__Spinal_Manual_Therapy__An_Introduction_to_Soft_Tissue_Mobilization__Spinal_Manipulation__Therapeutic_and_Home_Exercises

Pelvic Girdle Manual Therapy 205 Figure 23-3a. Manipulation for anterior iliac rotation left Figure 23-3b. Manipulation for anterior iliac rotation left lower 51). upper 51 joint. it left via the right arm from above down, including the Posterior Iliac Rotation: lumbosacral junction. Muscle Energy/Manipulation The MET is performed by having the patient perform a >- Lesion: Left posterior iliac rotation submaximal isometric contraction of the left hip extensors >- Motion rE'striction: Left anterior iliac rotation against the therapist's right hane!. The appropriate instruc­ tion is, \"Don't let me move your left knee up.\" following a >- C (Chief Complaint): 6-second contraction, the ilium is relocalized through further hip flexion against the new barrier as determined through » Pain usually localized to the ldt sacroiliac ioint palpation at the sacral sulcus. This process is repeated a total and ipsilatera I buttock of 3 times, and the patient is immediately reassessed. » Pain described as deer, achy, sore, tight, etc Side Lying Manipulation for Left » Pain may he referred into the left rosterior thigh Anterior Iliac Rotation but not generally below the knee as with radicular pain (symptoms in the contralateral SI joint are If additional force is required to reduce the anterior iliac often experienced, possibly Jue to compensa­ subluxation, the patient is then manipulated in the side­ lying position as follows: tion) 1. The p:1tient remains in the same side-lying position H (History): (Figure 23-.3a) as for the MET above (ie, lumbar spine » Repeated unilateral stanJing on the left sidE' is \"locked\" through ligamentous tension in rotation » Fall on the left buttock in trunk flexion left with the left iliac hone up against irs restrictive » Vertical thrust through the extended left leg barrier in posterior rotation). However, the amount of » Lifting in the forward bent position with the left hip flexion will vary slightly depending on which knees locked pole is being mobilized. » Female intercourse strain with the hips flexed 2. For a left upper pole impairment of posterior iliac rota­ >- A (Asymmetry of Bony Landmarks): tion, the left PSIS is engaged with the therapist'S right » Left PSIS is lower than the right in all positions pisiform contact; for a lower pole impairment of pos­ (possibly posterior also) terior iliac rotation, the patient's left ischial tuberOSity » Left ASIS is higher than the right in all positions is engaged with the the rapist's right pisiform contact (possibly posterior also) (Figure 23-3b). The left hand makes contact with the » Left medial malleolus is shorter than the right in ASIS regardless of which pole is heing mobilized. supine 3. The manipulation involves a simultaneous \"push\" R (Range of Motion): with both hands, causing posterior iliac rotation to » Standing flexion test is positive on the left occur, as if \"turning a wheel,\" at the restrictive barrier. » \"Reverse stork\" is positive on the left at the upper and/or lower pole The posterior rotation can be graded 1 through 4, as indicated, for up to 1 minute with 1 or 2 brief pauses along the way. Copyrighted Materail