TREATMENT OF INNOMINATE ROTATION

Not checked TREATMENT OF INNOMINATE ROTATION . Innominates:
o 3 fused bones:
. Ilium, ishium, & pubis
o Articulations of innominates:
. Femur at acetabulum
. Sacrum at SI joint
. Pubic bones articulate with each other at the symphysis
. During pregnancy, women may have discomfort at the
symphysis
o Remember to do the lateralzing tests first to determine side of
somatic dysfunction:
. ASIS compression test, standing flexion, seated flexion
. NBOE will have lateralze tests
. Anterior innominate rotation
o Definition: One innominate will rotate anteriorly, compared with
the other
o Etiology: Tight quadriceps muscles
o Diagnostic findings:
. ASIS more inferior on involved side
. PSIS more superior on involved side
. Right sulcus is more shallow
. Right sacrotuberous ligament is loose
. Right medial malleolus may be inferior
. Appears as a long leg on involved side
. AP compression test will have restriction on involved side
. Positive standing flexion test on involved side
. Positive sitting flexion test on involved side
. Anterior innominate rotation - Supine muscle energy
o Example: right anterior innominate
o Patient is supine & Dr. on the side of dysfunction
. Remember to get rid of artifact - have patient bend their
knees and push their butt off the table
o Flex lower extremity on side of dysfunction at knee and hip (no
abduction as in shear & flare)
o Put your (Dr.) shoulder against the patient's leg & cup
patient's ASIS with your cephalad hand & the ischial tuberosity
with your caudad hand
. Tell the patient that you are putting your hand on the bone
that they sit on
o Hold tension at all points until innominate rotates posteriorly
to restrictive barrier
o Tell the patient to "Push knee against my chest"
. Tell the patient to use about half strength when they push
o Sense that force is localized at the SI joint
o Wait for 3-5 seconds
o Flex patient's hip and rotate their innominate posteriorly to
new restrictive barrier
o Repeat until best motion occurs (usually 3 times)
o Recheck
. Anterior innominate rotation - Prone direct muscle energy
o Example: left anterior innominate
o Patient is prone and Dr. is on the side of dysfunction
o Patient's extremity hangs freely off table
o Flex the patient's hip and knee (grasp lower leg to do this)
o Place the patient's foot flat against your thigh
. Don't put the foot on the knee, when the patient pushes,
they may hurt your knee
o Place other hand on the posterior surface of the sacrum
o Grasp knee & further flex hip & knee
o Lift patient's knee & "squat" to raise foot superiorly - rotates
innominate posteriorly
o Tell patient to "push your foot against my knee"
. Tell the patient to only use about half their strength
. Maintain isometric counterforce
o After the tissues relaxes, flex hip to rotate innominate
posteriorly to new barrier
o Repeat until best motion (usually 3 times)
o Recheck
. Innominate posterior
o Definition: One innominate will rotate posteriorly compared to
other
. Remember to lateralize: ASIS compression, standing & seated
flexion tests
o Diagnostic findings:
. ASIS is superior on the involved side
. PSIS is more inferior on the involved side
. Short leg on the involved side
. Medial malleolus may be superior
. AP compression will be restricted on the involved side
. Positive standing flexion test on the involved side
. Positive sitting flexion test on the involved side
. Sacrotuberous ligament will be tight on the involved side
. SI joint is usually tender
. Innominate posterior - Supine muscle energy
o Example: left posterior innominate
o Patient is supine & Dr. is on the side of the somatic
dysfunction
o Patient is on the edge of the table - allowing the ischial
tuberosity to be off edge
o Patient's leg hangs freely
o Cephalad hand reaches across & stabilizes the opposite ASIS
o Apply tension to the anterior thigh rotating the innominate
anterior to a new restrictive barrier (Dr.'s leg is on the
outside of patient's leg)
. When treating pubis shear, Dr.'s leg is between the table &
the patient's leg - but not now
o Tell the patient to "pull your knee up to the ceiling"
. Use about half strength
o Sense that the contractile force is localized to the SI joint
o Extend the extremity to a new restrictive barrier
o Repeat until the best motion is obtained (usually 3 times)
o Recheck
. Posterior innominate - Prone muscle energy
. May be easier for smaller people or older patients
o Patient is supine & Dr. is on the side opposite the dysfunction
o Cephalad hand (hypothenar eminence) is on the iliac crest & PSIS
o Caudad hand - grasp the distal femur just above knee
o Extend patient's hip to move the innominate anteriorly to the
restrictive barrier
o Tell the patient to "pull your knee down toward the table"
. Use about half strength
o Sense that the force is localized at the SI joint
o Extend the extremity to a new restrictive barrier
o Repeat until the best motion (usually 3 times)
o Recheck