Muscle energy for pelvic
So first we have to make our diagnosis, we
assess the pelvis with the standing flexion test
or with the ASIS compression test to
see if there's a restricted side.
We check our landmarks to the ASIS and with the
PSIS to see if there's a rotation or a shear.
So for here, we're demonstrating muscle
energy for anterior innonimate rotation.
So the innonimate is rotated anteriorly,
we want to bring it into it's barrier
and have the patient activate
and push towards the freedom.
So I'm gonna monitor at the SI joint, I'm gonna
slowly bring the leg up and bring it to its barrier.
I'm gonna have the patient gently
push into my hand, 1-2-3 and relax.
Make sure you allow the patient to relax with
3 seconds before re-engaging the barrier,
so I'm gonna kinda bring the
hip more into its barrier
and go ahead and push
again, 1-2-3 and relax.
And then re-engage the barrier and go ahead
and push one more time, 1-2-3 and relax.
And so after three times of pushing,
we're gonna do a passive stretch
and then bring the leg back and then recheck
and re-assess to see if it's more symmetrical.
Muscle energy for posteriorly
So in a posteriorly rotated
innonimate, what we're gonna do
is we're gonna bring the leg off
the table and extend the hip.
In extending the hip, we're gonna bring the
innonimate more into a anterior position.
So we're gonna again gently
bring the affected side down.
Here we're treating a left
posteriorly rotated innonimate.
I'm gonna support the leg
and hold above the knee
and with my other hand I'm
gonna hold the contralateral ASIS.
So this way, the patient will feel stable as they're
bringing their knee up towards the ceiling.
So you can engage the barrier and then
have the patient push to the freedoms,
so go ahead and bring your knee up
to the ceiling, 1-2-3 and relax.
After the patient relaxes for 3 seconds, you're
gonna further bring the knee into extension,
the hip more to extension into its barrier,
go ahead and push up again, 1-2-3 and relax.
After relaxing for three seconds, re-engage the
barrier and push up again, 1-2-3 and relax.
And then we do a passive stretch
at the end, bring the leg back
and then reassess the landmarks to make
sure that the innonimate is more symmetric.
This technique could also be performed
with the patient lying prone
and then you would just bring the
hip more into extension each time.
So that is how you could utilize muscle energy
to treat a posteriorly rotated innonimate.
Muscle energy to treat a
superior innonimate shear.
So when we have a superior
innonimate shear, what we want to do
is to try to bring that
innonimate more inferiorly.
So here we're gonna treat a
left superior innonimate shear.
We're gonna get good purchase on the ankle
here, we're gonna internally rotate the hip.
And what internally rotating the hip does, it helps to
close pack the head of the femur into the acetabalum.
So any sort of motion or movement I put
will get directed right to the innonimate.
I'm gonna apply a little bit of inferior pull.
and I'm gonna instruct the patient to try to hike
their hip up towards their head, 1-2-3 and relax.
I'm gonna re-engage the barrier by gently tugging
on the leg and go ahead and pull up again,
re-engage the barrier by pulling inferior
again and pull up towards your head,
At the end of three isometric contractions
I'm gonna apply a little bit of a increased low
bit of a tug here and then bring her back,
and I wanna recheck to see if the innonimates
are more symmetric after the technique.
Sacral iliac articulatory technique
So SI joints are important areas to
look at especially with patients
that may have pelvic pain or
So what we're going to do is we're
going to stabilize the sacrum
and move the innonimates through the hip.
So when we take the hip here and if
we bring the ankle out laterally,
that's going to internally rotate the hip.
But that also takes the innonimate
and causes it to gap posteriorly.
So we're going to hold on to the sacrum and
create more internal rotation of the hip
and then alternate with external rotation.
and as I go on external rotation, I'm
stabilizing the sacrum with my palm.
So we move the SI joint and mobilize the
ligaments a little bit more back and forth.
Remember the articulatory techniques,
we engage the barrier repetitively
until we get improved joint motion
and so once you feel like
there's improved motion here,
you could bring the leg back
and reassess the SI joint.
This technique could be done bilaterally
to help improve any restrictions
that might be present in
the sacroiliac joints.
High velocity low amplitude
thrusting for the innonimates.
So if we have a rotational
dysfunction of the innonimate,
what we're going to do is we're gonna
provide a thrust though the barriers.
So if my innonimate is rotated posteriorly, we're
gonna put a force to drive it more anterior.
If I have an innonimate that's
rotated more anteriorly,
we're gonna put a force to
drive it more posteriorly.
So, we're going to set the patient
up so we'd localize to the SI joints
So I'm gonna flex the knees up to the SI joint
and then we're gonna set the torso
to rotate to the SI joints.
