Lumbar and SIJ

Question 1

Observation - The Buttgripper

Answer 1

(SIJ)
PASSIVE: Over activity deep external rotators of the hip joint uni or bilaterally

ACTIVE
*One leg stance
*Pelvic control [trunk control; abductor
*Hip control [overactive piriformis; glut med/min

Question 2

Control of pelvis/hip

Answer 2

*
Control of the pelvis/hip
*One leg stance: Recruitment of trunk muscles
If force closure is not in place
 ant sagital rot of tested sides’s ilium  CN ipsilat SIJ + longitudinal pelvic rot towards lifted leg + caudal pubic symphysis displacement
* One leg stance: Recruitment of hip muscles
If force closure is not in place –> anterior displacement/rot of femur

Question 3

LX / SIJ palpation

Answer 3

*Position of bony landmarks,
mostly for symmetry
*Iliac crests, PSIS’s, ASIS’s, greater
trochanters i.r.t pelvis

Question 4

Standing Forward
Flexion test (StFT)

Question 5

establish innominate asymmetry [‘torsion’]: Try to find a pattern

Answer 5

*Iliac crests R  L; PSIS R  L; ASIS R  L; PSIS ASIS R  L;
Greater trochanters  pelvis
*Palpate PSIS movement with trunk and leg movement
*Forward Flexion Test; Gillet Test
*Hip rotations

Question 6

Posterior Pelvic Pain Provocation test [P4] /Thigh thrust

Answer 6

*The test is performed supine and the
patient’s hip flexed to an angle of 90
degrees on the side to be examined:
*Light manual pressure is applied to
the patient’s flexed knee along the
longitudinal axis of the femur while
the pelvis is stabilized by the
examiner’s other hand resting on the
patients contralateral ASIS
*The test is positive when the patient
feels a familiar well localized pain
deep in the gluteal area on the
provoked side

Question 7

Gaenslen’s test

Answer 7

The patient, lying supine, flexes the hip/knee and draws it towards the chest by clasping the flexed knee with both hands. The opposite leg extends over the edge while the other leg remains flexed. The examiner uses this manoeuvre to gently stress both sacroiliac joints simultaneously.

Question 8

Anterior ligament stress

Answer 8

• Legs slightly bend on pillows
• Transvers opening force on ASIS
• Comfortable contact
• Take up soft tissue slack
• Strong small ‘overpressure’

Question 9

Posterior ligament stress

Answer 9

• patient in side lying
• Push down vertically
• Comfortable contact – careful avoiding ‘glut minimus pinch’

Question 10

Sacral thrust

Answer 10

P-a sacrum

Question 11

Nutation & counternutation of the sacrum

Question 12

EROM P-a-p differentiation
SIJ vs lumbo-sacral pain
provocation

Answer 12

Stabilise sacrum in p-a direction, do a-p pressure on ASIS

Question 13

EROM Longitudinal
movement SIJ vs LS
pain provocation

Answer 13

Stabilise sacrum in longit-ceph direction, do longit-caud
pressure innominate

Stabilise sacrum in longit-caud direction, do longit-ceph
pressure on ischial tub

Question 14

ASLR (MC test)

Answer 14

*Assessing pelvic control strategy: Just lift 10 cm and
observe
*Lumbopelvic stabilization lacking = compensation
*rib cage draws in = EO
*Lower ribs flare out = IO
*Thoracic extension = ES
*Abdomen bulge = breath holding
*Repeat with pelvic belt. Improvement = positive test
*+ test = a need for rehab of Force Closure

Question 14

ASLR (original test)

Answer 14

*The patient is asked to score any feeling of impairment
[‘how much effort?’] (on both sides separately) on a 6
point scale: not difficult at all = 0; minimally difficult = 1;
somewhat difficult = 2; fairly difficult = 3; very difficult =
4; unable to do = 5 Mens et al 2001 ; EBCG 2008]
*Feel under WB heel which one pushes down the
hardest to lift the other leg
*Repeat with pelvic belt. Improvement = positive test
*+ test = a need for rehab of Force Closure

Question 15

SIJ *Pain Provocation tests - best evidence base

Answer 15

*P4 , Ant gapping, Gaenslen FABER [3 out of 4 +]
*Post gapping; EROM sagittal rotation innominate in sidelying
*PAM in prone [ EndROM tests]

