Innominate Lab Flashcards
Steps for assessing innominates
1) screen for TART
2) Lateralization tests/reset hips
3) palpate landmarks
4) diagnose SD
5) treat
What does it mean to “reset” hips?
- always perform prior to supine evaluation
- have supine pt bend knees, place feet flat on table, lift hips off table, place hips back down, extend knees back to flat spine position
Major muscle of anterior innominate rotation
quads
Anterior innominate MET/ART
Patient: either supine or prone
Physician: standing or seated on side of dysfunction
1) passively flex hip and knee to edge of restrictive barrier which will induce a posterior rotation
2) instruct pt to extend hip towards ease of motion (anterior rotation)
3) maintain isometric contraction 3-5 seconds; relax and engage next restrictive barrier
4) Repeat until no new barriers have been met
Major muscle of posterior innominate rotation
hamstrings
Posterior innominate MET/ART
Patient: supine or prone
Physician: standing on side of dysfunction
1) stabilize patient’s ASIS if supine or PSIS if prone
2) passively extend leg to edge of restrictive barrier which will induce anterior rotation
3) instruct patient to flex hip towards ease of motion (posterior rotation)
4) maintain isometric contraction 3-5 seconds; relax and engage next restrictive barrier
5) repeat until no new barriers have been met
Major muscle for superior innominate shear
QL and erector spinae
Superior Innominate shear MET/ART
Patient: supine with feet off table
Physician: standing at foot of table
1) grasp patient’s tibia/fibula just above ankle
2) internally rotate and abduct leg to gap SI joint and facilitate “close packing” of the hip joint
3) gently lean back to maintain axial traction to engage restrictive barrier which induces an inferior shear
4) instruct patient’s to pull hip towards ipsilateral shoulder (ease of motion)
May also use respiration
Inferior Innominate shear MET/ART
Patient: supine with feet off table
Physician: standing at end of table on side of dysfunction with patient’s foot resting on thigh
1) internally rotate and abduct leg to gap SI joint and facilitate “close packing” of the hip joint
2) gently lean forward, pushing the leg cephalad to engage restrictive barrier which induces a superior shear
3) instruct patient to push foot towards physician’s thigh (ease of motion)
4) maintain isometric contraction for 3-5 seconds; relax and engage next barrier
5) repeat until no new barriers
Inflare of innominate MET/ART
Patient: supine
Physician: standing on opposite side of dysfunction
1) flex dysfunctional leg at hip/knee with foot placed at the lateral aspect of opposite leg
2) one hand contacts the flexed knee and other hand contacts the opposite ASIS for stabilization
3) gently externally rotate/abduct hop to edge of restrictive barrier which will induce an outflare
4) instruct pt to push knee into hand towards ease of motion (internal rotation/adduct)
5) maintain iso contraction and repeat as needed
Outflare of Innominate MET/ART
Patient: supine
Physician: standing on opposite side
1) flex dysfunctional leg at hip/knee with foot placed at lateral aspect of opposite leg
2) one hand contacts flexed knee and other contacts ipsilateral PSIS
3) gently internally rotate/addict hip to edge of restrictive barrier which will induce inflare
4) instruct pt to push knee into hand towards ease of motion (external rotation/abduct)
5) maintain isometric contraction and repeat as needed
Pubic Dysfunctions MET “Shotgun Approach”
Patient: supine, hips are flexed to 45 degrees and knees are flexed to 90 degrees with feet flat on the table
Physician: standing on side of table
1) while having patient use isometric contractions, alternate between adduction and abduction, holding for 3-5 seconds and repeating 3-5 times
Alternate method: start with knees together and progressively get wider between contractions
Superior Pubic Shear MET
Patient: supine
Physician: stand on side of dysfunction
1) doctor stabilizes opposite ASIS with one hand and holds dysfunctional side’s leg, abduct and slightly extend dysfunctional side off table
2) using an isometric contraction, have patient flex hip medially and toward ceiling to activate adductor muscles, hold 3-5 seconds, repeat 3-5 times
Inferior Pubic Shear MET
Patient: supine
Physician: standing same side as dysfunction
1) place superior hand on dysfunctional side’s ischial tuberosity to monitor guide rotation
2) flex patient’s hip until restrictive barrier adding significant adduction to target pubic dysfunction
3) using an isometric contraction have patient try to abduct and extend hip for 3-5 seconds, repeat 3-5 times using MET
