Omm Sacral

Front 1

Whyis it important to know sacral really well?

Back 1

it's very heavily tested on the boards

Front 2

What is the model of sacral mechanics that we teach and that will be tested? Why?

Back 2

The mitchell model because it works clinically

Front 3

What does sacrum mean?

Back 3

"sacred"

Front 4

When does the 5 sacral bones fuse?

Back 4

between 16 and 26

Front 5

How much stress is the sacrum under and what is it held up by?

Back 5

an incredible amount because it holds up the whole upper body and is only held in place by the ilium

Front 6

What is the sacral promontory?

Back 6

the most top, disc-like part of the sacrum

Front 7

What part Of the bone do we always named dysfunctions for?

Back 7

The direction that the top of the bone is going in.

Front 8

So what are sacral dysfunctions named for?

Back 8

what the promontory is doing

Front 9

Imagine what the sacrum looks like from the side. What shape is the sacroiliac joint in?

Back 9

The sacrum looks like a curved bone to the shape of your but. The sacroiliac joint like a C headed in the opposite direction

Front 10

Where do all the Coccxygeal nerve roots come out of?

Back 10

The sacral hiatus

Front 11

From the front, what are some differences between the male and female pelvis?

How can you visualize what is happening if you wanted to turn the male pelvis into the female?

Back 11

1. The pubic arch is much wider on a female
2. The iliac crests are much broader and wider on a female as well

You would pull all the prominences outward (iliac crests, ischial tuberosities, sacral promonence)

Front 12

From the top, what are some differences between the male and female pelvis?

How can you think about the shape of the whole pelvis?

Back 12

1. The female pelvic brim is oval-shaped whereas the males is somewhat heart-shaped because the sacrum kind of impinges on the space

on top, there is a big semi bowl facing front. on the back, there is a smaller semiibowl facing the back.

Front 13

Now we talk about the ligaments of the sacroiliac joint.

What does the end of your anterior spinal ligament looks like?

How far does the anterior sacral iliac ligament go? Why?

Back 13

The anterior spinal ligament covers all the way down to the coccygeal but narrows in between the foramen.

The anterior sacroiliac ligament goes in almost a complete ring around the pelvic brim ending just short of the pubic symphysis

Front 14

WHat is the ilio lumbar ligament? Why is it clinically relevant?

Back 14

It is the strong set of ligaments that attaches L4, L5 to the iliac bone.

It is clinically relevant because there are a lot of pain receptors here that are responsible for back pain in the case that they are sprained

Front 15

Back 15

Front 16

Dissect the meaning/ attachments of these following ligaments:
1. Sacral tuberous ligaments
2. posterior Sacroiliac ligaments
3. Interosseous sacroiliac ligaments

Back 16

1. Sacral tuberous ligaments - from sacrum to ischial tuberosity
2. Posterior Sacroiliac ligaments- from PSIS to sacrum
3. Interosseous sacroiliac ligaments- a bunch of tiny ones from each sacral level to the iliac

Front 17

Back 17

Front 18

What is the relationship between the posterior sacral iliac ligament and the sacral tuberous ligament?

What point of the sacrum do they both touch?

Back 18

They actually act as one long continuous ligament from the PSIS to the ischial tuberosity and connecting to the sacrum at the inferior lateral sacral angle

Front 19

What muscles attach to the posterior sacrum? Name what fascia are involved.

Back 19

1. gluteus maximus vis thoraco lumbar fascia
2. multifidus

Front 20

What muscles attach to the anterior sacrum? Name what fascia are involved.

Back 20

1. piriformis

Front 21

SO why do we need to know these muscles?

Back 21

in case we need to use muscle energy to pull the sacrum forward or backwards

Front 22

Where along that the spinal canal is the dura attached?

What does this explain?

Back 22

At the OA, AA, and very upper cervicals and then S2 where the meningeal sac ends.

This explains why you can feel a stratching of the dura when you move your head or legs

Front 23

What is unique about the dorsal root ganglia on location in the sacrum?

Back 23

They are encased within the sacrum

Front 24

Show how the sacrum sits on the pelvis from a side view.
What is the main motion that the sacrum can go through?

Back 24

The sacrum since almost horizontally on the pelvis.

It's main motion is rocking

Front 25

Describe the composition of the sacroiliac joint anteriorly and posteriorly

Back 25

It is a fibro cartilaginous joints anteriorly and a synovial joint posteriorly

Front 26

What model of naming sacral motion do we use? Dissect the name.

What structures motion is it based off of?

Back 26

We use nutation/counternutation which is based off the motion of the promontory and means "to nod"

Front 27

Show nutation.

What level is the axis you base it on?

What action does your sacrum do when you inhale? Why?

