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Motion:
With hands on the posterior aspect of the pelvic girdle, therapist shifts the pelvis forward and
backward into its end range.
Advantages:
General mobilization of pelvic girdle as well as increases the extensibility of the inferior hip joint
capsule.
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End Position
Motion:
The patient relaxes so the pelvis slopes obliquely down from the ilium.
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The slack is taken up at the SIJ of the supported side on the table.
Once the patient senses tension in the joint, very small downward vertical springing motions are
performed with the knee over the edge of the table, thus mobilizing the SIJ on the supported side.
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Advantages:
Mobilization of side bending and rotation of the lower lumbar spine are also achieved by this
technique.
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Place the caudal hand over the thigh and use it to push the hip into further extension; the cephalic
hand can be applied to the patient's PSIS, pushing upward to increase the forward rotation of the
innominate on the sacrum.
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Advantages:
Technique can be modified to use muscle correction, which can place an anterior rotatory
moment on the innominate (muscle energy) using the iliopsoas as the desired force.
Have the patient push the freely hanging leg up against your hand with a submaximal force while
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Self treatment technique to counteract posterior iliac dysfunction consists of passive hip extension in
prone or supine.
Prone:
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Supine:
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In the supine correction technique it is important that the (left) leg is off the table.
The hip should be maximally adducted and literally be suspended above the horizontal by the hip
capsule and soft tissue.
This position should be held for about 2 minutes.
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5) Backward Rotation for Anterior Iliac Dysfunction
For posterior innominate rotation dysfunction, signs on the involved side are as follows:
Superior and anterior PSIS
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Inferior and posterior ASIS
Positive Standing Flexion Test
Apparent Lengthening of leg in supine
Innominate Posterior rotation
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Patient Position:
Supine with the leg opposite to the side to be mobilized hanging over the edge of the table.
Therapist Position:
Stands on the side to be mobilized.
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Motion: ot
The therapist’s cephalic hand cups the ASIS in the palm while the caudal hand grasps the ischial
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tuberosity.
Transfer your weight toward the patient's head; this results in a backward rotation of the
innominate on the sacrum.
Advantages:
Technique can be modified to use muscle correction, which can place a posterior rotatory
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moment on the innominate (muscle energy) using the gluteus maximus as the desired force.
Have the patient resist a force provided by your trunk (or against the patient's own hands, which
fixates the knee) with a sustained submaximal contraction for 7 to 10 seconds.
This is repeated three or four times, not allowing the hip to move into extension, only flexion.
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6) Self Mobilization to counteract Anterior Iliac Dysfunction
Self treatment technique to counteract anterior iliac dysfunction consists of following techniques:
Standing:
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The patient places the foot on a table or bench, leans toward the knee, and stretches it into the
axilla.
Repeat this exercise several times a day and always making a correction when going to bed to
relieve the strain on the involved ligaments.
These techniques are powerful rotators of the innominate and can be overdone unless specific
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Method to correct right anterior rotation: a right posterior lever effect can be created by resting
right foot on a high stool (hip flexed 90° and abducted 45°), and then letting the trunk hang down
in forward flexion as far as feels comfortable.
Motion:
The cephalad hand applies postero-anterior pressure to the right side of the sacral base.
The caudad hand internally rotates the left hip to inflare and internally rotates the left
innominate.
8) Self Mobilization for Innominate Outflare
The patient lies on her back and bends the involved hip to 90˚.
With her hand, she pushes the thigh to the opposite side.
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A cushion or folded pillow under the foot and lower leg may be necessary to maintain 90 of hip
flexion.
The stretch is maintained for 2 minutes.
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Patient Position:
Prone with leg externally rotated
Therapist Position:
Stands on the left side.
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The cephalad hand contacts the medial aspect of the left ASIS and the caudad hand contacts the
area just lateral to the PSIS.
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Motion:
The cephalad hand pulls the ASIS laterally and inferiorly while the caudad hand applies medial
and superior force to the PSIS.
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Motion:
The outer hand contacts the superior aspect of the iliac crest and applies an inferior and slightly
medial force in the plane of the joint.
