Osteopathic Diagnosis of the Sacrum

00:01 When you want to see if a person has an issue with the sacrum, whether it's an anatomic issue, a pathologic issue, whether there's somatic dysfunction present, I do three tests.

00:12 I do the seated flexion test.

00:14 I check the sacral sulcus to see how deep it is, if it's deep or anterior on one side or whether it's symmetrical.

00:20 And I check the inferior lateral angle and the sacrotuberous ligaments.

00:25 I get three data points: seated flexion, sacral sulcus, and inferior lateral angle.

00:33 That's going to be how I determine whether or not the patient is functioning smoothly or they need help.

00:39 The spring test is when you push on the sacrum and you push on all four poles seeing where the motion is.

00:48 It'll tell you if there's restriction or if the patient has good motion; and the seated flexion test.

00:54 On the physical exam, all physical exams in osteopathic medicine need to be done in two positions.

01:00 You need to check them both static and dynamic.

01:03 They need to be stopped so you can check the anatomy.

01:07 They need to be moving so you can see how things function.

01:11 In checking the sacrum, we always tell people to check the lumbar spine as well.

01:16 A lot of times, you have a lumbarization of the lumbar spine or sacralization of the lumbar spine, and it will decrease motion and decrease what's possible.

01:25 In pushing on the sacral sulci, you'll see what kind of motion is possible.

01:30 And then in checking the inferior lateral angles, it'll tell you if the patient is functioning adequately as well.

01:35 When you put the patient on the table to examine them, if you put them prone and you want to examine L5-S1, you want to see how it's working.

01:46 You want to see if you have motion at the top and the top.

01:48 If you do have good motion in both upper poles, then it's not a torsion.

01:53 If you have motion in both lower poles, it's not a torsion.

01:56 Then you're dealing with the other angles of motion.

01:59 If they do have a restricted motion and they move on one side and not the other, so the sacrum is cemented, then you know you're looking at a torsion and you're looking at fixing something that might be gait-related or is likely gait-related.

02:13 A torsion and sacral rotation are the most common types of problems we see.

02:19 This is just a slide showing where the sacral sulci are.

02:22 So, if you're looking from behind, you want to go in the superior portion, the base of the sacrum right where it attaches to the ilium, the innominate bone and right below L5.

02:35 Again, you check the inferior lateral angles, the bottom, making sure you have good motion in the inferior lateral angles and making sure they're even.

02:43 Compare one side to the other.

02:45 People who have little motion on one side may have little motion on the other.

02:48 There's going to be some consistency.

02:50 Make sure you know if it's posterior and inferior or anterior and superior.

02:55 See where the motion is.

02:57 And that's the inferior lateral angles.