I’m pretty sure I’m not the only one, but the day(s) that I know OPP/OMT best tend to be the night before/morning of my practical. We had our midterm practical yesterday, so I figured…what better time to write up my notes on it (while it’s still fresh in my mind and I still remember it!!!) than now?
The sacrum is probably one of my worst sections, so I actually drew something out for it. (What is this sudden dedication!?)
If the answer to the light blue question in #1 is “no,” then you’d best be sure to lower the table until they are. :O
Images from “The Pocket Manual of OMT” (2nd edition).
(The actual diagnostic terminology.)
Sweet! Now that we’ve gotten those out of the way and we have a diagnosis, what next?
Ask about contraindications!
- Have they had any recent injuries to the area?
- Broken bones, fractures, sprains, cancer, infection?
- Arthritis? Blood clots? Possibility of going into premature labor!?
No? Alright, proceed!
But what are you gonna do to make it better? Give me a treatment!
For our midterm, we were responsible for 5 treatments in this section. (I have 5 more sections to write about. It’s gonna be fun.)
Forward sacral torsion ME
- (Lateral Sims) Have pt lie with their problem side (“axis side”) down.
- Since it’s forward, have the pt’s front (their chest) on the table.
- Put one hand on their lumbosacral jxn and flex their hips until you feel motion at the jxn.
- Ask pt to push their feet toward the ceiling for 3-5 seconds against your equal resistance.
- Tell them to relax, then move their legs to the new restrictive barrier.
- Repeat 3-5x. Retest motion/symmetry!
Backward sacral torsion ME
- (Lateral recumbent) Have pt lie with their problem side down.
- Since it’s backward, have the pt’s back on the table.
- Put on hand on their lumbosacral jxn + extend the bottom leg until motion is felt. Bend the top leg + place it behind the other knee.
- Hold shoulder w/ other hand to prevent pt from falling off the table.
- Ask pt to push their flexed knee toward the ceiling for 3-5 seconds against your equal resistance.
- Tell them to relax, then move their legs to the new restrictive barrier.
- Repeat 3-5x. Retest motion/symmetry!
Unilateral sacral flexion ME
- (Prone) Stand facing the pt’s head on side of flexion.
- Place thenar or hypothenar eminence on ILA + push anteriorly/superiorly.
- Use other hand to slightly abduct + internally rotate the leg.
- Ask pt to take a deep breath. Push ILA during inhalation + resist sacral flexion during exhalation.
- Repeat 3-5x. Retest!
Unilateral sacral extension ME
- (Prone) Stand facing pt’s feet on side of extension.
- Place thenar or hypothenar eminence on sacral base + push anteriorly/superiorly.
- Use other hand to slightly abduct + internally rotate the leg.
- Ask pt to take a deep breath. Resist during inhalation + push sacrum into flexion during exhalation.
- Repeat 3-5x. Retest!
Sacroiliac articulatory
- (Lateral Sims) Have pt lie on uninvolved side w/ chest down.
- Stand behind pt + put thenar eminence on sacral base of restricted SI joint + grasp knee w/ other hand.
- Lean in to stabilize, then ask pt to take deep breath + hold it as you flex it to its barrier.
- Slowly abduct + externally rotate hip to barrier + maintain abduction barrier as you extend hip (tell pt to exhale here!).
- Repeat 3-5x. Retest!