Question 16

SIJ - Motor Control tests medium to strong evidence base

Answer 16

*One leg standing
*ASLR

Question 17

SIJ RX - SIJ movement treatment
Pain - sidelying

Answer 17

• Physiological movement’ of the SIJ
  = Sagittal rotation of the
  innominate [Mid ROM in sidelying]
• Both legs bend – mid-ROM
• Do PSR and ASR movement

Question 18

SIJ RX - maitlands

Answer 18

• Any of the physical examination movements
• P-a, a-p movements of the Sx, ASIS or PSIS
• Sacral nutation and counternutation
• Innominate rotation

Question 19

SIJ RX - Rocabado

Answer 19

• Concept of restoring joint position with muscle
  energy techniques
• Use muscle energy to change bony position
  *Muscle pulling one articular surface
  *Muscles stabilising the other
• Sub-max muscle contraction
• Hold 6 secs
• Repeat 6x
• 6x per day

Question 20

SIJ RX - Mulligan: MWM: Pain with Lx extension

Answer 20

1. Stabilise sacrum in p-a direction and apply a-p pressure of
   innom: test LxE
2. Stabilise Sacrum in p-a direction and push PSIS lateral-& pa:
   test LxE

Question 21

SIJ RX - Passive joint mobilisation in hypo- or normal mobility
and/ or momentory pain

Answer 21

• Gr IV – IV+ movements: Sagital movement [P-a on sacrum, a-p on ilium]
• Transverse movement of ASIS [Ant gapping]
• Longitudinal movement caudad or cephalad
• EROM Rotation of the ilium/hemipelvis [ant or posterior]

Question 22

SIJ RX - * Passive joint mobilisation for ++pain and after injury

Answer 22

• Supine: NZTT movements
• Sidelying: MidROM pelvic sagital rotations

Question 23

Perform all Lx active movements + with over pressure (from above and below)

Question 24

Perform and explain one leg stance for SIJ

Answer 24

*One leg stance: Recruitment of trunk muscles If force closure is not in place  ant sagital rot of tested sides’s ilium  CN ipsilat SIJ + longitudinal pelvic rot towards lifted leg + caudal pubic symphysis displacement *One leg stance: Recruitment of hip muscles If force closure is not in place  anterior displacement/rot of femur

Question 25

Perform lumbar manipulation to the right side (contraindications?)

Answer 25

* P on R side, pillow under head, hips and knees in Flexion * P lies close enough to edge for L knee to glide over edge of bed * T in front of P between P’s trunk and flexed knees * P’s L shoulder is in minimal E with elbow F, forearm resting on P’s side STEP 1 * T localises correct level for L3/4 * T finds mid-position of the joint with F/E PPIVM * T keeps L index finger in L3/4 interspinous space to maintain mid-position of the joint * T or P straightens underneath R knee, keeping R hip in slight F * T bends P L knee in F until dorsum of P’s L foot hooks behind P’s R knee * T keeps R index or middle finger in L3/4 interspinous space * T pushes L hand underneath P’s R shoulder and pulls P’s arm towards ceiling until P’s L knee lifts slightly * P R hand under pillow. P R arm relaxes in abduction and lateral rot STEP 2 * T threads L arm through P’s elbow, L upper forearm against P L shoulder * T chest on P’s L arm * T’s R upper forearm behind P’s L hip * T’s L thumb pushes down against the upper L side of the spinous process of L3 * T middle finger pulls up against the under R side of P’s L4 spinous process * T uses mainly forearms to simultaneously rock P’s upper body backwards and lower body forwards in small oscillatory movements to achieve maximum rotary stretch * T increases the pressure against spinous processes until EOR of IVJ achieved and maintained * T executes a small, quick, sharp thrust to rotate L4 on L3 ADDITIONAL INFO * Adjust the position so that L3/4 is neutral, take up the slack, let the P’s upper leg drop off the bed if needed * Roll the P over to a balance point so that the thrust will affect the pelvis and thorax equally * Secure the thumb and finger contact * Thrust along the joint plane by a drop/twist of the body, using the forearm against the greater trochanter and the sternum against the ribcage as leverage * Uses: simple mechanical low back pain, in the absence of any risk factors

Question 26

FEMORAL SLUMP

Answer 26

Side-lying, half-foetal position, tested side upward, lower leg in hip and knee Flexion (held by Pt – but not fully flexed), Cx flexion; Pt holds own head in Flexion, Th supports upper leg under knee with arm closest to Pt feet, other hand stabilises pelvis, Move Knee into F and hip into E to onset of P1 or R1 Structural differentiation: Release head from flex to neutral/ Cx ext. Reapply Cx F to test the resistance to hip extension to confirm. Tx and Lx spine must not move.

