Static Testing
sacral sulcus, L5 rotation, ILA, 4 digit examination
Sacral Sulcus Dx
- Palpate the PSIS with thumbs
- Move thumbs medially and inferiorly
- Check symmetry (deep or shallow)
L5 rotation Dx
- Palpate Lumbar spine at level 5
2. Check for symmetry
Inferior Lateral Angle Dx
- Palpate with the heel of the hand in midline down sacrum until it drops anteriorly
- Place one thumb near the thenar eminence to feel the inferior lateral angle of the sacrum
- Place the other thumb roughly symmetrical to the first
- Adjust slightly to find the inferior lateral angle
- Compare each side for posterior/anterior and cephalad/caudal
4 Digital Evaluation Dx
- Place first fingers in sacral sulk
- Place thumbs at the ILAs
- Evaluate for symmetry - posterior/anterior and cephalad/caudal
If a landmark is deep, it’s considered to be…
in flexion
If a landmark is deep on the right, it is rotated to the…
left
3 types of Static Testing
- Lateralization
- Active motion
- Passive Motion
Seated Forward Bending Test (SeFBT)
- Unilateral – positive test on side of dysfunction
- Tells the side of dysfunction
- Negative in bilateral dysfunction
- Torsion – positive test is opposite of the side of axis
- seated: sacral-ileo motion dysfunction
- *standing is ileo-sacral motion dysfunction
Active Motion Test
Examine the flexion and extension motion
Respiratory Motion Test
- Place cephalad hand over sacrum with thenar and hypothenar eminence at the sacral base and the fingertips at the apex. Place the other hand on top of the cephalad hand pointing the opposite direction.
- Have the patient exaggerate inhalation and exhalation.
How should the sacral base move during inhalation? exhalation?
- posteriorly
2. anteriorly
Lumbar Spring Test
- The patient lying prone on a treatment table.
- The heel of the physician’s hand is placed over the spinous processes of the lumbar spine.
- Pressure is then exerted through the heel of the hand toward the table (extending the lumbar spinal region).
- The test is positive when the lumbar spine does not move well into extension. A positive backward bending test shows the sacrum is unable to flex (extended sacrum).
- negative: flexed sacrum
positive: extended sacrum (means you don’t have spring)
Sacral Axes
- Superior Transverse Axis (S2 posteriorly)
- Middle Transverse Axis (S2 anteriorly)
- Inferior Transverse Axis (S3)
- Left Oblique Axis (left base to right apex)
- Right Oblique Axis (right base to left apex)
- Vertical Axis
- AP Axis
Torsion
- restricted along oblique axis
- may be restricted in flexion or extension
- base may be restricted A or P
Unilateral
- restricted along vertical axis
- may be restricted in flexion or extension
Bilateral
- restricted along middle transverse axis
- may be restricted in flexion or extension
Torsion Naming
part 1: named for rotation of the sacrum
part 2: named for axis involved
- flexed/forward: L/L or R/L
- *extended/backward: L/R or R/L
L5 should be rotated in the ____ direction of the sacrum.
opposite
*if not, it is uncompensated, and should be treated first
What does a flexed sacrum mean for L5? extended sacrum?
- neutral
2. non-neutral
