Download TREATMENT OF INNOMINATE ROTATION

OMM #34
Thursday, 03/27/03, 11am
Dr. Williams
Ryan Kagan
Proscribe: Kevin Stancoven
Page 1 of 3
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TREATMENT OF INNOMINATE ROTATION
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Innominates:
o 3 fused bones:Ilium, ishium, & pubis
o Articulations of innominates:
 Femur at acetabulum
 Sacrum at SI joint
 Pubic bones articulate with each other at the symphysis
 During pregnancy, women may have discomfort at the
symphysis
o Remember to do the lateralzing tests first to determine side of somatic
dysfunction:
 ASIS compression test, standing flexion, seated flexion
 NBOE will have lateralze tests
Anterior innominate rotation
o Definition: One innominate will rotate anteriorly, compared with the other
o Etiology: Tight quadriceps muscles
o Diagnostic findings:
 ASIS more inferior on involved side
 PSIS more superior on involved side
 Right sulcus is more shallow
 Right sacrotuberous ligament is loose
 Right medial malleolus may be inferior
 Appears as a long leg on involved side
 AP compression test will have restriction on involved side
 Positive standing flexion test on involved side
 Positive sitting flexion test on involved side
Anterior innominate rotation – Supine muscle energy
o Example: right anterior innominate
o Patient is supine & Dr. on the side of dysfunction
 Remember to get rid of artifact – have patient bend their knees and
push their butt off the table
o Flex lower extremity on side of dysfunction at knee and hip (no abduction
as in shear & flare)
o Put your (Dr.) shoulder against the patient’s leg & cup patient’s ASIS with
your cephalad hand & the ischial tuberosity with your caudad hand
 Tell the patient that you are putting your hand on the bone that
they sit on
o Hold tension at all points until innominate rotates posteriorly to restrictive
barrier
o Tell the patient to “Push knee against my chest”
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OMM #34
Thursday, 03/27/03, 11am
Dr. Williams
Ryan Kagan
Proscribe: Kevin Stancoven
Page 2 of 3
 Tell the patient to use about half strength when they push
o Sense that force is localized at the SI joint
o Wait for 3-5 seconds
o Flex patient’s hip and rotate their innominate posteriorly to new restrictive
barrier
o Repeat until best motion occurs (usually 3 times)
o Recheck
Anterior innominate rotation – Prone direct muscle energy
o Example: left anterior innominate
o Patient is prone and Dr. is on the side of dysfunction
o Patient’s extremity hangs freely off table
o Flex the patient’s hip and knee (grasp lower leg to do this)
o Place the patient’s foot flat against your thigh
 Don’t put the foot on the knee, when the patient pushes, they may
hurt your knee
o Place other hand on the posterior surface of the sacrum
o Grasp knee & further flex hip & knee
o Lift patient’s knee & “squat” to raise foot superiorly - rotates innominate
posteriorly
o Tell patient to “push your foot against my knee”
 Tell the patient to only use about half their strength
 Maintain isometric counterforce
o After the tissues relaxes, flex hip to rotate innominate posteriorly to new
barrier
o Repeat until best motion (usually 3 times)RecheckInnominate posterior
o Definition: One innominate will rotate posteriorly compared to other
 Remember to lateralize: ASIS compression, standing & seated
flexion tests
o Diagnostic findings:
 ASIS is superior on the involved side
 PSIS is more inferior on the involved side
 Short leg on the involved side
 Medial malleolus may be superior
 AP compression will be restricted on the involved side
 Positive standing flexion test on the involved side
 Positive sitting flexion test on the involved side
 Sacrotuberous ligament will be tight on the involved side
 SI joint is usually tender
Innominate posterior – Supine muscle energy
o Example: left posterior innominate
o Patient is supine & Dr. is on the side of the somatic dysfunction
o Patient is on the edge of the table - allowing the ischial tuberosity to be off
edge
OMM #34
Thursday, 03/27/03, 11am
Dr. Williams
Ryan Kagan
Proscribe: Kevin Stancoven
Page 3 of 3
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o Patient’s leg hangs freely
o Cephalad hand reaches across & stabilizes the opposite ASIS
o Apply tension to the anterior thigh rotating the innominate anterior to a
new restrictive barrier (Dr.’s leg is on the outside of patient’s leg)
 When treating pubis shear, Dr.’s leg is between the table & the
patient’s leg – but not now
o Tell the patient to “pull your knee up to the ceiling”
 Use about half strength
o Sense that the contractile force is localized to the SI joint
o Extend the extremity to a new restrictive barrier
o Repeat until the best motion is obtained (usually 3 times)
o Recheck
Posterior innominate – Prone muscle energy
 May be easier for smaller people or older patients
o Patient is supine & Dr. is on the side opposite the dysfunction
o Cephalad hand (hypothenar eminence) is on the iliac crest & PSIS
o Caudad hand - grasp the distal femur just above knee
o Extend patient’s hip to move the innominate anteriorly to the restrictive
barrier
o Tell the patient to “pull your knee down toward the table”
 Use about half strength
o Sense that the force is localized at the SI joint
o Extend the extremity to a new restrictive barrier
o Repeat until the best motion (usually 3 times)Recheck