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Sacral Dysfunction: Bilateral Flexed Sacrum & Bilateral Extended Sacrum Cherise Russo D.O. Northwestern Orthopaedic Institute, LLC Clinical Instructor, Northwestern University School of Medicine April 21, 2010 Bilateral Sacral Flexion and Extension Reference is the sacral base Flexion & Extension Plane of motion is the sagittal plane Flexion & Extension: Postural Motion Moves through middle transverse axis Axis S3 S3 Postural Motion Forward Bending – Sacral base moves posteriorly Backward Bending – Sacral base moves anteriorly Flexion Dysfunction of the Sacrum Rotation of the sacrum about the middle transverse axis Sacral base moves anteriorly between the pelvic bones Sacral Base Anterior Extension Dysfunction of the Sacrum Rotation of the sacrum about the middle transverse axis Sacral base moves posteriorly between the pelvic bones Sacral Base Posterior Case Athlete presents to the athletic training room with complaint of midline low back pain. He points to his bilateral sacroiliac region. He is a gymnast. Work-up for spondylolysis was negative. Clinical Findings for Bilaterally Flexed Sacrum Static Findings: – Right and left sacral sulci deep/anterior – Inferior lateral angle shallow/posterior/dorsal bilaterally – Increased lumbar curve Clinical Findings for Bilaterally Flexed Sacrum Dynamic Findings – Lumbosacral spring test- Negative – Restricted springing on ILA’s bilaterally – Negative seated flexion test (false negative) Respiratory Assist Technique Respiratory Motion – Inhalation- sacral base moves posteriorly – Exhalation- sacral base moves anteriorly Respiratory Assist Technique Athlete lies prone and clinician stands beside the patient Clinician places thenar and hypothenar eminences of the caudad hand on the ILAs of the patient’s sacrum Reinforce the caudad hand by placing cephalad hand on top of the caudad hand Thenar and hypothenar eminences of the cephalad hand are placed at the sacral base Respiratory Assist Technique Clinician applies a continuous anterior downward force on the ILA’s of the patient’s sacrum Patient is directed to inhale deeply Clinician exaggerates sacral extension during inhalation and then resists sacral flexion during exhalation Respiratory Assist Technique Repeat these steps 7- 10 times Reassess initial findings Case Athlete presents to the athletic training room with complaint of midline low back pain. She points to her bilateral sacroiliac region. She is a diver. Clinical Findings for Bilaterally Extended Sacrum Static Findings: – Right and left superior sulci are shallow/posterior/dorsal – ILA’s deep/anterior/volar bilaterally – Decreased lumbar curve Clinical Findings for Bilaterally Extended Sacrum Dynamic Findings: – Lumbosacral spring test: Positive – Restricted springing on superior sulci bilaterally – Negative Seated Flexion Test (False negative) Respiratory Assist Technique, Bilaterally Extended Sacrum Athlete lies prone and clinician stands beside the patient Clinician places the caudad index finger on patient’s right sacral sulcus and long finger on the left sacral sulcus Clinician’s cephalad hand reinforces the caudad hand Respiratory Assist Technique, Bilaterally Extended Sacrum Clinician applies a continuous anterior force to the sacral sulci Patient is advised to inhale and exhale deeply Clinician exaggerates flexion during exhalation and attempts to resist extension during inhalation Repeat series 7-10 times and reassess References Nicholas, Alexander S. and Evan A. Nicholas. Atlas of Osteopathic Techniques. Philadelphia: Wolters Kluwer/ Lippincott Williams &Wilkins, 2008. Savarese, Robert G. OMT Review: A Comprehensive Review in Osteopathic Medicine. 2nd Edition. USA, 1998. Ward, Robert C., et al. Foundations for Osteopathic Medicine. Baltimore: Williams & Wilkins, 1997. Thank You! Questions? Craniosacral Motion Sacral flexion=sacral nutation – Occurs during sphenobasilar extension (craniosacral motion) Sacral extension=sacral counternutation – Occurs during sphenobasilar flexion (craniosacral motion)
