omm spring practical 2

Sacral diagnosis steps

- scrap paper will be provided

- verbally indicate landmarks as you diagnose (e.g., “left sacral base posterior”, “left ILA posterior”)

- must state diagnosis before time is up

1. Seated flexion test

   1. Place thumbs on inferior aspect of PSIS

      1. Positive for side that moves first/forward

2. Spring or sphinx test

3. Identify deep sulcus

   1. Locate PSIS and roll your thumbs so they’re more medial and superior

4. Identify posterior ILA

   1. Palpate down sacral bone until you feel the ledge and find the points on both ends

MET for forward sacral torsion

1. Pt’s side of axis faces DOWN

2. Monitor sacral sulcus (slightly medial to PSIS, hook thumbs medial to help locate it)

3. Flex hips and knees of pt towards you until motion is felt

4. Pt turns away and hugs table

5. Drop pt knees off table

6. Engage in barrier by pushing pt legs down while continuing to monitor + passive stretch

MET for backward sacral torsion

1. Pt side of axis faces DOWN

2. Monitor sulcus

3. Flex hips and knees until motion is felt

4. Straight bottom leg and hook top leg over

5. Grab pt shoulder to rotate them onto their back

6. Drop top leg off table, but keep it parallel to the floor. 

7. Push top leg DOWN and pt resists by move leg UP + passive stretch

MET for Unilateral Sacral Flexion

Pt prone

Stand on opposite side

Walk fingers/palpate down to ILA

ABduct leg and int rot side of dysfunction

Hypothenar on SD ILA, cover sacrum, place cephalad hand on top

Push down on inhale for ILA, as they exhale maintain pressure on SD ILA (push on inhale, resist exhale)

5-7 breaths

Test both sacral bases for reassessment,

MET for Unilateral Sacral Extension

Pt prone, physician stands on opposite side

Hand monitor PSIS and sacral bases of side of dysfunction

Abduct and int rot leg of SD

Place hypothenar on sacral base of side of dysfunction (points caudad), other hand on top (points cephalad)

Ask pt to Sphinx pose

Resist on inhale and follow on exhale for 5-7 times

Reassess sulci

MET for Bilateral Sacral Flexion with Respiratory Assist

Pt prone

Hypothenar and thenar on BOTH ILAs

ABduct and int rot BOTH legs

Push on inhale and resist exhale 5-7 times

Reassess sacral bases and ILA and spring test

MET for Bilateral Sacral Flexion with Alternative Method

Pt supine

Have pt turn on side so you can locate lumbosacral joint and keep that cephalad hand under them as they lie back down

Flex legs/knees until motion is felt at sacral base (brace shoulder into pt knees to get better leverage)

Pt push against your shoulder 3-5 sec for 3-5 times

Bring into knew barrier with more flexion

Passive stretch and reassess

MET for Bilateral Sacral Extension

Pt sphinx pose

Locate sacral bases with two fingers of one hand. Other hand covers the two fingers.

Optional: loose pack the legs

Resist on inhale and follow through on exhale 7-10 times.

Reassess.

Posterior Pelvic CS Points

we just need to know UPL5 and Piriformis

CS for piriformis (posterior pelvic)

Point is between sacral ILA and greater trochanter

1. Stand on same side

2. Ask pt to move to edge of table

3. Move leg down and hold between your knees

4. Flex and ABduct leg on affected side

5. Hold just below ankle and fine tune with internal or external rotation

CS for UPL5 (posterior pelvic)

Point is superior and medial to PSIS

1. Pt is prone

2. Stand on opposite side

3. Hold pt leg of the tender point above knee

4. Extend and ADduct

MET for Lumbar Type 1/2

osteopathic hug or pt arm on neck

monitor TP

(same as thoracic sitting MET)

Posterior Lumbar CS Points

CS of PL 1-5 SP

Point is inferior lateral aspect of SP

E Sa Ra

EXTEND, ADDUCT, EXTERNALLY ROTATE

Stand OPPOSITE of SP

hold leg ABOVE knee

When standing on same side

Use your knee to lift leg closest to you to externally rotate, extend, and ADduct

CS of PL 1-5 TP

Point is posterior lateral aspect of TP (also TP point is slightly one level above SP)

E Sa Ra

EXTEND, ADDUCT, EXTERNALLY ROTATE

Stand OPPOSITE of TP

hold leg ABOVE knee

When standing on same side

Use your knee to lift leg closest to you to externally rotate, extend, and ADduct

CS for QL

EXTEND, ABDUCT, EXTERNALLY ROTATE HIP

Stand on SAME SIDE of TP

QL attachments: inferior aspect of 12th rib, lateral aspect of lumbar TPs, superior aspect of iliac crest

Lumbar Soft Tissue

• prone pressure w/ counter leverage

• prone traction, two handed

• supine extension