Osteopathic Pelvis Treatment: Part 2

00:01 Muscle energy for pelvic somatic dysfunctions.

00:04 So first we have to make our diagnosis, we assess the pelvis with the standing flexion test or with the ASIS compression test to see if there's a restricted side.

00:15 We check our landmarks to the ASIS and with the PSIS to see if there's a rotation or a shear.

00:21 So for here, we're demonstrating muscle energy for anterior innonimate rotation.

00:26 So the innonimate is rotated anteriorly, we want to bring it into it's barrier and have the patient activate and push towards the freedom.

00:34 So I'm gonna monitor at the SI joint, I'm gonna slowly bring the leg up and bring it to its barrier.

00:41 I'm gonna have the patient gently push into my hand, 1-2-3 and relax.

00:46 Make sure you allow the patient to relax with 3 seconds before re-engaging the barrier, so I'm gonna kinda bring the hip more into its barrier and go ahead and push again, 1-2-3 and relax.

00:59 And then re-engage the barrier and go ahead and push one more time, 1-2-3 and relax.

01:05 And so after three times of pushing, we're gonna do a passive stretch and then bring the leg back and then recheck and re-assess to see if it's more symmetrical.

01:19 Muscle energy for posteriorly rotated innonimate.

01:22 So in a posteriorly rotated innonimate, what we're gonna do is we're gonna bring the leg off the table and extend the hip.

01:30 In extending the hip, we're gonna bring the innonimate more into a anterior position.

01:34 So we're gonna again gently bring the affected side down.

01:38 Here we're treating a left posteriorly rotated innonimate.

01:42 I'm gonna support the leg and hold above the knee and with my other hand I'm gonna hold the contralateral ASIS.

01:49 So this way, the patient will feel stable as they're bringing their knee up towards the ceiling.

01:53 So you can engage the barrier and then have the patient push to the freedoms, so go ahead and bring your knee up to the ceiling, 1-2-3 and relax.

02:02 After the patient relaxes for 3 seconds, you're gonna further bring the knee into extension, the hip more to extension into its barrier, go ahead and push up again, 1-2-3 and relax.

02:13 After relaxing for three seconds, re-engage the barrier and push up again, 1-2-3 and relax.

02:20 And then we do a passive stretch at the end, bring the leg back and then reassess the landmarks to make sure that the innonimate is more symmetric.

02:29 This technique could also be performed with the patient lying prone and then you would just bring the hip more into extension each time.

02:36 So that is how you could utilize muscle energy to treat a posteriorly rotated innonimate.

02:43 Muscle energy to treat a superior innonimate shear.

02:47 So when we have a superior innonimate shear, what we want to do is to try to bring that innonimate more inferiorly.

02:53 So here we're gonna treat a left superior innonimate shear.

02:57 We're gonna get good purchase on the ankle here, we're gonna internally rotate the hip.

03:02 And what internally rotating the hip does, it helps to close pack the head of the femur into the acetabalum.

03:09 So any sort of motion or movement I put will get directed right to the innonimate.

03:14 I'm gonna apply a little bit of inferior pull.

03:17 and I'm gonna instruct the patient to try to hike their hip up towards their head, 1-2-3 and relax.

03:23 I'm gonna re-engage the barrier by gently tugging on the leg and go ahead and pull up again, 1-2-3, relax.

03:30 re-engage the barrier by pulling inferior again and pull up towards your head, 1-2-3, relax.

03:35 At the end of three isometric contractions I'm gonna apply a little bit of a increased low bit of a tug here and then bring her back, and I wanna recheck to see if the innonimates are more symmetric after the technique.

03:51 Sacral iliac articulatory technique So SI joints are important areas to look at especially with patients that may have pelvic pain or sacroiliac dysfunction.

04:01 So what we're going to do is we're going to stabilize the sacrum and move the innonimates through the hip.

04:07 So when we take the hip here and if we bring the ankle out laterally, that's going to internally rotate the hip.

04:14 But that also takes the innonimate and causes it to gap posteriorly.

04:18 So we're going to hold on to the sacrum and create more internal rotation of the hip and then alternate with external rotation.

04:26 and as I go on external rotation, I'm stabilizing the sacrum with my palm.

04:29 So we move the SI joint and mobilize the ligaments a little bit more back and forth.

04:35 Remember the articulatory techniques, we engage the barrier repetitively until we get improved joint motion and so once you feel like there's improved motion here, you could bring the leg back and reassess the SI joint.

04:51 This technique could be done bilaterally to help improve any restrictions that might be present in the sacroiliac joints.

04:59 High velocity low amplitude thrusting for the innonimates.

05:04 So if we have a rotational dysfunction of the innonimate, what we're going to do is we're gonna provide a thrust though the barriers.

05:11 So if my innonimate is rotated posteriorly, we're gonna put a force to drive it more anterior.

05:17 If I have an innonimate that's rotated more anteriorly, we're gonna put a force to drive it more posteriorly.

