Innominates and Sacral Diagnosis Review and BLT treatments Lab

Question 1

Steps of Balanced Ligamentous Tension

Answer 1

1) position segment in an indirect manner
2) utilize activating force: inherent respiration
- breathing phase with greatest ease
- instruct patient to hold until “air hunger”
3) return to neutral and re-evaluate

Question 2

BLT: Left Posterior Rotated Innominate

Answer 2

1) patient seated, physician hands on distal tibias
2) Indirectly localize: slowly PUSH UP (ease direction) on ipsilateral leg and simultaneously PULL DOWN on contralateral leg
3) attain balance point
4) instruct pt to rotate trunk towards IPSILATERAL side until ipsilateral leg begins to draw upward with motion
5) attain new balance point
6) instruct patient to inhale deeply and hold for 5-10 seconds
7) release position and reassess

Question 3

BLT: Right Anterior Rotated Innominate

Answer 3

1) patient seated, physician places hands on distal tibias
2) Indirectly localize: slowly PULL DOWN (ease of motion) on ipsilateral leg and simultaneously PUSH UP on contralateral leg
3) attain balance point
4) instruct pt to rotate trunk towards CONTRALATERAL side until contralateral leg begins to draw upward with motion
5) attain new balance point
6) instruct pt to inhale deeply and hold for 5-10 seconds
7) release position and reassess

Question 4

How do the left posterior rotated innominate treatment position and right anterior rotated innominate treatment compare?

Answer 4

they are the same

Question 5

What axis does the sacrum flex and extend on?

Answer 5

transverse axis, sagittal plane

Question 6

What axis does the sacrum rotate around?

Answer 6

oblique axis, horizontal plane

vertical axis tilted

Question 7

What will a sacrum stuck in extension look like?

Answer 7

shallow sacral sulcus
\+ LS
\+ sphinx
unilateral extension
bilateral extension
backward torsion (R/L or L/R)

Question 8

What will a sacrum stuck in flexion look like?

Answer 8

unilateral flexion
bilateral flexion
forward torsion (R/R or L/L)

Question 9

What are the motion tests?

Answer 9

• seated flexion test (feet on the floor)
• respiratory motion (active)
• BBT/sphinx test (active)
• lumbar spring (passive)

Question 10

Which landmarks do you assess for sacral Dx?

Answer 10

L5
Sacral sulcus
ILA
sacral rock test/oblique axis (passive)

Question 11

What is indicated by an inhalation preference?

Answer 11

sacral extension

Question 12

What is indicated by an exhalation preference?

Answer 12

sacral flexion

Question 13

Describe BBT/sphinx test

Answer 13

• pt actively extends lumbar and flexes sacrum

- positive test when sacral bases become more uneven; sacrum prefers extension

Question 14

Describe lumbar spring test

Answer 14

• pushes lumbar into extension and sacrum into flexion

- positive test when there is resistance to springing; sacrum prefers extension

Question 15

Describe Oblique Axis Spring

Answer 15

• will have clear preference of rotation motion around an axis
• forward torsion: sacrum rotates to pressure on sacral base
• backward torsion: sacrum rotates to pressure on ILA

Question 16

Dx: Left Rotation on Left Axis (Forward Torsion)

Answer 16

Lateralization: right side +
Motion testing: flexed
Sacral Sulcus: right deep
ILA: left ILA posterior/inferior

Question 17

Dx: Right Rotation on Right Axis (Forward Torsion)

Answer 17

Lateralization: left side +
Motion testing: flexed
Sacral Sulcus: left deep
ILA: right ILA posterior/inferior

Question 18

Dx: Left Rotation on Right Axis (Backward Torsion)

Answer 18

Lateralization: left side +
Motion testing: extended
Sacral Sulcus: left shallow
ILA: right ILA anterior/superior

Question 19

Dx: Right Rotation on Left Axis (Backward Torsion)

Answer 19

Lateralization: right side +
Motion testing: extended
Sacral Sulcus: right shallow
ILA: left ILA anterior/superior

Question 20

Dx: Unilateral Flexion (Right)

