Outline of Pelvic Workshop
A. Postural Assessment – PDF’s online
B. Anatomy (handout)
C. Purpose & Flow of Treatment – Unimpeded flow of blood, lymph, nerve and joint motion, along with
organ motility…
-- General-Specific-General; Peripheral-Central-Peripheral; Superficial-Deep-Superficial.
Get very specific consent!
PRONE:
Checking Landmarks Prone
When the client is prone, check the following: levels of: plantar surface of heels; ischial tuberosities; ILA’s
of sacrum; PSISs (and height from table); lumbar vertebrae; (lateral curves in spine); tissue bulk of erector
spinae; and scapula orientation.
(May use blocks to level hips. Place block/towel roll under anteriorly rotated hip’s ASIS. You may add a
block under the posteriorly rotated hip’s greater trochanter.)
Treating the Lumbar Spine:

Lumbar oscillations = stand facing client’s low-back. Have one hand on their hip, providing a sideto-side rocking motion – other hand’s finger-tips (same side) or finger-pads (on far side) up
against the spinous process; palpate the motion passing through the vertebral segments. Were
motion is restricted or when several segments move as a block, then gently resist the motion
passing through one SP (with finger-tip on same side; or finger-pad on opposite side of SP) – Bring
wave like rhythm up that point, allowing it to open up the restrictions. (focus on T9 down to L5)

Use indirect corrections to any rotated segments:
1) Place thumb-pads over TVP’s. Determine which is superficial & which is deep.
2) Very slowly apply light pressure over the deeper TVP, stopping
once you feel its resistance (“balanced tension”). Hold till a
softening is felt and it feels like that TVP is sinking deeper.
3) Now, ask the client to take a deep breath in, hold for a count
of three, and then out “like a sigh” – when the client is holding
the in-breath for a second or two, slide the ‘deeper thumb’ so that
the tip just touches/presses up against the SP and be ready to
apply light pressure downwards with the thumb that is over the
superficial TVP.
Treating the Pelvis with Motion.
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4) When the client breathes out press gently down on the superficial TVP and gently press against
the SP (rotating the segment towards leveling the depth of TVP’s).
5) Continue to hold this levelling pressure and ask the client breath in deeply again (holding,
holding…) and during the relaxing out-breath slowly lessen pressure, till just a light palpation. Reassess.
Beginning hip rotations - -

Lift ankle and begin to laterally and medially rotate the hip joint with a slight flexing and extending
of the knee, (the ankle traces out a circle) – this action alone begins inhibiting/relaxing the
musculature (including the low-back muscles, gluteals, rotators, hamstrings, quads, and muscles
of the lower leg) and all the joints down from the spine to the toes. Circulation, including lymph is
assisted.
 Hip joint – rotators, gluteals, [TFL/ITB]
o Treat specific gluteals & TFL – via slow gentle compressions
along an arc running 1 or 2 inches below iliac crest – fully
externally rotate hip (foot moving over the contralateral leg)and
begin with TFL (if available) or gluteus minimus (superior &
slightly anterior to trochanter) – compress, rotate hip a few
degrees back and forth several times – holding muscle, (you can
modulate compressive pressure if you wish); shift finger-pads
along arc over more of the gluteus medius… maximus… As you
move closer and closer to the PSIS, increase internal & external rotation of the hip
o Treat pelvic wall muscles - piriformis, obturator internus
(through gemelli and quadratus) Continue moving along arc,
tracing it just lateral to the edge of the sacrum (i.e., into the
musculature) – As you continue along the hip rotators have
the hip slowly swinging the full, easy, available range of
internal & external hip rotations, shortening and lengthening
each muscle and its connective tissue at each contact point
o You can take a few moments and compress
hamstrings…gastrocs…lateral compartment…’swival ankle’
Treating the Pelvis with Motion.
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o Sacrotuberous ligament – Use thumb of tx-hand to locate ischial tuberosity &
Sacrotuberous lig. First, compressions over the Sacrotuberous lig from tuberosity up to ILA
of sacrum, press down towards table. Second, repeat (from tuberosity to sacrum) but
press over the lateral side of the ligament, towards the mid-line (at about 45⁰) –
coordinate with leg-rotations = begin compression when foot is over the other leg and hold
pressure as you swing foot out (internal rotation of hip) and swing back. Move up along
the lateral edge, bit by bit.

