Sacral Somatic Dysfunction Flashcards
What elements are in the sacral static testing?
- sacral sulcus
- L5 rotation
- Inferior lateral angle (ILA)
- 4 digit examination
How do you test the sacral sulcus?
1) palpate the PSIS
2) move thumbs medially and inferiorly
3) check for symmetry (deep or shallow)
How do you test L5 rotation?
1) palpate lumbar spine at level of T5
2) check for symmetry (L5 rotation)
How do you test the ILA?
1) palpate with the heel of the hand in the midline down sacrum until it drops anteriorly
2) place one thumb near the thenar eminence to feel the inferior lateral angle of the sacrum
3) place the other thumb roughly symmetrical to the first
4) adjust slightly to find the inferior lateral angle
5) compare each side for posterior/anterior and cephalad/caudal (inferior/superior)
How do you perform the 4 digit evaluation?
1) place the first fingers in the sacral sulci
2) place the thumbs at the ILA
3) evaluate for symmetry
What are the main steps of sacral testing?
1) static testing
2) motion testing
3) diagnosis
What are the 3 types of motion testing?
Lateralization
Active
Passive
What is the test for lateralization?
seated forward bending test
What is the test for active motion?
backward bend test (sphinx)
respiratory motion test
What is the test for passive motion?
lumbosacral spring test
oblique axis passive motion
Describe the seated forward bending test
- tells the side of the dysfunction
- negative in bilateral dysfunction
- unilateral = positive test on side of dysfunction
- torsion = positive test is opposite of the side of the axis (2nd letter of diagnosis)
Give the steps of the seated forward bending test
1) pt seated with both feet flat on the floor
2) physician’s eyes at level of patient’s PSIS’s
3) physicians thumbs are placed on the inferior aspect of the patient’s PSISs and a firm pressure is directed on the PSISs
4) pt instructed to bend forward as far as possible within a pain-free range
5) test is + on side where the thumb (PSIS) moves more cephalad (superior) at the end range of motion; a + test identifies the side of sacroiliac dysfunction, not the specific type of dysfunction
What do the active motions tests look for?
flexion and extension motion
Give the steps of the backward bending test (sphinx)
1) pt lying prone on a treatment table
2) physician stands with dominant eye at level of patient’s sacral sulcus
3) physician’s thumbs placed at sacral sulci, note symmetry
4) pt instructed to backward bend as far as possible within a pain-free range
5) test is + when sacral sulcus appears asymmetrical throughout or the asymmetry gets worse with movement; a positive backward bending test shows the sacrum is unable to flex (extended sacrum)
Give the steps of the respiratory motion test
1) place cephalad hand over the sacrum with thenar and hypothenar eminence at the sacral base and fingertips at the apex
2) place the other hand on top of the cephalad hand pointing in the opposite direction
3) have patient exaggerate inhalation and exhalation
- bilateral sacral base should move posteriorly during inhalation and anteriorly during exhalation
What does the Lumbar spring test define?
flexion/extension
What does the oblique axis passive motion define?
dysfunctional oblique axis
Give the steps of the lumbar spring test
1) patient lying prone on table
2) heel of physician’s hand placed over spinous process of the lumbar spine
3) pressure exerted through the heel of the hand toward the table (extending the lumbar spinal region)
4) test is + when the lumbar spine does not move well into extension; + test shows sacrum is unable to flex (extended sacrum)
Should the lumbar spring and backward bending test be the same?
yes; both are + if sacrum is extended
Give the steps of the oblique axis passive motion test
1) patient prone, physician at side
2) physician places monitoring finger at sacral sulcus and heel of opposite hand on contralateral ILA
3) physician applies anterior pressure with heel of hand at the ILA while monitoring for posterior motion at the opposite sulcus
4) repeat test on opposite sulcus and ILA
Which sacral axis tests respiratory and craniosacral motion?
superior transverse axis (S2 posteriorly)
Which sacral axis tests postural motion?
middle transverse axis (S2 anteriorly)
-dysfunction along this axis will have bilateral findings
Which sacral axis tests innominate rotation?
inferior transverse axis (S3)
How will a dysfunction along the oblique axis present?
deep sacral sulcus on opposite side of the posterior/caudal ILA
