00:01
We're going to do a look, feel, and
move evaluation of the sacrum.
00:05
We're going to evaluate the sacrum
to see if he has a problem,
or to see if the problem is referred
from somewhere else.
00:11
It's common to have the pelvis and
the sacrum, both have problems,
but it's always important to know
which one is primary
and which one may be
the only problem.
00:19
So, there are three tests I do to make
sure I know what's going on.
00:23
Number one is a screening test
for sacral pathology
and that is the seated
flexion test.
00:28
If you do a standing
flexion test,
that's going to tell you what's
going on with the pelvis.
00:33
If you do a seated flexion test,
you're taking the pelvis out of it
by putting the pubic symphysis on a
table and restricting motion.
00:40
So now, we're going to
get the sacrum.
00:42
What I'm going to do is I'm going to get
eye level with the sacrum,
put my finger
on the PSIS,
and I'm going to ask him to keep
his knees shoulder length apart
and then bend forward with your arms
going between your legs.
00:59
Back up, and let's try this one
more time, and bend over.
01:05
The one that moves first and furthest is the one that needs help.
01:09
You can sit up and let me have you
lie on your stomach now.
01:12
The one that moves is the one
that has the pathology
and you have to
focus on.
01:17
So, number one is
seated flexion test.
01:20
Number two is we're going to do
the spring test.
01:23
The spring test is going to
tell us what's going on
between the sacrum and
the lumbar spine.
01:29
When I do the spring test, I usually like
to check all four poles as well.
01:32
So, I check the motion of the sacrum
and see how much spring,
I think that's why they
call it the spring test,
and which pole is
going to have motion,
and which pole does
not have motion.
01:46
If it's stuck and
there's no motion,
that needs further evaluation
and should be taken care of.
01:53
So, to get to the deep sulcus,
I'm now going to go to the PSIS,
go interior, and push down to see
how deep the sulcus is.
02:03
We know about the motion now
and we're also evaluating the depth,
the symmetry, and where
the exam may point us.
02:11
The last test is called
the Sphinx test.
02:14
To do the Sphinx test,
you need to check the ILA,
the inferior lateral
angle of the sacrum.
02:20
So, you come down the sacrum,
find the inferior lateral angle.
02:23
I like to keep my fingers
on the deep sulcus as well.
02:27
And then I have the patient
sit up on your elbows.
02:31
Perfect.
02:33
If the sacrum moves
anteriorly, that's good.
02:36
If the sacrum doesn't move,
that's a positive Sphinx test
that shows pathology
in the sacrum.
02:42
Let me have you
down again.
02:44
You can have him go
on his elbows.
02:47
Let me do it on the elbows
one more time.
02:49
Then on your arms,
go all the way up.
02:52
Perfect.
02:52
You can accentuate it which will
give you more information.
02:55
And back down.
02:56
So again, the three tests you need to get
information on the sacrum:
Number one is the
seated flexion test;
number two, an evaluation
of the deep sulcus
which can be done
with a spring test
and done independently just
looking at the deep sulcus;
and checking out the inferior lateral
angle with the Sphinx test.
03:13
That's how you
evaluate the sacrum.