Answer 20

Lateralization: right +
Motion: flexed
SS: right deep
ILA: right ILA posterior/inferior

Question 21

Dx: Unilateral Extension (Right)

Answer 21

Lateralization: right +
Motion: extended
SS: right shallow
ILA: right ILA anterior/superior

Question 22

Dx: Bilateral Flexion

Answer 22

Lateralization: false negative
Motion: flexed
SS: bilateral deep
ILA: bilateral posterior/inferior

Question 23

Dx: Bilateral Extension

Answer 23

Lateralization: false negative
Motion: extended (false negative on BBT)
SS: bilateral shallow
ILA: bilateral anterior/superior

Question 24

Lumbar flexion indicates…

Answer 24

sacral extension

Question 25

Lumbar rotation left indicates…

Answer 25

sacral rotation right

Question 26

Lumbar sidebend left indicates…

Answer 26

engage sacral left oblique

Question 27

External rotation of legs gaps…

Answer 27

anterior SI joint, encourages flexion

Question 28

Internal rotation of legs gaps…

Answer 28

posterior SI joint, encourages extension

Question 29

Sacral Mechanics for sacral extension SD

Answer 29

Sacral Base shallow (extended)
Sacral ILA anterior/superior
Direct Barrier: sacral flexion 
-push base deep (flexed)
-move ILA posterior/inferior
-lumbar extended (TV position)
-legs externally rotated (gap anterior SI)

Question 30

Sacral Mechanics for sacral flexion SD

Answer 30

Sacral Base deep (flexed)
Sacral ILA posterior/inferior
Direct Barrier: sacral extension
-push base anterior/superior
-move ILA anterior/superior 
-lumbar flexed (supine)
-legs internally rotated (gap posterior SI)

Question 31

Dx: Left rotation on left oblique axis

Answer 31

Sacral Base: flexed
Rotation: left
Axis: left
Treatment: sacral base extended, rotation right, axis left

Question 32

Torsion Treatment Understanding: L/L diagnosis

Answer 32

Flexion/Extension: sacral sulcus flexed (deep), direct barrier extended, flex lumbar
Rotation: rotated left, direct barrier rotate right, rotate lumbar left
Oblique: left axis, direct barrier left axis, side bend lumbar left

L5 N Rr Sl compensates for L/L

Question 33

Torsion Treatment Understanding: L/R diagnosis

Answer 33

Flexion/Extension: sacral sulcus extended, direct barrier flexed, extend lumbar
Rotation: rotated left, direct barrier rotate right, rotate lumbar left
Oblique: right axis, direct barrier right axis, side bend lumbar right

L5 F/E Rr Sr compensating for L/R

Question 34

Sacral BLT Techniques

Answer 34

• traditionally done in supine position
• have pt flex knees then roll toward physician
• place hand on sacrum or on ipsilateral side

Question 35

Bilateral Sacral Extension BLT

Answer 35

1) use caudal palm to lift both sacral ILAs anterior to point of ligamentous balance
2) use cephalad hand to gap SI joint
3) pt instructed to take deep breath and hold; physician makes minor adjustments to maintain balance
4) repeated until best motion obtained (3x)

Question 36

Bilateral Sacral Flexion BLT

Answer 36

1) use caudal hand to lift both sacral bases anterior to point of balance
2) use cephalad hand to extend L5, encouraging sacral flexion
3) pt instructed to take deep breath and hold it; physician makes minor adjustment to maintain balance
4) repeat (3x)

Question 37

L/L BLT

Answer 37

1) physician seated on ipsilateral side as rotation
2) caudal hand use fingers to apply anterior pressure to the right sacral base to the point of balance
3) cephalad hand bridges the ASIS’s to gap SI joints or assist caudal hand pushing sacral base anterior or L5 extension
4) respiratory phases are tested and pt instructed to hold breath
5) repeat

Question 38

R/L BLT

Answer 38

1) physician seated on ipsilateral side as rotation
2) use palm of caudal hand to apply anterior pressure to the left ILA to the point of balance
3) cephalad hand bridges ASIS to gap SI joints or assist caudal hand by flexing L5
4) respiratory phase
5) repeat