treat sacrum first

(then check pelvis again)

• If “+” on opposite side, treat pelvis first, then if compression test shows restriction of ASIS

on either side, diagnose & treat pubes



How does “+” seated flexion test

help diagnose the sacrum?• “+” seated flexion determines which side the

piriformis SD is located upon.

• Bilateral sacral flexion OR extension is false “-”

because both sides have piriformis restriction, soboth sides move up

• Unilateral sacral flexion OR extension have “+”on the side of restriction as in pelvic SD

• Sacral torsions have a “+” on the opposite side

of the axis (axis named at sacral base, butpiriformis SD is at the bottom of oblique axis, soit is located on the opposite side from name of axis)



Sacral TORSION on OBLIQUE axis(note that relative prominents are on same side)

• Flexion

– Left on Left (LonL)

– Right on Right (RonR)• Extension

– Left on Right (LonR)

– Right on Left (RonL)



Axis along this line

True prominent underlined

Prominence relative to opposite side

Deep

Not prominent

P

D

KEY:

CONCLUSIONS:SACRAL TORSION has an oblique axis,

but the prominents are on the same side

UNILATERAL SACRUM has a low transverse axis, but the

prominents are on opposite corners

P

SIDE OF POSITIVE SEATED FLEXION



SACRAL

TORSION

Left onLeft

(LonL)

[flexion]

P

P

D



SACRAL

TORSION

Right on

Right

(RonR)[flexion]

D

P

P



SACRAL

TORSION

Left on

Right

(LonR)[extension]

P

DP



SACRAL

TORSION

Right onLeft

(RonL)

[extension]D P

P



e.g.,Torsion in flexion

LonL (mirror image of RonR)• Entire sacrum is rocked forwards (flexion)

• LonL means facing left on left axis

• Left upper pole prominent because sacrum is

facing left• Left axis means that the base of the sacrum

(where the axis is named) is the top of the axisaround which the sacrum moves

• Seated flexion test is “+” on the right which iswhere the restricted piriformis keeps the sacrumimmobile, so that the sacrum moves around it



e.g., Torsion extension

LonR (mirror image of RonL)• Sacral base in extension, facing left on a

right axis

• Sacral base is prominent on the left sidebecause it faces left

• Piriformis SD causes restriction of the leftILA (inferior lateral angle) where the “+”

seated flexion test is located. Follow upthe axis to the sacral base on the rightside to name this a right axis



What SD is found in the SACRUM?

1. Bilateral flexion OR extension

2. Unilateral flexion OR extension – Right side

– Left side

3. Torsion flexion – Right on Right, which is RonR

– Left on Left, which is LonL

4. Torsion extension – RonL

– LonR

5. (Some books list a Marginal, which is a rotation around

a vertical axis, think trauma can do anything)



BILATERAL

SACRAL

FLEXION

PP



BILATERAL

SACRAL

EXTENSION

PP



Unilateral flexion OR extension

• One side of sacrum is stuck, as by reaching

front/back and up/down while seated or standing

with feet even

• The opposite side of the sacrum-pelvis is normal

• The stuck side will be flexed or extended

• Seated flexion test will be positive on the stuck

side• Flexion has lower pole prominent, extension has

upper pole prominent



UNILATERAL

LEFT SACRAL

FLEXION

D

P



UNILATERAL

RIGHT SACRAL

FLEXION

P

D



UNILATERAL

LEFT SACRAL

EXTENSION

P

D



UNILATERAL

RIGHT SACRAL

EXTENSION

D

P



So how do I figure out whether it is

a torsion or a unilateral?• Find a relative prominent at the top and at the

bottom of the sacrum. If the sacral base is deepon one side, name the other side the relativeprominent

• If both relative prominents are the same on theleft or right, it is a torsion

• If the relative prominents are on oppositecorners of the sacrum, it is a unilateral

• DO NOT CONFUSE AXIS with relativeprominent patterns: torsions have oblique axisbut same side prominents; unilaterals have lowtransverse axis with opposite corner prominents!!!



Treatment:

• TORSIONS: If legs hang off table, place patient on sideof axis, rotate trunk to floor if flexion and up to ceiling if extension, bind while palpating Lumbo-sacral junction,have patient push lower legs up to ceiling for 3-5

seconds, 3-5 x, recheck.• UNILATERAL: patient prone, leg rotated in if flexion

lesion, out if extension, locate bind at the SI joint, thenpush down the axis of your treating outstretched arm onthe most prominent corner; as an HVLA this is a thrust,

as Muscle Energy hold the bind while patient breathsdeeply 3-5 seconds, 3-5 times and then recheck.



If you have questions on this

material,• Get a wallet or similar sized square and

hold the corners of the axis for torsion and

see where the prominents are, then hold

the low transverse axis of the unilateral

and see where the prominents are.

• Email me at [email protected] with

questions

Sacrum.self.Study.guide

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