Ilia & Pubes
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| What is the standing flexion test used for? | Finding dysfunctions that originate in the lower extremity (iliosacral)
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| 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
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| What does a positive standing flexion test indicate (3 possibilities)? | Iliosacral somatic dysfunction; contralateral tight hamstrings (false positive); ipsilateral tight hamstrings (false negative)
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| 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
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| 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
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| 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
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| What are the findings for a left inflare? | Positive left lateralization tests; left ASIS closer to midline
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| 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
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| What are the possible pubic dysfunctions? | Upslipped pube and compression
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| What are the findings for a uplipped pub? | Tenderness on tubercle; step-off sign; movement permitted superiorly or inferiorly
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| What are the findings for a pubic compression? | Tenderness on symphysis; step-off sign; movement permitted anteriorly or posteriorly
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What does muscle energy treatment do for pubic compression? | Fixes gapping of pubic symphysis
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| What are the common tender points for anterior pelvic pain? | Psoas (F ST), Iliacus (F ER), Low ilium (F), and Inguinal (F ADD IR)
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What is the location of the low ilium (psoas minor) tenderpoint? | Superior surface of iliopectineal eminence associated with attachment of psoas minor
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| 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
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| 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
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| What is the location of a high ilium sacroiliac tenderpoint? | 2 or 3 centimeters superior and lateral to PSIS, pressing medial to PSIS
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| 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
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| What is the location of a high ilium flare out tenderpoint? | Lateral aspect of inferior angle of sacrum associated with attachment of coccygeus muscle
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| 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
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| 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
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| What is the location of the PL4 lateral gluteus medius tenderpoint? | Lateral portion of gluteus medius near posterior margin of tensor fasciae latae
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| 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
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