So to treat the sacrum, we have to go over the
different counterstrain points for the sacrum.
So there are two points at the level of S1
and two points at the level of S5.
So the S1 points are just bilateral on
either side of the spinous processes.
The S5 ones are more by the ILA's.
At S2 and S4, there are
single points and also S3 midline.
So there's two at S1,
one at S2, S3, S4 and then two at S5.
And so the positioning when you find a
sacral tender point that you wanna treat,
S1 is gonna be paired with S5.
So to find the S1 tender point at the left side,
what I wanna do is I wanna push
on the opposite side of S5.
So, if I have a left S1 tender point,
I wanna push at S5 on the right.
If I have a S2 tender point,
I wanna push at S4 midline.
If I have a S3 point, you could try pushing
above and below to see what resolves it.
If I have a S4 point, I'm pushing at S2.
And if I have a S5 point, I'm
pushing on the opposite side at S1.
So depending on where the point is located,
you're trying to find the opposite point
to try to put a little bit of pressure to
decrease the amount of pain in that area
and again you're following all the principles
of counterstrain to try to treat the region
so that there is decreased pain.
You hold the point for 90 seconds
and allow it to reset and hopefully
that will be able to decrease
the pain in the sacral region.
Balance ligamentous tension
for the sacrum.
So what we wanna do here is
we're going to take the sacrum
and balance it underneath our hands,
the patient's on the supine position.
And so with our hand on the sacrum,
we could kinda take the sacrum and move it
towards its freedoms for indirect treatment
or into the barriers for a direct treatment.
With our other hand,
we're going to bridge the innonimates
by taking our forearm and our fingers
and bringing the AIIS closer together.
That will help to inflare the innonimate but
then it causes it to outflare posteriorly.
So I'll have the patient bend this knee up,
lift up your tail bone
and that allows me to get my hand
comfortably on the tail bone.
You could relax your leg, I'm fulcruming on
my elbow and I wanna take my forearm,
place it in one AIIS and my other hand,
my fingers come across and gap the AIIS.
And so my forearm and my fingers are squeezing
together, that helps to gap the SI joints.
With my hand on the tail bone here,
I'm getting a sense of the sacrum,
feeling to see if it likes to move superior
or inferior, translate right or left
likes to move counterclockwise
and taking it all into its freedom
to do a indirect treatment.
And so I hold the sacrum and the innonimates
at this point of balance and freedom.
If I wanted to, I could also shift the innonimates
into anterior-posterior rotation.
If I feel like there's a rotation present and I
hold this until I feel the ligaments loosen up.
There's a softening under the sacrum.
there might be improved excursion of
the sacrum as the patient's breathing
and then I will come back,
lift up a little bit
and then I could recheck
the sacrum and pelvis to see
if there is better excursion
and movement after technique.
Muscle energy to treat sacral dysfunctions.
So we could utilize muscle energy
to treat sacral dysfunctions.
Based on the dysfunction, we're gonna set the
patient up into the barrier and push to the freedom.
The first one that we're gonna look at
is for forward sacral torsions.
So with forward sacral torsions,
our mnemonic is F-S-U.
For forward sacral rotation or torsion,
we're gonna place the patient into sim's position
and have them push their legs up.
So F-S-U is the pnemonic that
you could try to remember
how to position the patient
for a forward sacral torsion.
So here, we're gonna be treating
a right on right.
The patient always lies with their axis side down,
we're going to monitor in the SI joint,
flex the knees until we feel motion in that
joint, have the patient hug the table.
So when they hug the table, they're placing
the sacrum into it's rotational barrier.
We're going to take the legs, we're
gonna drop the ankles towards the floor
'cause the patient's gonna
be pushing the ankles up.
So place them into the barrier,
we're gonna engage the freedom
by having them side-bend and push
their ankles up towards the ceiling.
1-2-3, relax and then re-engage
and push up again.
1-2-3 and relax
and push up one more time
2-3 and relax.
We're gonna provide a passive stretch
and then bring the patient back
and then you could have
them lie on their belly
and then you could re-assess to see
if the sacrum's moving a little better.
For a backward sacral torsion,
our mnemonic is going to be B-L-U,
backwards, lateral recumbent and they're
gonna be pushing their ankle up
So go ahead and lie on
your side again.
