OMM, #29
Thursday, March 6, 11am
Turner Slicho, PDF
Deana Lanham for Michelle Campbell
Page 1 of 4
Diagnosis of the Innominates and Pubic Symphysis
Announcement: The student clinic for the 3rd year core rotation is looking for patients. The
clinic usually gets older geriatric patients, and they are looking for a younger variety. The first
session will be for one hour and will consist of two students and the faculty supervisor. The cost
for this clinic is $15. If you are interested please call the clinic to make an appointment.
INNOMINATES
Movement of the Innominates
 Innominates rotate around the inferior transverse axis of the sacrum.
 They are located at the inferior limb of the sacroiliac joint.
 The sacrum rotates around the middle axis, and the superior axis is referred to as the
cranial axis.
Possible Somatic Dysfunctions of Innominates
 Anterior Innominate Rotation
 Posterior Innominate Rotation
 Unslipped Innominate (Superior Innominate Shear)
o Non-physiologic SD, usually a traumatic etiology
o Not involved in inferior transverse axis mechanics
o Here there is an upward slipping of the whole innominate on one side.
 Innominate Inflare/Outflare
o This is rare
o Innominates rotate around respective vertical axes that go through the middle of
the innominate.
Pelvic & Sacral Worksheet
 This is a worksheet that was received in class and can be found on the yahoo group site
under OMM files.
 It is a diagnosis worksheet for the pelvis and sacrum, and you should fill this out with
your clinical findings.
 In regards to the picture, the rectangular box on top is L5 and the two superior ends
represent the PSISs.
 These worksheets will be available at the next couple of classes to assist us in our
diagnostic skills.
Lateralization of the Pelvis
 There are three tests for this:
o Standing Flexion
o Seated Flexion
o ASIS compression
 The palms are cupping the ASISs, and the force vector is posteromedial.
 When performing these tests, make sure that your thumbs are UNDER the ASISs and the
PSISs.
 2/3 tests give you a reference side, which will be Right or Left. For example, if the right
side tests positive for 2 out of 3 tests, then the right side now becomes your reference
side.
 Remember: A positive test for the standing and seated flexion tests is when one side
moves superiorly compared to the other. A positive test for the ASIS compression test is
OMM, #29
Thursday, March 6, 11am
Turner Slicho, PDF
Deana Lanham for Michelle Campbell
Page 2 of 4

when you feel restricted movement (resistance to compression) compared to the other SI
joint.
Let’s put this all together in a basic chart:
Tests
Standing
Flexion
Description
Tests symmetry of motion between the innominates and the
sacrum (iliosacral dysfunction). Indicates the side of the
problem, but does not indicate if the problem is with the pelvis or
lower extremities, or both.
Positive Tests
PSIS is superior on one side of
the dysfunction. (If your
thumb moves superiorly.)
Seated Flexion
Lateralizes dysfunctions of the PELVIS. Tests for symmetry of
motion between the ilia and sacrum.
PSIS is superior on one side of
the dysfunction. (If your
thumb moves superiorly.)
ASIS
Compression
Here you are checking the resiliency of the SI joints. It is
basically a test to confirm your findings of the flexion tests.
Resistance of compression/
Lack of a spring/ Restricted
movement of the SI.

Why do we lateralize?
o To identify the restricted side (the reference side) for pelvic and sacral diagnosis
and treatment.
o To direct treatment specifically to the restricted side.
IMPORTANT DIAGNOSTIC COMMENTS
 Once you have lateralized the patient to one side, all other findings are named in relation
to what is found on the restricted side in comparison to the other one.
 You always name the dysfunction in relation to the lateralized side. Simply, it is called
on the lateralized side.
 This is because after you perform your laterization tests you assume that there is a
restriction of motion or dysfunction on the lateralized side. The other side is then
assumed to be “normal” in comparison to the lateralized side. The “normal side” is
referred to as the non-lateralized side.
 Basically we are comparing the dysfunctional side (lateralized side) to the normal side
(non-lateralized side).
Diagnosing the Innominates
 Diagnosing the Innominates while laying SUPINE
o Do this after you have lateralized the pelvis.
o ALIGN the PELVIS before you diagnose.
 Patient bends his/her knees
 The patient is asked to lift his/her hips off of the table
 The patient is then asked to return his/her hips to the table and to
straighten legs
 This allows you to accurately check the ASISs.
o Place your thumbs horizontally UNDER the ASISs.
o Are they level? Is the lateralized side inferior or superior relative to the nonlateralized side?
o You always name the dysfunction in relation to the lateralized side.
 For example, if you determined that your lateralized side is the LEFT
side, then your diagnosis should be whether or not the left side is
superior or inferior as compared to the right side.
OMM, #29
Thursday, March 6, 11am
Turner Slicho, PDF
Deana Lanham for Michelle Campbell
Page 3 of 4

