OMM #27
Tuesday, 03/04/03, 9am
Dr. Dickey, D.O.
Matthew Blackburn
Proscribe: Kevin Stancoven
Page 1 of 3
Being checked
Sacral Motion Testing
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Introduction
o This is a continuation of the 1st hour in the PTR this morning
o We will be performing motion testing of the sacrum during this hour
 When we get back from spring break, we will get a sheet,
Comprehensive Data Collection Sheet, that we will be able to
record all of our diagnostic findings on:
 Motion testing
 Lateralizing tests
 Compression test
 Landmarks
 Don’t diagnose until you have recorded all of the above
information from your findings
 Pelvis is made of three bones that move independently of
each other, so we can get multiple diagnoses
o Remember to dress appropriately, no denim
o During the pelvic portion of OMM, we may get a “little too close” with
our partners in some of the landmarks and testing
 We just have to get used to it
o The written test on Thursday will include lumbar and pelvis/sacrum
 All lectures through this one (hour #27), including the lumbar roll
which is tomorrow
Sacrum
o Sacrums can be of many different sizes and shapes
 Large & wide to short & squatty
 The degree of curvature of the sacrum is variable between people
 Some of the landmarks of the sacrum will be harder to find
on people with more curve to their sacrum
Sacroiliac Joint
o There are bevel changes in the sacroiliac (SI) joint between the upper &
lower poles
 Lower pole has about twice the surface area of the upper pole
 Because upper pole has less surface area, you get more motion at
the upper pole, compared to lower pole
 Ligaments between sacrum & pelvic bones also limit lower pole
mobility
o Bevels divide 1 joint – the SI joint – into two joints
 Upper pole of sacroiliac joint
 Lower pole of sacroiliac joint
o SI joint is divergent anterior & convergent posterior
 Wider anterior & narrower posterior
OMM #27
Tuesday, 03/04/03, 9am
Dr. Dickey, D.O.
Matthew Blackburn
Proscribe: Kevin Stancoven
Page 2 of 3
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Testing SI motion
o Doctor stands on the side of the patient opposite to the side testing for
motion
 Dr. stands on patients left, Dr. will reach over & test patient’s right
SI joint for motion
o Artifact – increased drag on 1 side of pelvis when patient gets on table
 Relieved when patient supine by having patient lift his buttocks of
the table with his/her legs to equalize pelvis
 Relieved when patient prone by bending patient’s knees and hips
to bring the ankles as close to the buttocks as you can
 This causes tension in the quadratus femoris, which pulls
pelvis level & eliminates any artifact so you can trust your
test findings
o SI sulcus appears deep on skeleton, but in live body, the sulcus is filled
with ligaments and fat
o Bevel changes usually occur at S2, but are variable
 On the same patient, the bevel may be at the top of S2 on the right,
but towards the bottom of S2 on the left
o There is little surface area above the axis of motion to place thumbs
 When testing upper pole motion – thumb pads will have to be
placed just above the axis
o There is more surface area below the axis of motion to place thumbs when
testing lower pole motion
 There is an area towards the apex of the sacrum that feels flat, this
is a handy place to place our thumbs to test lower pole motion
 Since there is less motion at the lower pole, more force must be
generated with our thumbs in order to move the sacrum
 By moving our thumbs toward the apex of the sacrum
(around the flat area), it will easier to introduce motion in
the lower pole
 Just remember to stay above the sacral-coccygeal junction
o To test: patient should be in the prone position
 Place 1 thumb just above S2 to contact upper pole
 Place other thumb on lower pole
 Lock elbows and lean into sacrum to test motion
 Don’t use arm muscles to push thumbs in
 Use your body weight to lean to generate the same force
each time
 When testing upper pole motion, aim your thumb’s force towards
the patient’s greater trochanter of the femur
 When testing lower pole motion, aim your thumb’s force towards
the patient’s ASIS
OMM #27
Tuesday, 03/04/03, 9am
Dr. Dickey, D.O.
Matthew Blackburn
Proscribe: Kevin Stancoven
Page 3 of 3
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Normal motion will allow you to push in with your thumbs until
you reach normal end feel – ligaments stretched as far as they will
go
 Normal range of motion limited by ligaments
 Sacrum motion is limited, and motion will be slight
 After you push until there is no more motion, when you
should be able to feel a “springing” (like a rubber band)
because the ligaments want to bring the sacrum back to
where it started
o To record findings:
 Good motion with springing: +
 Little motion with no springing: +/ No motion at all: o When comparing motion, don’t compare upper pole to lower pole
 Compare upper to upper & lower to lower
o This testing is easier if you put the table at a level that is comfortable to
lock your elbows
Example:
o Patient prone
o To find sacrum:
 Find PSIS, move fingers medial & cephalad to find sacrum
 Or, find the iliac crests, go over to L4, and move fingers down until
you contact sacrum
o Test for motion: feel for sacrum movement & feel for ligament
rebounding – these results are from the volunteer Dr. Dickey performed
this motion test on
 Upper right - movement with no rebounding: +/ Lower right - movement with rebounding: +
 Upper left - no movement:  Lower left - movement with rebounding: +
Correctly diagnosing the sacral movement takes practice, so we practiced for the
rest of the class
o Dr. Dickey said we would be doing this motion testing a lot more for the
next few weeks
During our practicing time, Dr. Dickey stated that this type of motion testing can
also be called articulatory treatment
o Articulatory treatment may cause an increase in the motion of the sacrum
 The 1st doctor who tested a patient may find a +/- result
 The next doctor may find a + result because of articulatory
treatment
o Motion will not get worse though
 Won’t go from + to +/ Or +/- to -