Sacral Somatic Dysfunction Lecture (Test 1)

Question 1

Nutation

Answer 1

• “Nodding Forward; Anterior movement of the Sacral Base around a Transverse Axis in relation to the Ilia, occurring during SPHENOBASILAR EXTENSION of the Craniosacral Mechanism”

Question 2

Counternutation

Answer 2

• Posterior movement of the Sacral Base around a Transverse Axis in relation t the Ilia
• Occurs during SPHENOBASILAR FLEXION

Question 3

Why Treat the Sacrum

Answer 3

1) Lumbosacral Plexus:
- Motor and Sensory innervation
- Sympathetic Innervation
- Parasympathetic Innervatino

2) Key player in Low Back Pain
- Functional Pathology
- Structural Pathology

3) Short Leg Syndrome
- Sacral Base UNLEVELING

Question 4

Landmarks

Answer 4

1) TWO Sacral Sulci
- Designated as feeling DEEP or SHALLOW

2) TWO Inferior Lateral Angles
- Designated as being POSTERIOR/INFERIOR or ANTERIOR/SUPERIOR

Question 5

Motion Testing

Answer 5

• Seated Flexion Test
• Lumbar Spring Test
• Four-digit Contact
• 4 point Passive Evaluation
• Respiratory Motion
• Side Bending PASSIVE Evaluation

Question 6

Seated Flexion Test

Answer 6

• Contact BOTH PSIS and have you patient bend forward from a Seated position. Whichever PSIS moves FIRST and/or FARTHEST indicates the POSITIVE SIDE
• The side of Laterality determined by this test helps decide the LATERALITY of Diagnosis

Question 7

Lumbar Spring Test

Answer 7

• Springing force ANTERIORLY into the Lumbosacral Junction while patient is PRONE

Hard End Feel:
- Indicates part of the Sacrum is SITTING POSTERIORLY and thus is a POSITIVE TEST

No Hard End Feel:
- Indicates part of the Sacrum is SITTING ANTERIORLY and thus is a NEGATIVE TEST

Question 8

Four Digit Contact/ Four Digit Passive Evaluation

Answer 8

Four Digit Contact:
- Contact each Sacral Sulci and ILA and feel which deals MOST DEEP or SHALLOW (For Sacral Sulci) and which feels most ANTERIOR/SUPERIOR or POSTERIOR/INFERIOR (for ILA)

Four Digit Passive Evaluation:
- Contact one Sacral Sulcus and the ILA on the CONTRALATERAL SIDE of the Body. Perform a LOAD and SPRING Force around the Oblique Axis. Perform this BILATERALLY to determine which OBLIQUE Axis has more Ease of Motion

Question 9

Respiratory Motion

Answer 9

• Place CEPHALIC 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 you Cephalic hand FACING THE OPPOSITE Direction
• The Sacral Base should move POSTERIORLY during INHALATION and ANTERIORLY during EXHALATION

Question 10

Side Bending Passive Evaluation

Answer 10

• Place palms on the ILA’s and Fingertips toward the Sacral Sulci
• DIRECT a CEPHALAD FORCE from the ILA’s
• This determines EASE or RESTRICTION of Side Bending

Question 11

Sacral Somatic Dysfunction

Answer 11

• Bilateral Flexion
• Bilateral Extension
• Unilateral Flexion
• Unilateral Extension
• Forward Sacral Torsion
• Backward Sacral Torsion

Question 12

Bilateral Flexion

Answer 12

• SEATED FLEXION test is NEGATIVE because the Dysfunction is BILATERAL
• LUMBAR LORDOSIS is INCREASE since the Sacrum is sitting ANTERIORLY
• SACRAL SULCUS are DEEP BILATERALLY
• ILA’s are POSTERIOR BILATERALLY
• LUMBAR SPRING TEST is NEGATIVE because there is NO HARD END Feel due to the base of the Sacrum being held forward
• RESTRICTED to INHALATION PHASE: “The Sacrum is “Stuck” FORWARD, so it doesn’t like to move Posteriorly on Inhalation
• NO RESTRICTION on SIBE BENDING Passive because it is a Bilateral Dysfunction
• NO RESTRICTION on 4 point Evaluation because it is NOT a Torsion