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You are always comparing the left side to the right side (the “normal”
side).
 Your diagnosis would be that the left side is inferior or superior to the
right side.
 Stating that the right side is inferior or superior would be incorrect
because it is your non-lateralized side.
Diagnosing Inflare/Outflare
o Visualize a line from each ASIS to the umbilicus. (It was suggested to use a
ruler or a straight edge here.)
o Is the lateralized side relatively farther (outflare) or closer (inflare) to the
umbilicus?
o Inflare:
 Lateralized ASIS is closer to the umbilicus than the non-lateralized side.
 For example, for a right inflare, there is a shorter distance between the
umbilicus and the right ASIS, than between the umbilicus and the left
ASIS.
o Outflare:
 Lateralized ASIS is farther away from the umbilicus than the nonlateralized side.
 For example, for a right outflare, there is a longer distance between then
the umbilicus and right ASIS than between the umbilicus and left ASIS.
Diagnosing the Innominates using the Medial Malleoli
o Place your thumbs UNDER the medical malleoli
o Apply slight inferior traction
o Is the lateralized side inferior or superior relative to the non-lateralized side?
 The malleoli are mixed landmarks because you are looking at leg length
in relation to the pelvis.
 This test can alert the D.O. to stresses placed on the pelvis, leg, ankle,
and/or to functional or anatomical short leg.
Diagnosing the Innominates while laying PRONE.
o Again, ALIGN the PELVIS before you begin.
 D.O. bends the patient’s knees, then returns the legs to the table.
 Or, the D.O. can lift the patient’s hips and recenter them over the table.
 This allows you to accurately check the PSISs.
Place your thumbs horizontally UNDER the PSISs.
o If you are having trouble finding the PSISs, just feel for the iliac crests and then
follow them around posteriorly until you feel them sticking out.
o Your thumbs should be in the same exact position they were in when you were
performing the lateralization tests.
Are they level? Is the lateralized side inferior or superior relative to the non-lateralized
side?


Innominate Diagnosis Checklist
Supine
o Lateralization of Pelvis
 Standing/Seated Flexion Tests
 ASIS Compression Tests
o ASIS (superior/inferior)
o Inflare/Outflare
o Medial Malleoli (superior/inferior)
Prone
o PSIS (superior/inferior)

OMM, #29
Thursday, March 6, 11am
Turner Slicho, PDF
Deana Lanham for Michelle Campbell
Page 4 of 4
Innominate Rotation Diagnoses:
 These could all be applied to the left or right sides. For practical purposes one side has
been chosen to demonstrate the following diagnoses.
 You can also see that the pubic symphysis usually follows these diagnoses as well.
 Left Innominate Anterior
o Putting your findings all together: If you have these specific findings, then you
will be able to come up with the diagnosis of left innominate anterior.
 Left ASIS relatively inferior
 Left PSIS relatively superior
 Right Innominate Posterior
o Findings:
 Right ASIS relatively superior
 Right PSIS relatively inferior
 Right Unslipped
o Both are superior in relation to the non-lateralized side.
o The whole innominate on one side is slipping straight up.
o Findings:
 Right ASIS relatively superior
 Right PSIS relatively superior
PUBIC SYMPHYSIS
Pubic Symphysis Somatic Dysfunctions
 Pubic Symphysis Superior/Inferior Shear
o May follow innominate somatic dysfunction, or be a somatic dysfunction by
itself, which is rare.
o This is common in obstetrical patients due to the presence of relaxin. This is a
hormone that is released during labor. It relaxes all of the ligaments in the pelvis
and gives the pelvis more mobility.
 Pubic Symphysis Anterior/Posterior Shear
o Relatively rare, usually caused by trauma.
Diagnosis of the Pubic Symphysis
 To prepare:
o Pelvis must be lateralized
o Patient should be supine.
o Pelvis should be aligned. This is done the same way as before: raise the hips of
the patients off the table with their knees bent.
o MEMO for the MALES: Make sure everything is out of the way.
o Remember not to palpate too hard.
 First, screen the location of the pubes with the heel of your hand.
 Then localize the pubic tubercles with the index fingers.
 Diagnosis of Anterior/Posterior Pubes
o Is the lateralized side relatively anterior or posterior?
 Diagnosis of Superior/Inferior Pubes
o Allow your index fingers to travel slightly superior until they are sitting on the
superior aspect of the pubic rami.
o Is the lateralized side relatively superior or inferior?