A. Distraction in supine
Patient Position:
Supine with both legs extended
Therapist Position:
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Stands at the foot of the table and grasps the patient’s ankle on one side just proximal to the
malleolus.
A belt may be used around the patient’s trunk, or you may support the opposite foot with
your thigh to stabilize the patient.
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Motion:
Apply a gentle, caudal distraction force through the lower leg until the exact position of the
leg that will localize the force to the SIJ is attained.
Distraction is then applied by pulling the leg, leaning backward with the trunk, and twisting
the pelvis, while pushing against the other (outstretched) leg with the thigh.
B. Distraction in prone
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C. Self Distraction in standing
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The patient is instructed to stand with one leg on a stool and hang the affected down over the
side with a weight attached (e.g., ankle weights, heavy boot).
Traction is applied for 15 to 30 minutes.
The patient should be encouraged to move the leg gently through a limited range of motion at
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the hip to help relax the muscles and stretch out any structures in the hip and pelvic girdle
region.
This is used to reduce a sacral counternutation positional fault, commonly caused by a postural flat back,
or flexed sitting or standing postures and coccygeal muscle spasm. Signs include
Lumbar spine hyperflexion
Shallow (posterior) sacral sulci
Deep (anterior) inferior lateral angles,
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Therapist Position:
Stands at the level of the pelvis on the involved side, facing the foot of the table
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Motion:
The base of the inner hand contacts the sacral base, with the arm directed at a right angle to the
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base.
The mobilizing hand glides the cranial surface of the sacrum ventrally, directing the sacrum into
nutation.
Incline the pressure toward the patient's feet.
14) Sacral Right Side-bending Technique for Left-on-Left Sacral Torsion Dysfunction
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with the fingers pointed toward the feet.
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Motion:
An inferior, slightly medial force is applied onto the left side of the sacrum by taking up
tissue tension on the posterior aspect.
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The right hand applies postero-anterior force to the posterior aspect of the left inferior lateral
angle, and the left hand applies antero-lateral force to the right ilium for stabilization.
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The patient lies supine with the hips and knees flexed. A padded dowel (2/5 cm x 10 cm) is placed
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vertically on the left side of the sacrum to encompass L5-S 1 and S1-S3.
The patient maintains this position for 2 minutes. After treatment, retest mobility.
Therapist Position:
Stands on one side of the patient facing the patient
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Motion:
Crossed-armed lateral pressure is applied to the medial aspect of the ASIS with the heels of the
hands to decompress.
Advantages:
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Soft tissue inhibition-stretch to the pelvic diaphragm is usually indicated. Encourage movement
within pain tolerance to promote pubic motion.
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16) Inferior-Superior Pubic Glide Technique
Patient Position:
Supine
Therapist Position:
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Motion:
The ASIS are moved in the opposite caudad and cephalad directions.
More localized accessory movements can be performed directly on the pubic ramus.
17) Inferior-Anterior Pubic Glide Technique
Patient Position:
Supine
Therapist Position:
Stands to the side of the patient.
The base of the left hand contacts the superior aspect of the pubic ramus on the involved side
(left side).
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Motion:
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The arm applies a gentle inferior and anterior force to move the pubis down and forward.
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18) Strain & Counterstrain Correction for Anterior Coccygeal Dysfunction
Patient Position:
Prone
Therapist Position:
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Motion:
Place the coccyx in the position of ease by caudally gliding the sacrum.
Rotation or lateral flexion of the sacrum, usually toward the tender point side, may be added to
fine tune the position.
Once the ideal position is achieved, it is held for a period of 90 seconds or so.
19) Postero-Anterior Coccygeal Glide
Patient Position:
Seated
Therapist Position:
Stands to the side of the patient.
Places the palm of the mobilizing hand over the sacrum and fingers on the coccyx.
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Motion:
Move the coccyx anterosuperiorly. ot
The mobilization may be easier if the other hand places slight compression on the skull.
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Alternatively this technique may be performed in supine.
Many times just performing the evaluation in sitting will free the coccyx and put it back in place.
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Reference: Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods
by Darlene Hertling & Randpolh M. Kessler (4th Edition)