00:01
So, this is an example of a
lumbosacral spring test
where you get your patient lying prone,
push on all four poles,
and make sure there’s
motion on all four poles.
00:11
You check for symmetry between
the right upper and left upper.
00:14
And you check for symmetry
between both lower poles.
00:17
You also check the
L-S junction as well.
00:20
Be mindful of
the patient.
00:21
Make sure they’re
comfortable.
00:22
If there’s tenderness in one area,
that’s another clue.
00:25
They may be
compensating.
00:27
They may be doing things
to help fix it themselves
that will cause other
problems as well.
00:32
Use a gentle
force.
00:34
If you re-examine a
patient multiple times,
they’re going to start to get
tender in the sacral sulcus.
00:38
You’re going to think you have a positive test,
which is an absence of spring.
00:43
A positive test for pathology
shows no spring,
no motion, a cemented
sacrum that’s not moving.
00:51
So, you want to test all four poles
looking to see that there’s motion,
absence of spring, and you have
a non-physiologic issue going on.
01:02
It’s negative or normal if they have
the ability to spring in all four poles.
01:06
Here is an example
of the spring test
and the motion animation
showing the spring.
01:14
We normally go from the
spring test to the Sphinx test
because you’ve got them lying
prone for the spring test
and then you have them sit up in
sphinx position on their elbows,
TV watching
position.
01:27
You check them in the prone position
looking at the sulci and the ILAs as well.
01:32
When you put them
in the sphinx position,
what you’re doing is you’re changing
some of the mechanics
and you’re changing
the lumbar curvature
so you can better examine
just the sacrum.
01:44
There should be an increased
lumbar lordosis
when you put them in
the sphinx position.
01:50
The sacral base should go anteriorly
during extension at the L-S junction.
01:56
So, if it goes anteriorly,
you’ll still have motion
but you’ll have
less motion
and you’re taking the sacrum
separate from the other parts.
02:05
A positive test
of a sphinx test
is when you have asymmetrical
positioning of the ILA.
02:12
So, if you have a
non-physiologic problem,
you will have asymmetrical inferior lateral
angles at the bottom of the sacrum.
02:21
A negative test is when you have good,
symmetric motion bilaterally.
02:25
It’s negative,
there’s no problem.
02:27
Here’s an example of how
I do the sphinx test.
02:30
You can have them do it
on their elbows
or you can have them arch themselves
to decrease the lumbar lordosis.
02:37
And the reason being is
we want to assess
whether or not a problem is
physiologic or non-physiologic.
02:43
A physiologic dysfunction
is a somatic dysfunction
that has a restriction within
a normal range of motion.
02:51
So, you should be able
to move a certain way.
02:54
If you can’t, that’s
physiologic dysfunction.
02:57
A non-physiologic dysfunction
is restriction of a joint
in a position that’s not part of
normal physiologic functioning.
03:06
We know that you have a
physiologic range of motion
which is what your muscles will
cause your bones to move.
03:13
There is an anatomic range of motion
which is what the anatomy allows
but the muscles can’t
get it all in there.
03:21
Then you have a pathologic barrier
if you have weakness, atrophy,
or other issues such as
overuse or hypermobility
that will cause people to
move in a different way,
and limit some motions
while exacerbating others.
03:38
That’s an example of a
non-physiologic dysfunction.
03:41
So, these are examples of physiologic
versus non-physiologic dysfunctions.
03:47
When you’re treating a patient,
start with the sacrum
and start with non-physiologic
dysfunctions.
03:55
The seated flexion test, one of the
keys to making a diagnosis.
04:00
Again, you have
the patient sit down.
04:02
Put your hand on the posterior
superior iliac spine
and then go inward towards the
sacrum and feel the sulcus.
04:10
When they lean forward, they put
their hands between their legs.
04:14
Don’t let them rest their
hands on their legs
because we want to see if
there’s sacral motion or not.
04:19
The sacrum should
stay where it is.
04:22
If it doesn’t, then you know that there is
some dysfunction in that area.
04:27
You want to stay eye level with a
posterior superior iliac spine
so you can see the motion and see whether
or not the PSIS is moving as well.
04:35
For the seated flexion test,
the side that moves the most
and moves first is the side
that has the problem.
04:42
So, you put your hand on the PSIS,
go slightly inward to get to the sulcus.
04:47
And then you have them bend forward,
hands between their legs.
04:51
The side that moves first and furthest
is the one you're going to focus on.
04:55
That’s a positive test for showing
that there’s pathology present.
04:59
A negative test is either no somatic
dysfunction, or no motion,
or normal motion
equal bilaterally.
05:08
Here’s a picture of the
seated flexion test.
05:10
Hands between the legs, don’t let
them support themselves.
05:14
Then make sure that the
pelvis is taken out of it
by having the pelvis
rest on a chair.
05:20
The ASIS compression test is the
anterior superior iliac spine.
05:25
When you flip the patient over,
have them lie supine
and then you put your
thenar eminence, you hand
along the ASIS and then
you rock them.
05:37
And see what kind of motion you get,
what kind of anterior posterior motion
to make sure there’s good pelvic motion
because pelvic is attached to the sacrum.
05:46
You want to get a sense
of the ASIS motion as well.
05:50
You want to determine if the
motion is equal bilaterally
or if there are
any restrictions.
05:56
A positive ASIS compression test is the side
that offers the greatest resistance.
06:01
So, if you’re trying to rock them
and one side doesn’t rock
or doesn’t move as equally
and it’s not comfortable,
that’s when you have a positive
ASIS compression test.
06:11
This is another point to help
you make a diagnosis
and see where the treatment
needs to be done.
06:17
This is not specific to the sacrum.
It’s sacroiliac dynamics.
06:24
Here’s a picture of the
ASIS compression test.
06:27
So, in putting it all together,
you want to examine the sacrum,
the sacral base, the ILA, the ilium,
ischium, and pubes.
06:35
Mostly, we’re focusing
on the sacrum
but it is attached to the pelvis
and the lumbar spine.
06:40
So, you need to focus on
all of them at some point
and examine all three areas before
you make your full diagnosis.
06:46
But again, start with the sacrum.
Treat the sacrum first.