Lecture 4: Sacrum Evaluation and Treatment I

Superior Transverse Sacral Axis

-axis of the sacrum

-S2 at the anterior aspect of the spinal dura

-Respiratory motion

-pulmonary and cranial rhythmic impulse

Middle Transverse Sacral Axis

-axis of the sacrum

-S2 at the anterior aspect of the sacrum

-sacroiliac motion

Inferior Transverse Sacral Axis

-axis of the sacrum

-S3 at the anterior aspect of the sacrum

-iliosacral motion

Neutral

a forward/anterior torsion is physiologic and ________________

Non-neutral

a backward/posterior torsion is physiologic and ____________________

Left on Right (L on R)

Right on Left (R on L)

options for Backward/Posterior torsions

Left on Left (L on L)

Right on Right (R on R)

options for Forward/Anterior torsions

1. Lateralization Tests

2. Salcral sulci comparison

3. ILA comparison

4. Functional/Motion Testing (Spring/Sphinx)

what are the 4 steps to diagnosing a sacrum?

superior/inferior and anterior/posterior

what are you looking at when evaluating the ILA?

Flexion

Flexion or Extension?

Absence of spring

or

negative sphinx

Extension

Flexion or Extension?

spring present

or

positive sphinx

Oblique

If the sacral sulcus is deep on one side and the ILA is posterior/inferior on the opposite side, there is an _____________ axis.

Unilateral

sacral sulcus is deep on one side and ILA is posterior/inferior on the same side

Opposite

With an oblique axis, the axis is always ____________ the positive seated flexion test.

Extend

inhalation will cause the sacrum to ______________

Flex

exhalation will cause the sacrum to ________________

Physiologic

describes a dysfunction that occurs around an axis

Non-Physiologic

describes a dysfunction that does not occur around an axis. Usually caused by trauma

Superior Transverse Sacral Axis

Respiratory axis

Middle Transverse Sacral Axis

Sacroiliac axis

Inferior Transvers Sacral Axis

Iliosacral axis

Vertical Axis

1

Right Oblique Axis

2

Respiratory axis (superior transverse axis)

3

Sacroiliac axis (middle transverse axis)

4

Iliosacral axis (inferior transverse axis)

5

Left oblique axis

6

Anteroposterior axis

7

Forward Torsion

• Neutral

• Rotation in same direction

• Left rotation on left oblique axis

• Right rotation on a right oblique axis

Backward Torsion

• Non-neutral

• Rotation in opposite direction

• Right rotation on left oblique axis

• Left rotation on a right oblique axis

Unilateral Sacral Extension

• Rare

• Shallow sulcus & deep ILA on same side

-positive sphinx

Unilateral Sacral Flexion

• Deep sulcus & prominent ILA on same side as positive seated & standing flexion tests

-negative sphinx

Bilaterally Flexed Sacrum

Seated Flexion Test: Positive/Negative Bilaterally

Both sacral sulci: Deep, anterior

Both ILAs: Shallow, posterior

Spring test: Negative

Sacrotuberous ligament tight bilaterally

Bilaterally Extended Sacrum

Seated Flexion Test: Positive/Negative Bilaterally

Both sacral sulci: Shallow, posterior

Both ILAs: Deep, Anterior

Spring test: Positive

Sacrotuberous ligament loose bilaterally

Spring Test and Sphinx Test

Purpose: An indicator of whether you are dealing with a sacral dysfunction which is going forward or going backward.

When dealing with oblique axes it will tell you if it is an Oblique Axis that is a neutral or non-neutral

Spring Test

1. Find sacral base

2. Place heel of hand over Lumbosacral junction

3. Spring in an Anterior motion(always spring in the direction of the joint)

-No springing allowed

-non-neutral condition (backward torsion) or unilateral/bilateral sacral extension

Describe a positive spring test

-Springing allowed

-Neutral condition (forward torsion) or unilateral/bilateral sacral flexion

describe a negative spring test

Sulci become more symmetrical

describe a negative sphinx test

Sulci become more uneven

describe a positive sphinx test