Test-techniques of the Sacrum

by Tyler Cymet, DO, FACOFP

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    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.

    About the Lecture

    The lecture Test-techniques of the Sacrum by Tyler Cymet, DO, FACOFP is from the course Osteopathic Diagnosis of the Sacral Region. It contains the following chapters:

    • Lumbosacral Spring Test
    • Sphinx Test (Backward Bending Test)
    • Seated Flexion Test
    • ASIS Compression Test

    Included Quiz Questions

    1. Absence of spring
    2. Presence of spring
    3. Physiologic movement present
    4. Normal spring test
    5. Slight movement of sacrum
    1. Symmetric inferior lateral angle (ILA) during extension
    2. Nonphysiologic sacral position
    3. Maintained asymmetry of inferior lateral angle (ILA)
    4. Worsened asymmetry of inferior lateral angle (ILA)
    5. Abnormal test
    1. Just inferior to the PSIS (posterior superior iliac spine)
    2. Just superior to the PSIS (posterior superior iliac spine)
    3. Below the iliac crest
    4. Above the iliac crest
    5. Along the ASIS
    1. Thenar eminences
    2. Thumbs
    3. Proximal phalanges
    4. Distal phalanges
    5. Volar surface

    Author of lecture Test-techniques of the Sacrum

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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