Diagnosis of the Sacrum (SeFT)

00:01 We're going to do a look, feel, and move evaluation of the sacrum.

00:05 We're going to evaluate the sacrum to see if he has a problem, or to see if the problem is referred from somewhere else.

00:11 It's common to have the pelvis and the sacrum, both have problems, but it's always important to know which one is primary and which one may be the only problem.

00:19 So, there are three tests I do to make sure I know what's going on.

00:23 Number one is a screening test for sacral pathology and that is the seated flexion test.

00:28 If you do a standing flexion test, that's going to tell you what's going on with the pelvis.

00:33 If you do a seated flexion test, you're taking the pelvis out of it by putting the pubic symphysis on a table and restricting motion.

00:40 So now, we're going to get the sacrum.

00:42 What I'm going to do is I'm going to get eye level with the sacrum, put my finger on the PSIS, and I'm going to ask him to keep his knees shoulder length apart and then bend forward with your arms going between your legs.

00:59 Back up, and let's try this one more time, and bend over.

01:05 The one that moves first and furthest is the one that needs help.

01:09 You can sit up and let me have you lie on your stomach now.

01:12 The one that moves is the one that has the pathology and you have to focus on.

01:17 So, number one is seated flexion test.

01:20 Number two is we're going to do the spring test.

01:23 The spring test is going to tell us what's going on between the sacrum and the lumbar spine.

01:29 When I do the spring test, I usually like to check all four poles as well.

01:32 So, I check the motion of the sacrum and see how much spring, I think that's why they call it the spring test, and which pole is going to have motion, and which pole does not have motion.

01:46 If it's stuck and there's no motion, that needs further evaluation and should be taken care of.

01:53 So, to get to the deep sulcus, I'm now going to go to the PSIS, go interior, and push down to see how deep the sulcus is.

02:03 We know about the motion now and we're also evaluating the depth, the symmetry, and where the exam may point us.

02:11 The last test is called the Sphinx test.

02:14 To do the Sphinx test, you need to check the ILA, the inferior lateral angle of the sacrum.

02:20 So, you come down the sacrum, find the inferior lateral angle.

02:23 I like to keep my fingers on the deep sulcus as well.

02:27 And then I have the patient sit up on your elbows.

02:31 Perfect.

02:33 If the sacrum moves anteriorly, that's good.

02:36 If the sacrum doesn't move, that's a positive Sphinx test that shows pathology in the sacrum.

02:42 Let me have you down again.

02:44 You can have him go on his elbows.

02:47 Let me do it on the elbows one more time.

02:49 Then on your arms, go all the way up.

02:52 Perfect.

02:52 You can accentuate it which will give you more information.

02:55 And back down.

02:56 So again, the three tests you need to get information on the sacrum: Number one is the seated flexion test; number two, an evaluation of the deep sulcus which can be done with a spring test and done independently just looking at the deep sulcus; and checking out the inferior lateral angle with the Sphinx test.

03:13 That's how you evaluate the sacrum.