Question 27

STRAIGHT LEG RAISE

Answer 27

TESTS Sciatic N/ Lumbo-pelvic plexus) * Supine: Hip F with straight knee. Structural diff: add DF for proximal symptoms; no further diff needed for distal symptoms – hip flexion/proximal movement produce distal symptoms. Sensitising movements are Hip adduction, Hip IR/MR, Dorsilexion/ Inversion (Sural), DF/Eversion (Tibial), PF/Inversion (Fibular/Peroneal)

Question 28

SLR: SENSITISATION

Answer 28

TIBIAL NERVE * DISTAL HAND HOLDS FOOT IN DF & EVERSION PERONEAL NERVE * DISTAL HAND GOES UNDER THE PLANTER ASPECT OF THE FOOT. FOOT HELD IN PF & INVERSION, WITH FINGERS OVER THE TOES (HOLDING THE BABY). * PROXIMAL HAND ON TIBIAL PLATEAU PREVENTING KNEE FLEXION AND TIBIAL IR SURAL NERVE * PROXIMAL HAND GOES AROUND THE MED ASPECT OF THE FOOT HOLDING THE FOOT IN DF/INVERSION * DISTAL HAND PASSES UNDER THE LOWER LEG TO THE MED TIB & KNEE.

Question 29

SLUMP

Answer 29

* Sitting over bed: * Starting position: Hips and knees Flexed, back up straight/ sacrum vertical, arms behind back, Slump Shoulder above hips = Spinal Flexion, add neck flexion. * For leg pain add: straighten non-symptomatic leg, then symptomatic leg, DF can also be added. * Structural differentiation: release Cx Flexion; or release/reapply DF

Question 30

NEURAL PALPATION

Answer 30

* SCIATIC N: LATERAL FROM ISCHIAL TUBEROSITY * TIBIAL N (POST KN MEDIAL TO LATERAL HAMSTRING TENDON (HIP F, KNEE E) * TIBIAL N (POST/INFERIOR TO MED MALLEOLUS) * SURAL (LATERAL FOOT, BEHIND LATERAL MALLEOLUS AND LATERAL TA) * COMMON FIBULAR/PERONEAL N (FIBULA HEAD) * DEEP FIBULAR/PERONEAL (FOOT = LAT TO EHL (BETWEEN 1ST AND 2ND TOE) * SUPERFICIAL FIBULAR/PERONEAL (DORSUM OF FOOT (PF/INV) AND UP) * FEMORAL N: ILIOPSOAS (AP’S = INDIRECT) * FEMORAL N (MED TO ASIS JUST UNDER INGUINAL LIGAMENT)

Question 31

LATERAL GLIDE WITH PERIPHERAL NEURAL SENSITISATION

Answer 31

LOCALISE JOINT AND APPLY TRANSVERSE PRESSURE TO SP ABOVE SYMPTOMATIC LEVEL * OSCILLATE PELVIS INTO LF X 10 * NOW PERFORM NEURAL SLIDER WITH HIP AND KNEE FLEX X5

Question 32

LUMBAR CEPHALAD GLIDE

Answer 32

STABILISE THORAX ANT WITH ONE HAND * OTHER HAND USES BASE OF HAND TO CEPHALAD GLIDE THE SP ABOVE THE PAINFUL JOINT

Question 33

ILIOPSOAS length

Answer 33

THOMAS TEST: POSITIVE DECREASED HIP EXTENSION * DISTAL ILIOPSOAS TP DEEP ALONG LAT WALL OF FEM TRIANGLE, JUST ABOVE DIST ATTACHMENT TO LESSER TROCHANTER ILIACUS TP’S INSIDE BRIM OF PELVIS BEHIND ASIS * PRACTICAL: PROX PSOAS TP – BEND IPSILATERAL LEG, APPLY DIGITAL PRESSURE FIRST DOWNWARD BESIDE, AND THEN MEDIALLY BENEATH THE RECTUS ABDOMINUS MUSCLE TOWARDS PSOAS – COMPRESSES PSOAS AGAINST LX SPINE * TP OR SHORTNESS DUE TO MAL-ALIGNMENT, SUSTAINED POSTURE REPETITIVE ACTIVITY, * SPINAL DYSFUNCTION OR INCREASED TONE – IRRITATION OF L2, L3 AND PART OF L4 NR’S

