Osteopathic Sacral Treatment

by Sheldon C. Yao, DO

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    00:01 Sacral counterstrain So to treat the sacrum, we have to go over the different counterstrain points for the sacrum.

    00:07 So there are two points at the level of S1 and two points at the level of S5.

    00:13 So the S1 points are just bilateral on either side of the spinous processes.

    00:19 The S5 ones are more by the ILA's.

    00:22 At S2 and S4, there are single points and also S3 midline.

    00:29 So there's two at S1, one at S2, S3, S4 and then two at S5.

    00:35 And so the positioning when you find a sacral tender point that you wanna treat, S1 is gonna be paired with S5.

    00:42 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.

    00:50 So, if I have a left S1 tender point, I wanna push at S5 on the right.

    00:55 If I have a S2 tender point, I wanna push at S4 midline.

    01:00 If I have a S3 point, you could try pushing above and below to see what resolves it.

    01:05 If I have a S4 point, I'm pushing at S2.

    01:08 And if I have a S5 point, I'm pushing on the opposite side at S1.

    01:13 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.

    01:29 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.

    01:39 Balance ligamentous tension for the sacrum.

    01:42 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.

    01:49 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.

    01:59 With our other hand, we're going to bridge the innonimates by taking our forearm and our fingers and bringing the AIIS closer together.

    02:08 That will help to inflare the innonimate but then it causes it to outflare posteriorly.

    02:13 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.

    02:20 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.

    02:36 And so my forearm and my fingers are squeezing together, that helps to gap the SI joints.

    02:42 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 or clockwise and taking it all into its freedom to do a indirect treatment.

    02:59 And so I hold the sacrum and the innonimates at this point of balance and freedom.

    03:06 If I wanted to, I could also shift the innonimates into anterior-posterior rotation.

    03:13 If I feel like there's a rotation present and I hold this until I feel the ligaments loosen up.

    03:19 There's a softening under the sacrum.

    03:21 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.

    03:37 Muscle energy to treat sacral dysfunctions.

    03:40 So we could utilize muscle energy to treat sacral dysfunctions.

    03:43 Based on the dysfunction, we're gonna set the patient up into the barrier and push to the freedom.

    03:48 The first one that we're gonna look at is for forward sacral torsions.

    03:52 So with forward sacral torsions, our mnemonic is F-S-U.

    03:58 For forward sacral rotation or torsion, we're gonna place the patient into sim's position and have them push their legs up.

    04:06 So F-S-U is the pnemonic that you could try to remember how to position the patient for a forward sacral torsion.

    04:13 So here, we're gonna be treating a right on right.

    04:16 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.

    04:27 So when they hug the table, they're placing the sacrum into it's rotational barrier.

    04:32 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.

    04:40 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.

    04:47 1-2-3, relax and then re-engage and push up again.

    04:51 1-2-3 and relax and push up one more time 2-3 and relax.

    04:58 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.

    05:09 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.

    05:23 So we're going to monitor at the SI joint.

    05:26 Here, the axis side is down, so here we're gonna be treating a left on right.

    05:32 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.

    05:45 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.

    05:54 Good.

    05:55 And so that will rotate the patient, put them into a lateral recumbent position which is the barrier.

    06:02 And now we're gonna take the ankle, drop it off the table and have them push their ankle up towards the ceiling.

    06:07 So go ahead and push up, 1-2-3 and relax.

    06:10 Push up again, 1-2-3 and relax.

    06:14 And push up one more time, 2-3, relax.

    06:17 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.

    06:28 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.

    06:36 So when the patient breathes in, we wanna add anterior pressure.

    06:39 And when they breathe out, we wanna prevent that sacrum from dipping forward again.

    06:43 So this is to treat the unilateral sacral flexion.

    06:46 Here, we would be treating a unilateral sacral flexion on the left side.

    06:49 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.

    06:59 Internally rotate the leg and push down and that helps to bring the ILA more into our palms here.

    07:07 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.

    07:14 Take a breath in again then we push when the patient takes a breath in and go ahead and breathe out.

    07:21 And one more time, take a breath in and we hold and then patient breathes out.

    07:27 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.

    07:36 So those are the three different techniques that we could utilize to treat sacral dysfunctions with muscle energy.

    07:43 Sacral rock articulatory technique.

    07:46 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.

    07:54 So remember, when the patient inhales, the sacral base is gonna move posterior and when they exhale the sacral base is gonna move anterior.

    08:02 So what we wanna do is to try to encourage that motion.

    08:04 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.

    08:16 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.

    08:25 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.

    08:34 And as they exhale, I'm gonna bring the base more anterior.

    08:36 Go ahead and breathe in again.

    08:38 And then we continue this until we feel increased mobility of the sacrum and the sacrum is moving a little bit better.

    08:45 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.

    08:59 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.

    09:11 HVLA for the sacrum.

    09:13 To perform HVLA for the sacrum, we treated the region with soft tissue and we are going to now perform the thrust.

    09:21 So I wanna find the deep sulcus, I wanna stand on the side of the deep sulcus and bring the pelvis more towards me.

    09:27 We're going to form a letter C by "smiling" the person's body away from us so we further isolate to the sacrum.

    09:35 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.

    09:44 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.

    09:53 You wanna keep that C curve when you do the thrust.

    09:55 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.

    10:05 Afterwards, they could relax, come back to the middle and then you double check to see if there's more symmetry in the sacrum.

    About the Lecture

    The lecture Osteopathic Sacral Treatment by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Sacral Counterstrain
    • Balance Ligamentous Tension for Sacrum
    • Muscle Energy Treating Sacral Dysfunction
    • Sacral Rock Articulatory Technique
    • High-velocity, Low-amplitude for Sacrum

    Author of lecture Osteopathic Sacral Treatment

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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