Osteopathic Pelvis Treatment: Part 1

00:01 Anterior Pelvic Counterstrain.

00:04 So what we're going to go over today, are the tender points in the pelvis that could be treated with counterstrain.

00:12 So remember with counterstrain, we're gonna follow the principles, we're gonna find these tender points, establish a pain scale with the patients find the mobile point by usually positioning the muscle into a position of ease, holding that for 90 seconds and then returning the patient without their help and then the point should no longer be tender So there are four basic points in the anterior pelvis that we're gonna cover If you find the ASIS and midline along the umbilicus and so if you come one-third of the way medial to the ASIS, you'll find your iliacus point If you come in a little more two-thirds of the way in, then that's gonna give you your psoas point so the iliacus point and psoas point are gonna be one thirds of the way towards midline and then two thirds of the way towards the midline.

01:03 Low ilium which is associated with the psoas minor, what we're gonna do is we're gonna find the pubic tubercle and come out a little bit lateral to it and so that the attachment of the psoas minor is the low ilium point.

01:19 And then finally, on the pubic tubercle, we have the inguinal tender point.

01:25 So iliacus, psoas, low ilium and inguinal.

01:32 We're gonna go over the treatment positions but remember when you're practicing and performing the techniques, to go through all the steps.

01:38 So we're gonna demonstrate first the iliacus positioning, so for iliacus if we find that tender point here, what we're going to is to perform the action of the muscles, Remember the iliopsoas muscle does primarily flexion and external rotation of the hip, so what we're going to do is we're gonna move the leg into that position.

01:56 So go ahead and bend your knee up for me.

01:59 I'm monitoring the point with my thumb here, we're going to flex the legs up, We're gonna cross the far ankle over the near and this allows the patient to kinda let their knees fall out to the side and that causes external rotation of the hip.

02:14 We're gonna flex up, until we feel the softening here and this would be the final position for iliacus tender point.

02:23 Of course if you're patient's still in pain then you may need to fine tune it a little bit more.

02:27 For the psoas point, which is just two-thirds of the way a little bit more medial, poisitioning initially is the same - so you're gonna cross the legs over, flex up, externally rotate the hip It may require a little more flexion and it may require some side bending to the ipsilateral sides So what I'm gonna do is I'm gonna bring the ankles towards me and when I bring the ankles towards me, that's gonna sidebend the patient to that side and shorten the muscle more.

02:53 So that is the positioning for psoas - flexion, external rotation, then maybe a little bit of fine tuning and sidebending the pelvis towards me.

03:04 I'm gonna bring you back now, relax.

03:09 For the low ilium point, what we're going to do is pure flexion on the same side as the points, so for low ilium, we're gonna take the leg, flex the knee up, and try to maximally flex the hip and then this should be the final positioning for the low ilium.

03:29 For the inguinal points on the pubic tubercle, what we're going to do is we're gonna flex both legs up again, and then again I put my leg up so I can support the weight of the legs for 90 seconds, we're gonna cross the far knee over the near.

03:45 Good.

03:46 and now we're going to flex up and then we're gonna induce a little bit of rotation.

03:52 So rotation is taking the knees and bringing it towards me and then we're gonna induce a little bit of side bending which is bringing the ankles towards me, so we're gonna rotate and sidebend towards the point and this should be the final positioning for the inguinal canal, inguinal tender point.

04:10 So we're gonna bring you back.

04:13 Good.

04:13 So that is the location and the positioning for the four anterior pelvic tender points Counterstrain for the Posterior Pelvis Tender Points.

04:25 So in the posterior pelvis there are several points that could be treated with counterstrain We wanna find the PSIS - they come a little bit above it and that's the upper pole L5 just below the PSIS but still pushing superiorly That's the lower pole L5 from the PSIS we could come out lateral to the Tensor Fasciae Latae and that is the posterior aspect of that is gonna be upper pole of L4 and two-thirds of way between PSIS and that point, it's gonna be upper pole L3 So these are the upper and lower pole lumbar points and the posterior aspect of the pelvis.

05:06 You also have the piriformis tender point, so here is the sacrum.

05:11 In the middle of the sacrum, you could have a tender point connecting from this piriformis muscle to the greater trochanter so usually in between this region, you might be able to find a piriformis tender point and then on the sacrum itself, by the ileus and the sacrococcygeal junction, you could find a high ilium flare up tender point.

05:34 So again applying the principles of counterstrain, we're gonna go through all the steps, let's establsh a pain scale, hold the point for 90 seconds and then turn them slowly, we're gonna focus more on the final positioning for these points.

05:49 So for upper pole L5, what you're gonna do is you're gonna stand opposite to the side of the tender point cause final positioning for the upper pole L5 is hip extension and ADduction so it's easy to ADduct the leg when you're standing on the opposite side.

06:09 So I'm gonna have you pick up your knee a little bit, I'm just gonna hold on to the leg and once I have control of the leg I'm going to extend and ADduct the hip You might have to fine tune with a little bit of internal external rotation but this would be the general final positioning for upper pole L5.

06:30 For upper pole L4 and L3, they both have the same starting position where we're going to stand on the same side because upper pole L3 and L4 both involve extension and ADduction so I'm gonna stand on the same side of the tender point, I'm going to extend the ipsilateral leg and I'm gonna ABduct - great.

06:55 L4 might require a little less ABduction than L3 and then you could fine tune with external and internal rotation so positioning for L3-L4, upper pole L3-L4 is extension, ABduction and fine tuning with the external rotation or internal rotation.

07:14 In this position, external rotation is when the toes kinda point out, and internal rotation is when the toes kinda point more medially so external rotation and internal rotation.

07:28 So the piriformis muscle attaches from the sacrum, the middle of the sacrum to the greater trochanter So the tender point usually wll rise somewhere between its atachments, usually within the muscle belly.

07:39 So to treat the piriformis counterstrain point, what we're going to do is start in an inital position where you're taking it through its action on the muscles.

07:50 Remember the piriformis muscle will flex and externally rotate the hip so what we're going to do is flex the hip up and externally rotate and usually the final position here will give you a shape of the P with the legs so it helps you remember the piriformis points, you're gonna make a letter P with the legs and so this usually is the initial starting position.

08:13 Sometimes you could fine tune with a little bit of internal or external rotation to treat it but most of the time you might have to just add more flexion if the patient still doesn't reach a mobile point with the treatments.

08:28 Counterstrain to treat the high ilium flare out or better known as HIFO So the point is gonna be close to the sacroileus or between the sacrum and the coccyx And so when we're treating the points, what we're gonna do is we're gonna stand opposite from the point because the treatment is to extend and ADduct the hip so w'ere going to find a point, we're going to stand opposite from it so here I'm treating a point more by the right ILA I'm gonna bring the hip up into extension and then gently ADduct the hip and so this will be the final positioning for a high ilium flare out Counterstrain for Lower Pole L5.

09:13 So for lower pole L5 the motion is gona be flexion, ADduction and external rotation for positioning so what we're going do is that we're going to take the leg, I want to bring it down into flexion and then we're going to ADduct the knee towards the table and then we're going to internally rotate by bringing the ankle a little bit more lateral and so this would be the final positioning for lower pole L5.

09:42 of course having the position in a seated position will help you with holding the position for 90 seconds.