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6/15/2015 All materials contained in this PowerPoint Presentation are protected by copyright laws, and may not be reproduced, republished, distributed, transmitted electronically, displayed, broadcast or otherwise exploited in any manner without the express prior written permission of Howard Pettersson, DC. Howard Pettersson, DC, either owns the intellectual property in all the information and media in this PowerPoint Presentation or has obtained permission of the owner to use the content in this presentation. You may download or print this material for your own personal and educational use only, without altering or removing any trademark, copyright or other notice from such material. Viewing this PowerPoint Presentation constitutes explicit agreement with the terms of this copyright declaration. Copyright © 2014 Howard Pettersson BASE POSTERIOR SACRUM INSTRUMENTATION An instrumentation break will usually occur at the lower 1/3 of the L5 spinous. 1 6/15/2015 PHYSICAL EXAM FINDINGS • Motion palpation reveals a fixation at L5. • Edema may be present between the L5-S1 segments. PHYSICAL EXAM FINDINGS • Tenderness may be found over the S1 and S2 segments. • Sudoriferous changes may be noted over L5 and S1. LATERAL X-RAY The lateral x-ray will usually reveal a flexion malposition of L5 on the sacral base. 2 6/15/2015 SACRAL BASE ANGLE The sacral base angle is usually less than 36 degrees. LATERAL X-RAY The lateral x-ray will usually exhibit hypolordosis of the lumbar spine. GRAVITATIONAL STRESS LINE If the Gravitational Stress Line passes posterior to the anterior one-third of the sacral base, this suggests hypolordosis of the lumbar spine. 3 6/15/2015 GEORGE’S LINE The lateral x-ray will usually reveal that the sacral base George’s line is relatively posterior to the L5 George’s Line. Sacral Compression Test may relieve Base Posterior Sacrum discomfort because it may be closing the L5 posterior open disc wedge (flexion malposition). Sacral Distraction Test may aggravate a Base Posterior Sacrum because it is increasing the L5 posterior open disc wedge even more (flexion malposition). 4 6/15/2015 BP TISSUE PULL I-S Tissue Pull & then extend the wrist. Correct for Base Posterior Sacrum. LOC is P-A & I-S through the midline of the L5 disc. 5