Question 34

MODIFIED THOMAS TEST

Answer 34

* THE PATIENT IS POSITIONED SITTING AT THE END OF AN EXAMINATION TABLE. THE PATIENT IS THEN ASKED TO LIE DOWN WHILE BRINGING BOTH KNEES TO THEIR CHEST. THEY SHOULD THEN PERFORM A POSTERIOR PELVIC TILT- FLAT BACK. * ONE LIMB SHOULD THEN BE LOWERED TOWARDS THE TABLE WHILE KEEPING THE OPPOSITE TUCKED TOWARDS THEIR CHEST

Question 35

PIRIFORMIS anat

Answer 35

* * O: ANT SURFACE OF SACRUM AND SACROTUBEROUS LIGAMENT * * I: SUP BORDER OF GREATER TROCHANTER OF FEMUR * * A: LAT ROT AND HIP EXT (>90 HIP FLEXION MED ROT) GLOBAL MOBILISER * * N: SACRAL PLEXUS L5-S1, VENTRAL RAMI S1-S2

Question 36

PIRIFORMIS MUSCLE LENGTH TEST

Answer 36

* SUPINE: HIP FLEXION + ADD + LR * PT PASSIVELY FLEXES HIP TO 90⁰, THEN ADDUCTS THE HIP TO THE END POINT RESISTANCE (KNEE RELAXED) AND THEN PT LR THE HIP * IDEALLY - 45⁰ LR , IN PRONE KNEE FLEXION AND HIP IR - COMPARE L TO R

Question 37

PIRIFORMIS: PALPATION

Answer 37

* INCREASED TONE – IRRITATION OF L4, L5, S1, S2 NR’S PALPATION IF TIGHT: DEEP PRESSURE * PALPATE THE POINT WHERE AN IMAGINARY LINE BETWEEN THE ILIAC CREST AND THE ISCHIAL TUBEROSITY CROSSES A LINE BETWEEN THE PSIS AND THE GREATER TROCHANTER * CAN CAUSE DECREASE IN L5/S1 REFLEX DUE TO RESTRICTION SCIATIC NERVE MECHANICS AT MECHANICAL INTERFACE

Question 38

PIRIFORMIS TREATMENT TECHNIQUES

Answer 38

PIN & STRETCH, WITH ADDITIONAL HOLD RELAX * PIN THE PIRIFORMIS DOWN, CHECK ROM, * POSSIBLY ADD STRETCH. * ASK THE PATIENT TO PULL FOOT TOWARDS THE MIDLINE * HOLD 10 SEC * RELAX * PT STRETCH LL INTO NEW ROM

Question 39

QUADRATUS LUMBORUM anat

Answer 39

* O: ILIOLUMBAR LIG, ILIAC CREST. OCCASIONALLY FROM UPPER BORDERS OF TRANSVERSE PROCESSES OF L2-L5 * I: INF BORDER OF LAST RIB AND TRANSVERSE PROCESSES OF L1-L4 * GLOBAL MOBILISER

Question 40

QUADRATUS LUMBORUM length

Answer 40

* PT PUSHES UP SIDEWAYS AS FAR AS POSSIBLE WITHOUT MOVEMENT OF THE PELVIS - MERMAID SITTING * LIMITED ROM, LACK OF CURVATURE IN THE LX SP AND/OR ABNORMAL TENSION ON PALPATION (JUST ABOVE ILIAC CREST AND LAT TO ES) INDICATE TIGHTNESS

Question 41

QUADRATUS LUMBORUM kinetic control

Answer 41

* BEND STAND WITH FEET SHOULDER WIDTH APART AND HANDS TOUCHING SIDE OF HEAD AND LX FLATTENED ONTO THE WALL. * PT THEN SIDE BENDS KEEPING BACK FLAT ON THE WALL AND WITHOUT ALLOWING PELVIS TO SHIFT LATERALLY, TILT OR ROTATE IDEALLY: * GOOD SYMMETRY AND 35-45⁰ SF