Sacroiliac joint -Gapping, oscillating sacrum on ilia: Return hip rotation to a neutral point.
……….
Landmak the
Sacrum’s ILA’s
if necessary.
Place two or three fingers over the Sacroiliac joint line. As you gently internally rotate the
hip feel for the gapping of this joint. Fine tune the gap – avoid going farther than the
initial, gentle gapping. When gap is opened: 1) Pause hip rotations momentarily and have client take several long slow deep breathes.
2) Slide tx-fingers medially up against central crest. Apply gentle lateral pressure away
from you (away from the gapped joint). Oscillate leg two or three times while sustaining
this light pressure.
3) Return to position of gapping the S.I. jt.; again pause here. Lay the leg down internally
rotated (toes pointed in) and walk around the table to the other side. (You may or may
not reach across and lift the lever-leg… to ensure gapping…)
4) Place the heel of your hand across sacrum’s ILA and gently push inferiorly and superiorly
(again, on a 45⁰ angle towards the lumbar spine) – ASK ABOUT PAIN OR RELEIF - If px-free
then Rock the sacrum gently.
5) IF there is restricted motion on the right S.I. jt. (and you are now standing on their left
side) roll the heel of your hand till your pressure is mostly on the Left ILA, and intend
motion (still at the 45⁰ down into the table) slightly towards that side.
Pelvic Floor Release Treating the levator ani (= levator prostratae/vaginae, puborectalis, pubococcygeus,
iliococcygeus), and coccygeus muscles.
Treating the Pelvis with Motion.
1. To contact the pelvic diaphragm with your thumb: Follow the
natural curve of the medial surface of the ischial tuberosity & move
up onto the medial side of the sacrotuberous ligament. The applied
force should be in a superior and lateral direction. Press lightly at
first, adding pressure till the pressure is quite firm. If painful/tender,
decrease pressure a little, and hold till release, then resume
progress.
2. Be sure to treat both layers.
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Now that you are on the other side, repeat the process from lumbars down.
Sidelying: Here we are going to address specific structures/muscles, often much of what we might
have already treated, but now from a different angle, with a different access, and therefore in a
new way. Stand facing the client.
Pillow the client’s head. Have them lay with knees bent, (and with a pillow between the knees
if necessary)
 Treat transverse, internal & external obliques abdominals
Contact the internal and external obliques half-way between the
iliac crest and the 12th rib. Push down (medially) and a little
inferiorly (down towards the contralateral hip joint). Wait for
release.
This release is crucial for reducing the stiffness of the
abdominal cavity, softening apprehensive musculature, all of
which improves the motion/coordination between the thoracic and pelvic diaphragms.
Treating restricted ribs specifically.
Use a light springing motion

More Treatments in Side-lying:
Compressions over TFL, gluteus medius and minimus.
ITB
PIR stretching of Hip Adductors… Rectus Femoris…
Psoas(Therapist Seated) – rhythmic oscillations to spine…

Treating Lumbars, Sacroiliac Joint, abdominal muscles involved in rotation, rotating the
pelvis, and the piriformis (etc.) specifically (“Side Roll”)
-- Have the client place their upper arm behind their back and tell them to let their upper
body roll backwards.
-- Have them bring the upper leg forward (off the other leg) and ask them to let you take
hold of this leg (from just above medial knee and under lower leg), asking the client to let
you have the weight of it/relax…
-- Tell them to straighten the lower leg…
-- Gently assist the client to roll their (upper) shoulder further backwards till you feel that
the leg you are holding is beginning to hold itself there. Have client reach back and grasp
the edge of the table behind them (if possible).
-- Swing their upper (straight) leg forward into about 45⁰ of hip flexion. Stabilize their hip
(at ASIS). Slowly lower the leg till it almost reaches the tabletop.
-- Ask the client to gently lift their leg (with only a few pounds of pressure – and instruct
them that as they try to lift the leg that they should also be turning the toes towards the
Treating the Pelvis with Motion.
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ceiling) After a count of three have them relax -- while still stabilizing their hip –lower the
leg. If/when the knee comes in contact with the table flex the hip more (lift it a few inches
as you do so and try to roll their pelvis back a little more)… repeat several times…
Supine:

Level Pelvis/innominate rotations. [correct via "Scissors"-MET]
Assess hip rotation and leg length discrepancy: Straighten the client on the table. Check
ASIS’s and medial malleoli’s – compare findings (see PDF).
If one leg is long/short due to unilateral hip rotation then perform the following:
Lift the Long leg about 8 to 10” off the table. Cup the heel with one hand. Stabilize over
the other leg’s ankle, holding it firmly on the table. Instruct the client: “In a few moments I
will want you to take a long slow breath in, slow enough so that I can count to 5. As you
are breathing in I will want you to try and bring your ankles towards each other – imagine
your legs are like a pair of scissors and that you are trying to close them. (So, you are trying
to bring the leg I am holding up down to the table, and trying to lift the leg I am holding
down on the table.) I will not let your legs move. After I count to 5 I will tell you to relax.
We will wait a moment and then repeat this 3 or 4 times. Let me know if there is any pain.”