So the patient's gonna hold on to your shoulder
here and relax the other shoulder back. Good.
And then so we rotated everything
above the SI joint away
and now we're going to set
up to treat the SI joint.
So if we have anteriorly
what we want to do is to support the
top leg, straighten out the bottom leg
and then we're gonna let this leg
hang and by letting this leg hang,
what happens is this allows the weight of the
leg to help pull the innonimate more posterior.
We're gonna get our hand underneath the patient's
elbow and stabilize the rotation of the upper body
and then we put the meaty part of our
forearm on the innonimate itself
and then we're gonna to provide a
thrust that drives following the leg
to bring the innonimate more posterior.
So this is the treated
anterior innonimate rotation
we want the patient relaxed,
take a breath in and breathe out
And when they fully breathe
out, we're going to provide
a quick high velocity thrust
down the leg this way.
If I had the opposite diagnosis, so if
we had a posteriorly rotated innonimate,
we're gonna set up the same way but this time
I don't want the leg hanging off the table.
We want to try to bring the innonimate
that's stuck posterior more anterior
So i'm gonna put the meaty part of my
forearm more closer by the PSIS
and so we're gonna thrust more this way.
So i'm gonna have the patient take a
breath in, breathe out, I'm gonna lock out
and it's almost like I'm almost driving
and trying to bring my wrist and
forearm towards my own stomach.
breathe in again and breathe out, good.
And then once you lock out, you
do a quick thrust that way.
And then afterwards, you could straighten out
the legs, have the patient lie on their back
and then reassess the innonimates
to see if they're more symmetric
and if your treatment was successful.
Sacraoiliac joint balance ligamentous tension
And so what we wanna do
with this technique
is we wanna get our fingers between
the innonimate and the sacrum
to try to gap and soften the
ligaments between the SI joints.
So what we wanna do first is to assess
and see how restricted the SI joint is,
you wanna sit on the side
that you want to treat
you want to get your hand between
the innonimate and the sacrum
So one of the things you could do is
you kinda bend the patient's knee up,
push the knee away from you
and that opens up the region
for you to find the PSIS
you wanna come a little bit medial to the
PSIS between the innonimate and the sacrum
and you could place your other hand to
support it, go ahead and bring your leg down
so my fingers now are at the SI joint, I'm
gonna push my elbows down towards the table
that allows me to fulcrum and allows my
fingers to lift up into the SI joint
we're gonna wait for the soft tissue to soften up and
then when I feel like I'm really in the SI joint,
I wanna gently lean back, I wanna
match the tension of the tissues here
I don't wanna pull back too hard
'cause if I pull back too hard,
things will actually feel
like they tighten up
so I just wanna reach a point of
balance, allow the ligaments to relax
and when I feel things soften up, my
fingers sink in a little bit more.
I'm gonna come out and then I
could recheck the SI joint
to see if the technique was able to help loosen up
the SI joint and decrease restrictions in the area.
Muscle energy for pubic shear dysfunctions
So the pubic bones sometimes could undergo a lot
of force especially with pregnancy and delivery
so it's a good thing to try to check for somatic
dysfunctions in that area and address it
So we could treat that area
with muscle energy technique.
So what we wanna do is first
to assess the pubic region,
we're gonna explain to the patient we're
gonna place our palm on the pubic bone
to diagnose any sort of somatic
dysfunction or asymmetry.
So I'm gonna find the iliac crest, place my
hand more midline and find the pubic bone
and once I find the pubic bone,
I'm gonna place my thumbs there
and just see if there is
any sort of asymmetry.
Now if there is asymmetry, we
could perform muscle energy.
The muscle energy here is going to
utilize the hip AB- and ADductors
and how they attach to the pubic
bone to bring it more symmetric.
So what I'm gonna do is have the
patient bring their knees up
and first I'm gonna ask the patient
to bring their knees apart
while I resist them with
So patient's gonna push out, 1-2-3 and relax.
And after relaxing for 3 seconds, now
we're gonna engage the hip ADductors
So I wanna first start with my fist
in between the knees and go ahead
and push together,
1-2-3 and relax.
and after relaxing for three seconds,
I'm gonna put two fists here
and go ahead and push your knee
together, 1-2-3 and relax.
So the goal is to gradually increase
the distance between the knees
now i'm putting my forearm in between
and go ahead and push together,
And again, each time allowing the knees
to kinda fall out a little bit more
to engage the hip ADductors here, and
so go ahead push your knee together,
1-2-3 and relax.
At the end, we're gonna do a
little bit of a passive stretch
and then bring the knees back
together, bring the legs back down
and then reassess the pubic tubercles
to see if they're more symmetric
after the technique was performed.