Question 13

Bilateral Extension

Answer 13

• SEATED FLEXION test is NEGATIVE because the Dysfunction is BILATERAL
• LUMBAR LORDOSIS is DECREASED since the Sacrum is EXTENDED and Flattens out the Lumbar Spine
• Sacral Sulcus are SHALLOW Bilaterally
• ILA’s are ANTERIOR BILATERALLY
• LUMBAR SPRING Test is POSITIVE because there is a HARD END FEEL
• RESTRICTED to EXHALATION PHASE: The Sacrum is “Stuck” BACKWARD, so it doesn’t like to moe Anteriorly on Exhalation
• NO RESTRICTION on Side Bending Passive because it is a Bilateral Dysfunction
• NO RESTRICTION on 4 point Passive Evaluation because it is NOT a Torsion

Question 14

Unilateral Flexion

Answer 14

• SEATED FLEXION Test is POSITIVE on the Involved Side
• SACRAL SULCUS is DEEP on the Involved Side (Flexion Component)
• ILA is INFERIOR on Involved Side (Side Bend Component)
• LUMBAR SPRING Test is NEGATIVE because part of the Sacrum is held FORWARD
• RESPIRATORY MOTION is ASYMMETRICAL
• SIDE BENDING Passive Evaluation is RESTRICTED to SB toward the UNINVOLVED SIDE (EASE of MOTION toward INVOLVED SIDE)
• 4 point Passie Evaluation has NO RESTRICTIONS because it is NOT a Torsion

Question 15

Unilateral Extension

Answer 15

• SEATED FLEXION Test is POSITIVE on the Involved Side
• SACRAL SULCUS is SHALLOW on the INVOLVED Side (Explains Extension Component)
• ILA is Superior on Involved Side (Explains Side Bending Component)
• LUMBAR SPRING TEST is POSITIVE because part of the Sacrum is HELD BACKWARD
• RESPIRATORY MOTION is ASYMMETRICAL
• SIDE BENDING Passive evaluations is RESTRICTED to SB TOWARD the INVOLVED SIDE (EASE of Motion toward UNINVOLVED SIDE)
• 4 point Passive Evaluation has NO RESTRICTIONS because it si NOT a Torsion

Question 16

Sacral Torsions

Answer 16

• Axis is named for the Cranial End of the Axis
• LEFT AXIS has Cranial End of the Axis at UPPER LEFT CORNER of the Sacrum
• Sacrum rotates around the AXIS which is Seen as DIAGONAL

Question 17

Forward Torsion

Answer 17

• SEATED FLEXION Test is POSITIVE on the Side OPPOSITE of the Axis (However, Pelvic Compression Test is POSITIVE on the SIDE OF AXIS)
• SACRAL SULCUS is DEEP on UNINVOLVED AXIS SIDE (SHALLOW on INVOLVED AXIS Side)
• ILA is POSTERIOR on Side OPPOSITE DEEP SACRAL SULCUS
• LUMBAR SPRING TEST is NEGATIVE because part of the Sacrum is held FORWARD (THIS IS HOW YOU TELL THE DIFFERENCE BETWEEN A FORWARD AND BACKWARD TORSION)
• RESPIRATORY MOTION is ASYMMETRICAL
• SIDE BENDING PASSIVE Evaluation has NO Restriction because it is NOT a UNILATERAL Dysfunction
• 4 Point Passive Evaluation is RESTRICTED to POSTERIOR ROTATION around the INVOLVED Axis

Question 18

Backward Torsion

Answer 18

• Seated Flexion Test is POSITIVE on the SIDE OPPOSITE of the Axis (However, PELVIC COMPRESSION Test is POSITIVE on the SIDE of AXIS)
• DEEP on INVOLVED AXIS Side (SHALLOW on UNINVOLVED Side)
• ILA is POSTERIOR on SIDE OPPOSITE DEEP Sacral Sulcus
• LUMBAR SPRING Test is POSITIVE because part of the Sacrum is HELD BACKWARD (This is how you tell the difference between a Forward and Backward Torsion)
• RESPIRATORY MOTION is ASYMMETRICAL
• SIDE BENDING Passive Evaluation has NO RESTRICTION because it is NOT a Unilateral Dysfunction
• 4 Point Passive Evaluation is Restricted to ANTERIOR Rotation around the Uninvolved Axis