So we're going to monitor
at the SI joint.
Here, the axis side is down, so here
we're gonna be treating a left on right.
We're going to flex the knees up
till I feel motion at the SI joint,
This time we're gonna
straighten out the bottom leg
and just like that, relax.
And we're going to have them
hold on to our shoulder
and we're gonna rotate them into the
barrier in the opposite shoulder
to reach back and grab the table.
And so that will rotate the patient, put them into
a lateral recumbent position which is the barrier.
And now we're gonna take the
ankle, drop it off the table
and have them push their ankle
up towards the ceiling.
So go ahead and push up,
1-2-3 and relax.
Push up again,
1-2-3 and relax.
And push up one more time,
We do a passive stretch, bring them back slowly,
have let them lie back on their stomach
and that'll allow us to double check
to see if the sacrum is moving better.
To treat a unilateral sacral flexion, what we
want to do is we try to push on the posterior ILA
to get the sacrum to come back up.
So when the patient breathes in,
we wanna add anterior pressure.
And when they breathe out, we wanna prevent
that sacrum from dipping forward again.
So this is to treat the unilateral sacral flexion.
Here, we would be treating a unilateral
sacral flexion on the left side.
We place our palm,
the thenar eminence,
we place the thenar eminence
on the posterior ILA,
we're gonna bring the leg out to
the side to gap the SI joint.
Internally rotate the leg and push down
and that helps to bring the
ILA more into our palms here.
Patient's gonna take a breath in and again
we push when the patient takes a breath in
and when the patient breathes out, we kinda
hold it preventing it from going forward.
Take a breath in again
then we push when the patient takes a
breath in and go ahead and breathe out.
And one more time, take
a breath in and we hold
and then patient breathes out.
And then one last we passive stretch, we could
give a little bit of a push with our palm,
bring the leg back and then recheck
to check for sacral symmetry.
So those are the three different
techniques that we could utilize
to treat sacral dysfunctions
with muscle energy.
Sacral rock articulatory technique.
With the sacral rock articulatory
technique, what we wanna try to do
is to increase the excursion of the sacrum
with the different phases of breathing.
So remember, when the patient inhales,
the sacral base is gonna move posterior
and when they exhale the sacral base
is gonna move anterior.
So what we wanna do is to try
to encourage that motion.
So we're gonna contact the sacrum,
we're gonna put the first hand,
initially the palm at the sacral
base and the fingers kinda come down
and we will reach the coccyx and the
other hand is gonna go above that.
So I have good contact on the sacrum
and I'm gonna alternate my compression
to encourage the sacrum to move better and rock
the sacrum so it moves a little bit better.
So the patient's gonna take
a deep breath in
and as the patient takes a deep breath
in, go ahead and breath in deep,
I'm gonna bring the base more posterior
and then breathe out.
And as they exhale, I'm gonna
bring the base more anterior.
Go ahead and breathe in again.
And then we continue this until we
feel increased mobility of the sacrum
and the sacrum is moving
a little bit better.
So this technique could help to articulate
the sacrum and improve motion of the sacrum
and perhaps help with decreasing any nerve
compression especially from S2 to 4
which does parasympathetic
to the abdomen.
So once we feel like the sacrum
is moving a little bit better,
we could go back and recheck to see
if the sacrum is more symmetric
and if there's better excursion
when the patient breathes.
HVLA for the sacrum.
To perform HVLA for the sacrum, we
treated the region with soft tissue
and we are going to now
perform the thrust.
So I wanna find the deep sulcus, I wanna
stand on the side of the deep sulcus
and bring the pelvis more towards me.
We're going to form a letter C by
"smiling" the person's body away from us
so we further isolate to the sacrum.
The patient's gonna interlock
their fingers behind their neck
and before they bring their elbows
together you're gonna get your hand,
back of your hand on top
of the sternum.
Now bring your elbows together, we're
gonna stabilize the opposite ASIS
and you could put your knee up here just
to prevent them from straightening out.
You wanna keep that C curve
when you do the thrust.
The patient's gonna take a breath in
and when they breathe out,
you bring them and rotate them on to the
shoulder and perform a quick thrust,
rolling them down towards the ground.
Afterwards, they could relax,
come back to the middle
and then you double check to see if
there's more symmetry in the sacrum.