Download Basic III – Midterm Review

Basic III – Midterm Review
Sacroiliac Joint = diarthrodial joint
Basic = the technique is founded on the importance of the base of the spine, the sacrum
# of vertebra in normal adult spine = 24
# of intervertebral discs in normal adult spine = 23
# of bones in the human spinal column = 26 (includes sacrum + pelvis)
Spine = vertebra + disc
Spinal column = vertebra, disc, sacrum + pelvis
Joints of von Luschka found in cervical spine
Sacrum Anatomy
 5 segments
 wide base, narrow apex
 base (cephalic)
 apex (caudal)
 concave anterior, convex posterior
3 Divisions of erector spinae muscles
 Illiocostalis (lumborum, thoracis, cervicis)
 Longissimus (thoracis, cervicis, capitis)
 Spinalis (thoracis, cervicis, capitis)
Major Premise – the body of the lowest freely moveable vertebra rotate towards the low side of
the sacrum
Riding the ligament refers to being posterior to the ligament, thereby increasing the subluxation
5 Cardinal Signs
 High crest
 Erector spinae muscles
 Lowest freely moveable vertebral body rotation
 Pain
 Sacrotuberous ligament
Taking a “high pocket contact” refers to ???? and given during illness
Notch contact given at the sacrosciatic notch, or the border of the sacrum which helps to make
up the greater sacrosciatic foramen
 1/3 Thumb tip, inverted, closed fist position and thumb nail placed against the tissue
Switch from spinal  cervical pressures at approximately T4
True Sacral Angle determined by ½ of P.A.
 For every degree of sacral base angle change, there is a 10.76 millimeters of change of
atlas
 Normal range of sacral base angle = 41 +/- 7.7 degrees
Basic III – Spring 2007
Dr.Montgomery
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Order of Correction for Unilateral AI Sacral Subluxation
1. Determine AI sacral subluxation (HELPS)
2. Determine lumbar lordosis type
3. Patient placement
4. Hamstring Release
5. Piriformis contact – superior or inferior hand
6. Sacral Unlock
7. Apex/Notch/Ulnar contact
a. Auxillary contacts
i. Vertebral
ii. Muscular
b. Abdominal contacts
8. Spinal pressures
9. Cervical pressures
Special procedures: double notch, lumbar pressures, Webster Technique
Doctor Positions
Hamstring Release
Piriformis Contact
Sacral Unlock
Apex/Ulnar Contact
Standing or Sitting
Notch Contact
Double Notch
Auxillary/Abdominal
Contact
Spinal Pressures
Cervical Pressures
Perineal Contact
*Patient prone
*Can be performed on both sides
*Doctor stands on same side of contact
*Patient prone
*Performed on opposite side of AI
*Doctor sits on same side of contact (facing the
patient)
*Patient prone
*Doctor bends both legs toward the buttocks
and greater resistance will indicate side of
fixation
*Doctor stands on same side of fixation
*Patient prone
*Performed on same side of AI
*Doctor sits on side opposite the side of
contact (parallel to patient)
*Patient prone
*Doctor may use either hand and may sit on
either side (facing the patient)
*Use of the free hand or hand opposite the
adjusting hand to palpate areas of tenderness
in the muscle structures of the spine, abdomen,
pelvis and extremities
Lumbar
*LOD – through disc plane
*contacting R/L mamillary
Thoracic
*LOD – through facet plane (P/A and I/S)
*contacting R/L TP
Cervical
*LOD – through facet plane (P/A and I/S)
*contacting R/L junction of laminae with TP
*Ideally given during 5th month of pregnancy
*2nd trimester (2X per month)
Basic III – Spring 2007
Dr.Montgomery
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Webster Technique
*3rd trimester (once a week)
*Patient on side (AI side is up)
*Contact is given to restore the perineal floor
muscles back to its previously normal
relaxation level
*Contact given with straight thumb, lateral to
the side of the external anal sphincter muscles
*LOD – towards umbilicus
*Doctor sits on the side of the table the patient
is facing
Dr.Webster found:
*posterior sacrum/fixated SI jt – opposite side
of AI
*contracted round ligament – same side of AI
Determining fixated SI joint:
*Patient prone on side
*Doctor bends both knees to buttocks and if
there is a fixation, he/she will feel resistance
near the end motion and that foot will not travel
as far as the opposite foot
Procedure:
*Sacral unlock used to free fixated SI joint
*Relax round ligament – opposite side of the
formerly fixated SI joint (same side as AI)
*ligament found at the junction of two lines
formed by umbilicus and ASIS
*1st line drawn from umbilicus inferiorly and
laterally 45 degrees from midline
*2nd line drawn from ASIS inferiorly and
medially 45 degrees
*Doctor’s thumb (inferior hand) is used to
contact round ligament
10 Distortions
Distortion #1
Distortion #2
Distortion #3
Distortion #4
Distortion #5
Distortion #6
Distortion #7
Distortion #8
Distortion #9
Distortion #10
Acute and transitional. Seen in children
Primary and secondary rotatory scoliosis
Primary, secondary and tertiary scoliosis
Leg deficiency on same side as SI subluxation
Paradox
Traumatic or structural short leg
Bilateral AI sacral subluxation (hyperlordosis)
Ramrod spine (hypolordosis)
Entire sacrum anteriority (hyperkyphosis)
5th lumbar wedge
14 Indicators of Unilateral AI Sacrum
SAME SIDE
1. Anterior Sacrum
2. Taut Erector Spinae Muscles
3. Prominent PSIS
4. High Iliac Crest (early chronicity)
5. Sacrosciatic Ligament tension (sacrotuberous + sacrospinous ligament)
Basic III – Spring 2007
Dr.Montgomery
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6.
7.
8.
9.
10.
11.
Tip of Coccyx
Fifth Lumbar Body Rotation
Knee-flex
Short leg – functional
Gluteal line deviation
Moderate to sever pain
EITHER SIDE
12. Toeing Out/Foot Flare – helps determine side of Piriformis contracture
OPPOSITE SIDE
13. High Iliac Crest (late chronicity)
14. Taut Hamstring Muscles
Basic III – Spring 2007
Dr.Montgomery
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