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Principles of Manual Medicine

Unilateral Extended Sacrum

A direct action, muscle energy procedure for treating a right extended sacrum in the prone position.

Diagnosis

  • Position: Right unilateral posterior nutated sacrum (right extended sacrum).
  • Motion restriction: Anterior nutation of right sacrum.

Overview

Step 1

The operator's right hand monitors the right sacroiliac joint as the left hand abducts the right leg to approximately 15 degrees, loose packing the right sacroiliac joint. Patient is instructed to hold the right leg in that position.

Step 2

After the patient's left leg is abducted to loose pack the left sacroiliac joint, they are instructed to hold the right leg in that position.

Step 3

The patient's trunk is extended by prone prop position while the operator's right pisiform is in contact with the right sacral base. The operator's left hand on the right ASIS provides a counterforce against the compression through the right hand.

Step 4

Patient performs a series of forced exhalation efforts while the operator maintains ventral and caudad compressive force against the right sacral base. At the end of each exhalation effort, the patient is instructed to pull the right ASIS toward the table as a muscle activating force.

Retest