Back 27

It will counter nutate because you are pulling the whole spine up and it will straighten out of its kyphosis.

axis at S2.

Front 28

What is the oblique axis of sacral motion?

When do we use this axis vs when do we use nutation?

Back 28

torsional rotation for walking

we use nutation/cn all the time because we breath.

Front 29

Where does the vector of force go through the sacrum and femur when you are standing on one leg?

Back 29

Through the SI joint and the head of the femur

Front 30

At what point of our gait do we rotate around the torsional axis?

What gets locked in and what is free to move on the sacrum?

For which direction is the axis named?

Back 30

When one leg is on the ground and the other one is off the ground.

The sacroiliac joint of the leg on the ground is locked in whereas the joint of the leg moving is rotating the sacrum

The is named for the upper SI joint which is locked in (right versus left)

Front 31

What kind of sacral rotation would you have when you are swinging your left leg?

What structure are you basing this naming off of?

Back 31

Right rotation because the sacral promontory is rotating to the right

Front 32

What rotation would you have swallowing your left leg backwards?

Back 32

You would have left rotation of the sacrum

Front 33

What is the proper naming for sacral dysfunction?

Back 33

SI joint that is moving (rotaion) on SI joint that is locked (axis)

Front 34

Name this

Back 34

Right on right sacral torsion

Front 35

What are anterior versus posterior sacral torsion? Why?

Give the nomenclature

Back 35

Right on right and left arm left our anterior sacral torsions because you are moving your leg forward with them.

Front 36

Which torsions are physiologic versus non-physiologic? And why?

Back 36

Only anterior portions are physiologic because they occur normally during gait

Front 37

What muscle would you use to treat anterior Versus posterior sacral torsion?

Back 37

Gluteus maximus for anterior
Piriformis for posterior

Front 38

What is the relationship between L5 and the sacrum in terms of flexion/extension?

What other bony pair does this remind you of?

Back 38

They are always opposite to one another because they push on one another much like the manubrium and the Gladiolus

Front 39

So what direction with your sacrum go when you bend it to touch your toes?

Back 39

Your sacrum would be in counter nutation

Front 40

How does the sacrum matchup with L5 in terms of side bending?

Back 40

It goes to the same side because it drags it along

Front 41

What kind of sacral dysfunction would you get if you had L5 SLRL?

Back 41

Right on left sacral torsion

Front 42

What two things must you treat before you treat the sacrum?

Back 42

L5 and inominnts dysfunction To make sure that it isn't responsible for the dysfunction

Front 43

What should you imagine happening to be sacrum when the L5 is side bends and rotated to a certain side?

Back 43

The side that it is sidebending towards is the joints that is locked in

The side that it is rotating is the joint that is moving forward

Front 44

If L4-5 is SRRL what is the sacral dysfunction?

Back 44

Right on right sacral torsion

Front 45

Now we talk about sacral shear. Is this common? What is it usually caused by?

Back 45

It is always pathological and very uncommon. It's usually related to trauma

Front 46

What motion is sheer incredibly similar to? In what ways?

Back 46

It is based off of flexion/extension a.k.a. nutation/counternutation.

It is named for the promontory and goes around the transverse access of S2

Front 47

What categories you have to put in when naming sacral sheer?

Back 47

The direction, whether it is one side or both, whether it is forward or backwards

Front 48

Name this.

Back 48

Front 49

What would move forward versus backwards versus staying neutral in this dysfunction?

Back 49

The left SI will move anteriorly
the right SI will a neutral
the left inferior lateral sacral angle will move posteriorly

Front 50

Give two names for this dysfunction

Back 50

Bilateral extension shear
stuck in counter nutation

Front 51

Where would you apply force to treat flexion versus extension shears?

What is this similar to treating?

Back 51

Treated like a seesaw like the Gladiolus.

If it is in flexion apply force to the apex to rotate the sacrum back.

If it is in extension apply force to the base at the top of the sacrum to make it go into nutation

Front 52

How many things Can we test for to make a diagnosis?

How many of them we need?

Back 52

We need three out of four possible pieces of information

Front 53

Can you list the four tests that we can do?

Back 53

1. Seated flexion test
2. Spring test a.k.a. sphinx test
3. Sacral sulcus depth
4. Inferior lateral angle position

Front 54

In the seated flexion test, why is the side that moves first the side of the dysfunction?

What is the normal order of movement when you bend forward ?

Back 54

Your lumbar is supposed to fully lockout before the pelvis rotates forward. If there is tightness, the SI joint will lock earlier and rotate the pelvis earlier.

Front 55

Give a step By step guide on how to do the seated flexion test.

Where should your eyes be?