Question 42

ITB LENGTH TESTS

Answer 42

OBER’S TEST * BOTTOM LEG FLEXED NEUTRAL SPINE STABILISE PELVIS TOP LEG * KNEE FLEXED TO 90⁰ ABD AND EXT TOP LEG. NEUTRAL HIP ROTATION * DROP LEG TO TABLE MODIFIED OBER’S TEST * LESS STRAIN MEDIALLY ON KNEE, LESS TENSION ON PATELLA, LESS INTERFERENCE OF A TIGHT RF * STABILISE PELVIS AND KEEP LATERAL TRUNK IN CONTACT WITH TABLE * NEUTRAL HIP ROT HIP EXT IN LINE WITH TRUNK ALLOW LEG TO DROP TO TABLE

Question 43

ERECTOR SPINAE anat

Answer 43

* ILIOCOSTALIS (LAT) N: L1-L3 * O: ANT SURFACE OF BROAD TENDON ATTACHED TO MEDIAL CREST OF SACRUM, SPINOUS PROCESSES T11-L5, POST PART OF MEDIAL LIP OF ILIAC CREST, SUPRASPINOUS LIGAMENT, LAT CREST OF SACRUM * I: INF BORDERS OF ANGLES OF LOWER 6/7 RIBS * LONGISSIMUS (INTERMEDIATE) N: C1-S1 * SPINALIS (MED) N: T2-L3 * GLOBAL MOBILISER

Question 44

E/S: MOBILITY

Answer 44

* SITTING – NON-NEURAL SLUMP * SIT AND FLEX SPINE BY ALLOWING SHOULDERS TO SLUMP TOWARDS PELVIS BENCHMARK: EVEN FLEXION THROUGHOUT THE TX AND LX SP WITH 20⁰ LUMBAR FLEXION * HOME STRETCH - PEDAL STRETCH

Question 45

lumbar bony landmarks

Answer 45

* L3 → OPPOSITE THE BELLY BUTTON * L4-L5 INTERSPACE →LEVEL WITH THE ILIAC CRESTS * L5 → SLIDE FINGERTIPS ALONG THE FUSED SPINES OF THE SACRUM, & THEN ONTO THE L5 SPINOUS PROCESS. IT IS DEEP, SMALL & HAS A BLUNTED BONY POINT

Question 46

general palpation

Answer 46

* TEMPERATURE & SWEATING * SOFT TISSUE CHANGE * SUPERFICIAL TISSUE * SOFT TISSUE SURROUNDING THE FACET JOINTS * NEW SOFT OR OLD HARD TISSUE CHANGES * SUPRASPINOUS LIGAMENTS USING THE FINGER TIPS * ALIGNMENT OF VERTEBRA & ANOMALIES * GENERAL MOBILITY OF THE SPINE FOR HYPO- OR HYPER MOBILITY PPIVMS, PAIVMS

Question 47

MAITLAND AX

Answer 47

* GRADES I –V (DIFFERENT TREATMENT GOALS) & RHYTHM OF MOVEMENT * BODY PLANE : PA & AP DIRECTIONS FOR ACCESSORY MOVEMENTS LONGITUDINAL MOVEMENT, FOLLOW BODY PLANE (PERPENDICULAR) BUT CAN BE CAUDAD/CEPHALAD OR MEDIAL/LATERAL ORIENTATION PASSIVE PHYSIOLOGICAL MOVEMENTS * TREATMENT PROGRESSIONS: START IN ‘LOOSE PACKED’ POSITION, PROGRESS TO EROM POSITIONS OR ‘CLOSE PACKED

Question 48

PALPATION PPIVMS

Answer 48

TO DETECT ABNORMALITIES IN RANGE ON INDIVIDUAL LEVELS * F/E DOUBLE LEG * F/E SINGLE LEG P.A VERTEBRAL PRESSURE HANDLING SKILLS: * THUMBS FOR GENTLE GRADES * LAT HAND/ PISIFORM FOR STRONGER GRADES (CENTRAL PA) * MOBILISE AT RIGHT ANGLES TO THE BODY * L5 LESS MOVEMENT * USE WITH CENTRAL PAIN OR SPASM OF BOTH SIDES * PAIN AND SPASM SHOULD NOT BE PROVOKED CENTRAL PAIN WITH PA: * SUPERFICIAL OR DEEP? * DOES PAIN SPREAD * MARK REPRODUCTION OF PAIN WITH *

