anterior sacral torsion, coccyx, ila, inspection, L on L, ortho, pelvis, physical therapy, posterior sacral torsion, prone, PSIS, R on L, sacral sulcus, sacral torsion, SI joint eval

Purpose

To evaluate the SI joint in prone. Also used to identify sacral torsion.

Technique

Patient is positioned in prone.

Clinician first palpates the PSISs and compares their position to each other and notes any differences from standing or sitting positions.

Clinician then palpates sacral sulcus and notes its depth.

To check for sacral torsion, the Clinician palpates the sacral sulcus and asks the patient to come up to prone on elbows. The Clinician expects the sacrum to nutate and to feel more depth in the sacral sulcus.

To confirm sacral torsion, the Clinician looks for cross findings at the inferior lateral angel (ILA).

Clinician first palpates the coccyx looking for symmetry.

Clinician then moves thumbs lateral, up, and in to find the ILA noting the depth.

Positive

Differences in depth.

Interpretation

Anterior Torsion (L on L axis): sacral sulcus- deep on R and shallow on L
ILA- shallow on L and deep on R

Posterior Torsion (R on L axis): sacral sulcus- shallow on R and deep on L
ILA- deep on L and shallow on R

References

1. Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York, NY: The McGraw-Hill Companies, Inc.

Related videos:

1. [Muscle Energy] Correct Counternutated Sacrum on the Right (R on L)
2. [Muscle Energy] Correct Nutated Sacrum on the Right (L on L)
3. SI Joint – Lifting Test
4. SI Joint – Trunk Flexion & Extension Test
5. Sacroiliac Evaluation (in sitting)