Sacral/Lumbar Assessment

Type 1 Dysfuntions of the sacrum and lumbar vertebrae.

Sacral Assessment

Type 1 Dysfunction: (20% effort)

  • ïInvolves a group motion restriction that is maintained by muscles spanning several spinal segments.
  • ïUsually can see imbalance with the naked eye.
  • ïInvolves the large, extrinsic muscle groups.
  • ïSide bending and rotation usually occur to opposite sides.

Type 2 Dysfunction:  (10% effort)

  • Restrictions between individual facet joints
  • Muscles span one or two segments or functional units (Functional Unit = vertebrae above and below, and the facet joint between them).
  • Always side bend and rotate to same side (except OA joint).
  • Closed facet joints become an axis to pivot on

Guidelines for Assessing Bony Landmarks

Accurate assessment will give you the information needed for effective treatment. Some practitioners struggle with trying to find bony landmarks, but some are easier to locate than others, so we usually have some solid ground to stand on while we attempt to improve our skills. Here are two specific tips to help you to cultivate palpatory sensitivity.

  1. Try keeping your eyes closed when feeling for landmarks. For many therapists, looking at what they’re trying to feel, adds confusing input.
  2. “THINK MEASUREMENT”. You’re locating bony landmarks, not palpating soft tissues.

Tips for the visual aspect of assessment:

  1. The angle from which landmarks are viewed is critical. For example, if you were looking at a standing client, with your thumbs on his transverse processes, could you better see a rotation by standing back and trying to see which of your thumbs was farther away, or by standing up close and looking down, parallel to the axis of the spine?
  2. Make sure when you are palpating with you’re thumbs or fingers, that they are positioned parallel to each other.
  3. Don’t get distracted by clothing (i.e. if you’re client’s pants are pulled up higher on one side, it makes the other side look lower).
  4. Use the best light available and try to keep the area you’re evaluating free from shadows.
  5. Purely visual assessment, such as Type 1 curves in a standing position can be especially challenging. Try palpating the curves by tracing over the spinous processes (both seeing and feeling).

Sacral Dysfunctions:

  1. Rotation - palpate for a deep sacral sulcus.
  • side to side comparison of depth determines the direction of rotation
  • halfway between the PSIS and the spinous processes you'll find dish-shaped grooves that the tips of your index fingers should fit right into.
  • being symmetrically positioned on the base of the sacrum is the most important thing.
  • press into the sacrum at exactly the same time with both fingers.
  • decide which of your fingers is more anterior and that is the deep sulcus.
  • a deep left sulcus indicates that the sacrum is rotated posteriorly to the right.

2. Side bend - palpate for inferior lateral angle (ILA) of sacrum

  • palpate the tip of the coccyx and move slightly laterally with both thumbs, then superiorly until you feel the bottom of the sacrum on both sides.
  • palpate both ILA's with your thumbs to determine which one is inferior.
  • the inferior side will also be slightly posterior.
  • an inferior sacrum indicates a side bend