Question 49

PAIVMS

Answer 49

* CENTRAL PA * UNILATERAL PA * LUMBAR ROTATION, PG. 372 – 376 * LOCALISED ROTATION MOBILIZATION PG 396 - 398

Question 50

lower and upper lumbar rotations

Answer 50

Patient with painful side up Gr I hand on bed, Gr II hand on abdomen Gr III one knee bent, knee off bed. Thoracic rotation, with counter pressure Gr IV, top leg off bed

Question 51

LOCALISED ROTATION: ROTATION TO THE RIGHT

Answer 51

* PATIENT LIES ON THE RIGHT SIDE * PPIVM THE CHOSEN JOINT TO THE MIDPOINT * FLEX TOP LEG TO TUCK FOOT BEHIND EXTENDED BOTTOM LEG * ROTATE THE THORAX PASSIVELY * PATIENTS FOREARM RESTS ON THEIR SIDE * PT FOREARMS RESTING ON PATIENT SHOULDER AND HIP * OSCILLATE ROTATION BETWEEN PT THUMB AND MIDDLE FINGERS

Question 52

mulligan self LX snag

Answer 52

see picture on slide - use fist and other hand, push up

Question 53

LX FLEXION SNAG IN SITTING

Answer 53

STARTING POSITION PATIENT: * SIT ON A PLINTH, LEGS OVER THE SIDE * BELT AROUND THE P ABDOMEN JUST BELOW THE ASIS STARTING POSITION THERAPIST: * T STAND BEHIND THE P, BELT BELOW THE T HIPS * ULNAR BORDER OF THE R HAND, HEEL OF HAND OR THUMB PLACED INFERIOR TO THE SPINOUS PROCESS OF THE VERTEBRA ABOVE THE SYMPTOMATIC SPINAL LEVEL * L HAND ON THE PLINTH FOR STABILITY' * P FLEXES THE LX TO P1, & EXTENDS A LITTLE * T APPLIES A GLIDING FORCE WITH R HAND UP ALONG THE FACET TREATMENT PLANE AS P FLEXES AGAIN (ONLY ONCE) * IF YOU ON THE RIGHT LEVEL P WILL FLEX PAINLESSLY TO NEW ROM * THIS MEANS THIS TREATMENT CAN BE USED * REMEMBER TO MAINTAIN (SUSTAIN) YOUR GLIDE A FEW SECONDS * MAINTAIN THE GLIDE UNTIL THE PATIENT IS BACK IN NEUTRAL VARIATION * L4 & ABOVE: UNILATERAL GLIDE, USE ULNAR BORDER * L5/S1: THUMBS REINFORCED ON L5 * IF NOT EFFECTIVE, CHANGE LEVEL OR DO UNILATERAL OR USE DIFFERENT TECHNIQUE * TREAT A/A IN STANDING IF APPROPRIATE (OR 4 POINT KNEELING) * ACUTE DISC LESION: MAY ADD TAPE ‘X’ TO MAINTAIN NEUTRAL E

Question 54

MCKENZIE EXTENSION EXS

Answer 54

* PRONE LIE, HANDS UNDER THE SHOULDERS, REPEATED E, RAISE ONLY UPPER BODY, PELVIS REMAINS RELAXED, LX SAGS, MAY ADD EXHALAôON FOR ↑ E, * REPEAT 10 X * PRONE LIE: ADD O/P WITH HEEL OF HAND ON TRANSVERSE PROCESSES, * T ARMS PERPENDICULAR TO SPINE, SUSTAIN AS P DOES REPEATED E * MAINTAIN THE LORDOSIS FROM LYING TO STANDING * REPEATED E IN STANDING * FINALLY INTRODUCE F, AND ‘SANDWICH’ E, F, E

Question 55

SIJ: Supine: Neutral zone translation tests A-P

Question 56

SIJ: Prone: PA and longitudinal movement of the sacrum differentiating SIJ from L5/S1 movement (Maitland peripheral book p 404 – 405)

Question 57

SIJ: Prone: Sacral nutation and counter-nutation - Maitland Vert. Manip p 404 -406

Question 58

SIJ: Side-lying: Innominate Anterior and posterior rotation - Mid ROM (Maitland Vert. Manip p 404 – 406) - End ROM (Petty)