This is one of the regions I was assigned to assess for my midterm practical last year. I got off to a wonderful start by handing my grading sheet to my preceptor and smashing my elbow into the corner of the table as I turned to face my patient. We had a good laugh over my misery. :O
Diagnosis:
- Standing flexion test
- SEAT THE PELVIS
- ASIS
- Pubic symphysis
- Inflare/outflare
- SEAT THE PELVIS
- PSIS
Image from “The Pocket Manual of OMT” (2nd ed.).
As usual, ask for contraindications!
- Any recent injuries? Sprains? Fractures?
- Cancer? Infection?
- Arthritis? Joint instability? Hypermobility?
Anterior (aka inferior) innominate ME
- (Supine) Stand on involved side + flex/adduct the hip to its restrictive barrier.
- Pull the buttbone (ischial tuberosity) up.
- Ask pt to push knee into your shoulder for 3-5 seconds against your equal resistance.
- Allow relaxation + move hip to new barrier.
- Repeat 3-5x. Retest.
Posterior innominate ME
- (Supine) Stand on involved side + hold opposite ASIS.
- Move involved leg off the table + let it drop to its extension barrier. (Since it’s posterior, you want your leg to be more posterior, hence why you drop it off the table.)
- Ask pt to push thigh upward for 3-5 seconds.
- Allow relaxation + move hip to new barrier.
- Repeat 3-5x. Retest.
Anterior innominate thrust, supine
- Stand at foot of table and grasp leg above malleoli (use both hands).
- Lift leg to ~30 degrees hip flexion + slightly abduct + internally rotate leg. (Since it’s anterior, you want your leg to be more anterior, hence the flexion.)
- Ask pt to take deep breath. During exhalation, apply a caudad (towards the feet) tug.
- Retest.
Posterior (aka superior) innominate thrust, supine
- (SAME AS ANTERIOR but you don’t flex to 30 degrees.)
Pubic ME, thrust
- Grasp outside of both (flexed) knees. Ask pt to push knees apart for 3-5 seconds. Relax. Repeat 3-5x.
- Separate knees but holding inside of knees with hand/elbow of one arm. Ask pt to push knees together for 3-5 seconds. Relax. Repeat 3-5x.
- Add thrust by applying a short, quick + lateral push at the end.
- Retest.
Ilium inflare ME
- (Supine) Stand on opposite side of inflare + flex knee + hip, putting the foot on the table close to the butt.
- Hold opposite ASIS (the one closest to you) + laterally abduct hip to restrictive barrier.
- Ask pt to push knee medially for 3-5 seconds. Allow for relaxation.
- Repeat 3-5x. Retest.
Ilium outflare ME
- (Supine) Stand on side of outflare + flex knee + hip, putting the foot on the table close to the butt.
- Pull PSIS laterally while medially adducting the hip.
- Ask pt to push knee into external rotation for 3-5 seconds. Allow for relaxation.
- Repeat 3-5x. Retest.