05:22 So, we're going to set the patient up so we'd localize to the SI joints So I'm gonna flex the knees up to the SI joint and then we're gonna set the torso to rotate to the SI joints.

05:34 So the patient's gonna hold on to your shoulder here and relax the other shoulder back. Good.

05:39 And then so we rotated everything above the SI joint away and now we're going to set up to treat the SI joint.

05:49 So if we have anteriorly rotated innonimate, what we want to do is to support the top leg, straighten out the bottom leg and then we're gonna let this leg hang and by letting this leg hang, what happens is this allows the weight of the leg to help pull the innonimate more posterior.

06:09 We're gonna get our hand underneath the patient's elbow and stabilize the rotation of the upper body and then we put the meaty part of our forearm on the innonimate itself and then we're gonna to provide a thrust that drives following the leg to bring the innonimate more posterior.

06:27 So this is the treated anterior innonimate rotation we want the patient relaxed, take a breath in and breathe out And when they fully breathe out, we're going to provide a quick high velocity thrust down the leg this way.

06:40 If I had the opposite diagnosis, so if we had a posteriorly rotated innonimate, we're gonna set up the same way but this time I don't want the leg hanging off the table.

06:53 We want to try to bring the innonimate that's stuck posterior more anterior So i'm gonna put the meaty part of my forearm more closer by the PSIS and so we're gonna thrust more this way.

07:07 So i'm gonna have the patient take a breath in, breathe out, I'm gonna lock out and it's almost like I'm almost driving and trying to bring my wrist and forearm towards my own stomach.

07:17 breathe in again and breathe out, good.

07:21 And then once you lock out, you do a quick thrust that way.

07:24 And then afterwards, you could straighten out the legs, have the patient lie on their back and then reassess the innonimates to see if they're more symmetric and if your treatment was successful.

07:35 Sacraoiliac joint balance ligamentous tension And so what we wanna do with this technique is we wanna get our fingers between the innonimate and the sacrum to try to gap and soften the ligaments between the SI joints.

07:47 So what we wanna do first is to assess and see how restricted the SI joint is, you wanna sit on the side that you want to treat you want to get your hand between the innonimate and the sacrum So one of the things you could do is you kinda bend the patient's knee up, push the knee away from you and that opens up the region for you to find the PSIS you wanna come a little bit medial to the PSIS between the innonimate and the sacrum and you could place your other hand to support it, go ahead and bring your leg down so my fingers now are at the SI joint, I'm gonna push my elbows down towards the table that allows me to fulcrum and allows my fingers to lift up into the SI joint we're gonna wait for the soft tissue to soften up and then when I feel like I'm really in the SI joint, I wanna gently lean back, I wanna match the tension of the tissues here I don't wanna pull back too hard 'cause if I pull back too hard, things will actually feel like they tighten up so I just wanna reach a point of balance, allow the ligaments to relax and when I feel things soften up, my fingers sink in a little bit more.

08:48 I'm gonna come out and then I could recheck the SI joint to see if the technique was able to help loosen up the SI joint and decrease restrictions in the area.

08:58 Muscle energy for pubic shear dysfunctions So the pubic bones sometimes could undergo a lot of force especially with pregnancy and delivery so it's a good thing to try to check for somatic dysfunctions in that area and address it So we could treat that area with muscle energy technique.

09:15 So what we wanna do is first to assess the pubic region, we're gonna explain to the patient we're gonna place our palm on the pubic bone to diagnose any sort of somatic dysfunction or asymmetry.

09:24 So I'm gonna find the iliac crest, place my hand more midline and find the pubic bone and once I find the pubic bone, I'm gonna place my thumbs there and just see if there is any sort of asymmetry.

09:34 Now if there is asymmetry, we could perform muscle energy.

09:37 The muscle energy here is going to utilize the hip AB- and ADductors and how they attach to the pubic bone to bring it more symmetric.

09:46 So what I'm gonna do is have the patient bring their knees up and first I'm gonna ask the patient to bring their knees apart while I resist them with isometric contraction.

09:55 So patient's gonna push out, 1-2-3 and relax.

10:00 And after relaxing for 3 seconds, now we're gonna engage the hip ADductors So I wanna first start with my fist in between the knees and go ahead and push together, 1-2-3 and relax.

10:11 and after relaxing for three seconds, I'm gonna put two fists here and go ahead and push your knee together, 1-2-3 and relax.

10:18 So the goal is to gradually increase the distance between the knees now i'm putting my forearm in between and go ahead and push together, 1-2-3, relax.

10:27 And again, each time allowing the knees to kinda fall out a little bit more to engage the hip ADductors here, and so go ahead push your knee together, 1-2-3 and relax.

10:40 At the end, we're gonna do a little bit of a passive stretch and then bring the knees back together, bring the legs back down and then reassess the pubic tubercles to see if they're more symmetric after the technique was performed.