Back 55

1. Put your thumb on the PSIS
2 have the patient bend forward starting with the thoracic slowly rolling to the lumbar
3. Check to see which side earlier (which side "ask for help earlier")

make sure eyes are level with your thumb

Front 56

What information does the seated flexion test give us? What information doesn't not give us?

Back 56

It tells us which side had a rotational dysfunction, but does not tell us what direction that dysfunction is in

Front 57

What side would be positive on the seated flexion test here?

Back 57

The left side because this is the side that is rotated

Front 58

What side would be positive on the seated flexion test here?

Back 58

The right side because this is the side that is rotated

Front 59

Can the seated flexion test detect shear dysfunction as well?

Back 59

Yes, but again it cannot detect that the direction

Front 60

How can you use the seated flexion test to see if you have a bilateral Shear?

Back 60

If you are thumbs start moving before the lumbar spine is fully flexed

Front 61

What should you be doing during the spring test?

What position should the patient be in?

Back 61

You should be pressing down on the sacrum directly to see if it springs up.
The patient should be in the Sphinx position

Front 62

What should you feel in a positive spring test?

What dysfunction does this indicate?

Back 62

No recoil upon direct compression

This means that the sacral base is displaced posteriorly, which means it already rotated in the direction that you are pressing it down so there is no normal to "spring back to"

Front 63

What should you feel in a negative spring test? Does this indicate a dysfunction?

Back 63

You should feel a spring upon compression. This means that the sacrum is displaced anteriorly at the base

Front 64

What information does the spring test give you?
What information does it not give you?

Back 64

It tells you if the sacrum is stuck anteriorly or posteriorly but does not tell you if it is left or right doing it

Front 65

What kind of spring test would you get for this dysfunction?

Back 65

A negative spring test because it is displaced anteriorly so it will spring

Front 66

How would you test for the sacral sulcus?

Back 66

You put your thumb just medial to the PSIS and see how far down you can press

Front 67

How would you describe the sacral sulcus on a right on right sacral torsion?

Back 67

It would be deep on the left

Front 68

How would you describe the sacral sulcus on the left on right sacral torsion?

Back 68

It would be shallow on the left

Front 69

Upon palpation, do you know which sacral sulcus is shallow/deep versus neutral?

Back 69

No, one usually feels deeper than the other but you don't know if it actually deep or if the other one is just shallow.

Front 70

How do you test for the inferior lateral angle (ILA) posterior?

Back 70

You feel for the ILA and see which side is more posterior

Front 71

Try a couple of these.

Back 71

Front 72

Is spring testing of the sacral sulcus and inferior lateral angle following the same logic as lumbral sacral spring testing?

Back 72

No, if those things are displaced deep/anterior, they will tend to spring more because you are putting them more in the direction of their dysfunction. (From OMT review)

Front 73

What is the axis of rotation for each shear dysfunction?

Back 73

The transverse access along S2. So the top and the bottom of the sacrum should move in opposite directions

Front 74

Which part of the bone is dysfunction usually named for?

Back 74

the most anterior and superior part.

Front 75

can spring test vary with torsions? How?

Back 75

yes, a forward torsion is negative spring test (does spring)
a backwards torsion is positive spring test

Front 76

how can you tell a backwards from a forwards torsion in the naming?

Back 76

if they are different, (left on right) then it is backwards

Front 77

what can you do to visualize how the sacrum moves in your hands?

Back 77

use a flexible rectangle like a piece of paper and move it about the axis

Front 78

where are you pressing for the spring test?

Back 78

between L5 and the sacrum

Front 79

why would the spring test work in flexion?

Back 79

you are pusing the top of the sacrum more into the direction of dysfunction

Front 80

If you are leaning on your left leg to shovel snow and then throw out your back, what is the dysfunction??

what part of the back will the pt complain of>

Back 80

right on left
people will complain they threw their right back out

Front 81

what if you bent down to pick something up with both hands and throw your back out? dysfunction?

Back 81

bilateral extension because you lumbar is flexed

Front 82

What in you just picked up a suitcase with one hand and threw your back out? dysfunction?

Back 82

unilateral extension

Front 83

how can you shear just one side of the sacrum which is one big bone?

Back 83

you technically can;t, but this is the mitchell model that works

Front 84

how can you think about what is actually happening?

Back 84

there is disturbed forces being placed on the sacrum in the direction of the dysfunction (muscles pulling it)

the bone is not actually moving!

Front 85

how common are unilateral shears?

Back 85

not common

Front 86

what are the most common dysfunctions?

Back 86

the physiologic ones (anterior torsion)

Front 87

What are a little more common than unilateral shears, but still kind of uncommon?

Back 87

posterior torsions.