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Principles of Manual Medicine

Left Posterior Rotated Innominate

Overview A direct action, muscle energy procedure for treating a left flexed sacrum in the prone position.

Diagnosis

  • Position: Left innominate rotated posteriorly
  • Motion restriction: Anterior rotation of left innominate.

The patient should be prone with the operator standing on the right side.

Step 1 The operator's right hand is placed on patient's left iliac crest, 5-6 cm anterior to the posterior superior iliac spine.

Step 2 The operator controls the patient's left leg by grasping the flexed knee in the left hand. The patient's left leg is abducted to loose pack the left sacroiliac joint.

Step 3strong> The operator extends the patient's leg to the barrier while exerting pressure with the right hand in the direction of the iliac crest.

Step 4Patient's muscle effort is a series of three to five contractions for 3-5 seconds of hip flexion (pull leg to table) against operator resistance. After each muscle effort operator engages new extension barrier.

Note This dysfunction frequently accompanies a left sacrum flexed (anteriorly nutated). A combination technique can be performed as the last step of the muscle energy procedure for the left sacrum flexed. While holding the sacrum in the posteriorly nutated position with the right hand, the operator's left extends the left hip, rotating the left innominate anteriorly, and resists the muscle effort of pulling the knee to the table.