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OPP_2

Ilia & Pubes

QuestionAnswer
What is the standing flexion test used for? Finding dysfunctions that originate in the lower extremity (iliosacral)
Describe how to conduct a standing flexion test. With patient standing, place thumbs on inferior slope of PSIS; as one PSIS moves more cephalad with forward bending, then that side is positive
What does a positive standing flexion test indicate (3 possibilities)? Iliosacral somatic dysfunction; contralateral tight hamstrings (false positive); ipsilateral tight hamstrings (false negative)
What are the possible somatic dysfunctional diagnoses of the pelvis? Anteriorly or posteriorly rotated innominate; superior innomiate shear (upslip); innominate inflare or outflar; superior or inferior pubic shear; anterior or posterior pubic shear; pubic compression
What are the findings for an anteriorly rotated left innominate? Positive left lateralization test; lefts ASIS inferior; left PSIS superior; ischial tuberosities and iliac crests level
What are the findings for a posteriorly rotated left innominate? Positive left lateralization test; left ASIS superior; left PSIS inferior; ischial tuberosities and iliac crests level
What are the findings for a left inflare? Positive left lateralization tests; left ASIS closer to midline
What are the findings for a left upslipped innominate or superior innominate shear? Positive left lateralization test; left ASIS superior; left PSIS superior; left ischial tuberosity and iliac crest superior
What are the possible pubic dysfunctions? Upslipped pube and compression
What are the findings for a uplipped pub? Tenderness on tubercle; step-off sign; movement permitted superiorly or inferiorly
What are the findings for a pubic compression? Tenderness on symphysis; step-off sign; movement permitted anteriorly or posteriorly
Describe the set-up and treatment of an anteriorly rotated innominate using muscle energy. Patient is supine; posteriorly rotate innominate to barrier; patient isometrically contracts muscles to push leg towards end of table, patient is relaxed and is repositioned to barrier
Describe the set-up and treatment for a posteriorly rotated innominate using muscle energy. Patient is supine; anteriorly rotate innominate to barrier; patient isometrically contracts muscles to lift the leg towards ceiling; patient relaxes and is repositioned to barrier and repeats contraction
Describe set-up and treatment for a left innominate shear using HVLA. Patient is supine; slightly elevate leg and place wedge at level of ILA; internally rotate and slightly abduct leg; apply traction through leg to localize to innominate barrier; apply focused tug
Describe set-up and treatment for a superior pubic shear using muscle energy. Patient is supine; abduct and extend leg to pubic barrier; patient isometrically contracts muscles lifting leg to ceiling; patient relaxes and is repositioned to barrier and repeats contraction
Describe set-up and treatment for an inferior pubic shear using muscle energy. Patient is supine; abduct and flex the leg pubic barrier; patient isometrically contracts muscles to push leg to end of table; patient relaxes and is repositioned to barrier and repeats contraction
Describe set-up and treatment for pubic compression using muscle energy. Patient is supine; with knees flexed, resist as patient pulls legs apart; then separate knees and resist while patient pulls knees together
What does muscle energy treatment do for pubic compression? Fixes gapping of pubic symphysis
What are the common tender points for anterior pelvic pain? Psoas (F ST), Iliacus (F ER), Low ilium (F), and Inguinal (F ADD IR)
What is the location of the iliacus tender point? Found 1/3 of the distance from the ASIS to the midline and pressing deep in a posterior-lateral direction toward iliacus
Describe the treatment position for a iliacus tenderpoint. Patient lies supine; flex patient's hips/knees and place over physician's leg on table; cross patient's ankles and externally rotate both patient's hips; fine tune and hold until tenderness is completely alleviated
What is the location of the inguinal ligament/pectineus muscle? Found on medial aspect of inguinal ligament near pubic tubercle associated with attachment of pectineus muscle
Describe the treatment position for inguinal ligament/pectineus muscle tenderpoint. Patient is supine; physician flexes patient's hips/knees and places them over physician's leg on table; contralateral thigh is placed over ipsilateral thigh; pull patient's ipsilateral lower leg laterally inducing adduction and internal rotation and hold
What is the location of the psoas major tenderpoint? Found 2/3 of the distance from the ASIS to the midline and pressing deep in a posterior direction toward belly of psoas
Describe the treatment position for psoas major tenderpoint. Patient is supine; physician flexes patient's hips/knees and pulls feet/ankles toward tenderpoint to side bend lumbar spine; hold until tenderness is completely alleviated
What is the location of the low ilium (psoas minor) tenderpoint? Superior surface of iliopectineal eminence associated with attachment of psoas minor
Describe the treatment position for low ilium tenderpoint. Patient lies supine; patient's hip on side of tenderpoint is flexed; physician holds position until tenderness is completely alleviated
What tenderpoints are found in patients who complain of buttock pain, or pain when attempting to rise from a chair, or beginning to walk after sitting for a period of time? High ilium sacroiliac, high ilium flare out, and PL3, PL4 lateral gluteus medius
What is the location of a high ilium sacroiliac tenderpoint? 2 or 3 centimeters superior and lateral to PSIS, pressing medial to PSIS
Describe the treatment position for high ilium sacroiliac tenderpoint? Patient lies prone; patient's hip/lower extremity is extended, abducted, and externally rotated; fine tune and hold until tenderness is completely alleviated
What is the location of a high ilium flare out tenderpoint? Lateral aspect of inferior angle of sacrum associated with attachment of coccygeus muscle
Describe the treatment position for a high ilium flare out. Patient lies prone; patient's hip/lower extremity is extended and adducted enough to cross over contralateral leg; fine tune and hold until tenderness is completely alleviated
What is the location of the PL3 lateral gluteus medius tenderpoint? Upper outer portion of gluteus media muscle, 2/3 the distance between PSIS and tensor fasciae latae
What is the location of the PL4 lateral gluteus medius tenderpoint? Lateral portion of gluteus medius near posterior margin of tensor fasciae latae
Describe the treatment position for a PL3 or PL4 tenderpoint. Patientl lies prone; patient's hip/thigh is extended and abducted; may require external or internal rotation; fine tune until tenderness is completely alleviated
Created by: Cory67