Tx = respiratory diaphragm Abdominal Pump:
First Version: Using the heel of your dominant hand,
scoop up the viscera, starting from just above the
umbilicus. Be careful not to traumatize the aorta (I.e., do
not do if you feel a strong pulse under your hand!) .
Compress the viscera in a superior direction toward the
chest, causing the upper portion of the respiratory
diaphragm to move superiorly and assume a nice dome
shape. Maintain firm, balanced pressure until the
respiratory diaphragm relaxes. This procedure also
moves any lymphatic fluid trapped below the diaphragm
in the cisterna chyli up across the diaphragm and into the thoracic duct. Also assists in
venuous blood return up into the vena cava… Further, freeing the diaphragm normalizes
organ motility and the autonomic nervous system.
Second version: Start with one hand on abdomen supra-pubic – Pressure is over mid-line.
As you press inferior side of hand, then palm, and then superior edge of hand (a rolling
motion) add a side to side oscillation. Now move hand up abdomen and repeat till that
hand reaches xiphoid. In tandem: With the other hand touch the lower thoracic aperture
and tell the client to breathe into that area; then as lower hand moves up touch mid
sternum and tell client to breathe into that area, and finally touch the S.C. jt. areas and tell
the client to breathe into there (lifting superior ribs). [This working of pressure and area of
breathing into helps the lymph to move up through cistern chilia up into upper thoracic
duct.]

Can try rib springing via the sternum….
Treating the Pelvis with Motion.
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
Symphysis Pubis correction: balancing adductors & abductors, and assisting in realigning S.I. jts.
Part 1 of Pubic Symphysis Correction:
Client tries to bring knees together, starting with
minimal effort, building to full effort. This test stresses
the adductor muscles that attach to the pubic rami,
and will stress the joint by gapping it. If the joint is
severely misaligned or impaired, this can generate
pain if the client exerts too great an effort too quickly.
Part 2 of Pubic Symphysis Correction:
Therapist holds client’s knees together as client tries
to draw knees apart. Client should start with minimal
effort, slowly building to full effort. Hold this effort for
a count of five. This action stresses the symphysis
pubis by compressing it. Further, this action also gaps
the posterior S.I. joints and can restore the proper
orientation of the sacrum to the ilia within the
sacroiliac joints.

Further innominate rotation corrections – Flex hip and knee. You can tuck the knee into
the front of your shoulder, or you can hold it with your hand (sometimes, with the hand on
posterior thigh just below the knee/popliteal fossa). Begin circumducting the hip within
the limit of easy motion! Bring hip into flexion, swing/circling out into abduction and down
into less hip flexion. Circumduct several times, slowly, feeling the circle of ease widening. If
on circumducting you feel a restricted arc,
then slow down, go just past the restriction
(into free motion) and then reverse motion,
slowly swinging backwards along the arc of
restricted motion you just traversed; again,
just back into the free motion. Swing back
and forth this arc till more ease develops.
You can address the rectus femoris insertion point on the AIIS by placing thumb pressure
over it as you continue circumductions… TFL… Glute Minimus…

Pelvic wall Tx cont. = Iliopsoas release
Classic SCS/Positional Release: Have client’s knees bent…palpate psoas through
abdomen… Can have client flex hip slightly to identify … Sustain “tender pressure” as you
bring the hip into full flexion, adding some adduction…(hip up towards other shoulder)…
wait for release.
Treating the Pelvis with Motion.
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Straight Leg Psoas Release: (as above till -) after palpating psoas, while holding “tender
pressure” straighten leg, with some small abduction & external rotation: Do PIR – have
client hold leg suspended, count of 5, then support again. Do 3 times, re-evaluate psoas.

Inguinal Ligament release: Palpate along
lateral third of inguinal ligament. Press
gently down over the ligament. Wait for
release. May repeat once each in a
posterior-superior and /or posteriorinferior direction.

Indirect Inguinal Ligament release: Sit side-ways (facing the head of the table) beside
client at the level of their hip. Locate the ASIS. Hook the ASIS with either the ulnar border
of your hand or with the inside edge of your wrist. Pull gently laterally (& slightly superiorly
if innominate anteriorly rotated), finding the balancing tension. Hold till release, moving
with tissue, (… if necessary: Hold and wait for another release…)
Repeat all on the other side…
Mid-line Treatments – Ligamentous Articular Strain
Linea Alba : Above Umbilicus – Below Umbilicus
Treating the Pelvis with Motion.
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Umbilicus: Median ligament of the Pelvis
Pre-sacral Fascia Release:
Alternative: Sitting at clients side, place finger pads on far side of opposite ASIS, lower forearm till
it contacts other ASIS. Stabilize nearest ASIS with forearm’s soft tissue, and gently pull the opposite
ASIS towards you with your finger-pads.
Treating the Pelvis with Motion.
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