AAJ. See Atlantoaxial joint (AAJ)
Abbreviations, 10
Abdominal crunch in transverse plane, 49
Acetabular labrum, 164. See also Hip joint
Active straight leg raise (ASLR), 10, 203
Adductors, 132. See also Muscle energy technique (MET)
assessment of, 133
hip abduction test, 133
MET treatment of, 133–134
AHC. See Anterior horn cell (AHC)
AIIS. See Anterior inferior iliac spine (AIIS)
Anterior horn cell (AHC), 10, 119
Anterior inferior iliac spine (AIIS), 10, 13
Anterior innominate motion, 23
Anterior oblique sling, 47, 48
Anterior rotation, 58
Anterior superior iliac spine (ASIS), 10, 13, 200
ASIS. See Anterior superior iliac spine (ASIS)
ASLR. See Active straight leg raise (ASLR)
Atlantoaxial joint (AAJ), 10, 104
Back pain, 34
Backward bending, 26. See also Pelvis assessment
test, 207–208
Basic reflex arc, 120
Bend
to extend with rotation, 51, 56
to extend with rotation on unstable base, 65
high to low, 66
low to high, 67
Bulging discs. See Herniated discs
Center of gravity (COG), 10, 39
Cervical spine, 104
Coccyx, 15. See also Innominate bone
COG. See Center of gravity (COG)
Combined push–pull, 60
on one leg, 61
Combined sacroiliac and iliosacral motion, 25
backward bending, 25
forward bending, 25
unilateral motion of sacrum, 26
Compression test, 197
Computerized tomography (CT), 10, 98
Core
ball squat, 54
muscle relationships, 45–49, 71–72
Counter-nutation, 23
Coupled spinal motions, 98. See also Spinal mechanics
CT. See Computerized tomography (CT)
Deep longitudinal sling (DLS), 10, 75
Degenerative disc disease (DDD), 10, 190–191. See also Intervertebral discs
Dermatome pathways, 189
Dimples of venus, 218
Distraction test, 198
DLS. See Deep longitudinal sling (DLS)
Dysfunction testing tables, 269
hip extension firing pattern, 269
iliosacral dysfunctions, 272
initial observation, 269
palpatory assessment, 271
pelvic dysfunction evaluation, 270
sacral dysfunctions, 273–274
symphysis pubis dysfunctions, 274
Electromyography (EMG), 43
EMG. See Electromyography (EMG)
ERS (extension, rotation, side bending), 10
ERS dysfunction, 107. See also Laws of spinal mechanics
ERS(R), 109–111
extension position, 108
flexion position, 108
neutral position, 107
Exercise
for outer core muscles, 49
variations, 60
FABER (flexion, abduction, external rotation), 10
Facet joints syndrome, 190. See also Lumbar spine
FADIR test. See FAIR—test
FAIR (flexion, adduction, internal rotation), 10
test, 160
Femoroacetabular impingement (FAI), 10, 165–166. See also Hip joint
Flexing towards left, 28
ligaments, 36
Force couple, 37–38
Fortin finger test, 194–195
Forward
bending, 25
head posture, 40
FRS (flexion, rotation, side bending), 10
FRS dysfunction, 111. See also Laws of spinal mechanics
FRS(L), 111–113
FRS(R), 114–115
Fryette’s laws, 99, 102. See also Spinal mechanics
Functional LLD, 84
Functional scoliosis compensation, 88
Gaenslen test, 198
Gait cycle and pelvis, 79
gait cycle, 74
heel-strike, 74
ilium roation, 76
myofascial link, 75–77
pelvis and SIJ motion, 77–79
posterior oblique sling while running, 77
sacral rotation and lumbar counter-rotation, 77, 78
Gillet test. See Stork test
Gluteal muscles, 168
Gluteus maximus (Gmax), 10, 35, 176. See also Gluteus medius (Gmed)
assessment of, 178
case study, 182–183
gait cycle, 181–182
hip extension firing pattern test, 179–181
holistic approach, 183
normal muscle activation sequence, 178
posterior oblique sling, 177
prognosis, 184
thoracolumbar fascia, 182
treatment, 184
Gluteus medius (Gmed), 10, 169. See also Gluteus maximus (Gmax)
anterior fibers strength test, 173
assessment of, 170–172
case study, 175
function of, 170
hip abduction firing pattern test, 172–173
posterior fibers strength test, 174
Gluteus minimus (Gmin), 10
Gmax. See Gluteus maximus (Gmax)
Gmin. See Gluteus minimus (Gmin)
Golgi tendon organ (GTO), 10, 119
Group neutral dysfunction, rotation left (NR(L)), 116. See also Laws of spinal mechanics
Group neutral dysfunction, rotation right (NR(R)), 116. See also Laws of spinal mechanics
GTO. See Golgi tendon organ (GTO)
Hamstrings, 135. See also Muscle energy technique (MET)
assessment of, 136
assessment of lateral, 139
assessment of medial, 138
hip flexion test, 136
MET treatment of, 136–139
Heel-strike, 74
Herniated discs, 188. See also Intervertebral discs
High-velocity thrust (HVT), 10
Hip abduction
firing pattern test, 166
test, 133
Hip extension. See also Pelvis assessment
firing pattern test, 179
test, 213
Hip flexion test, 136
Hip joint, 154
acetabular labral tear, 164
anatomy, 154
case study, 165
FABER test, 160
FAIR test, 160
femoroacetabular impingement, 165–166
passive ROM for external rotation, 157
passive ROM for flexion, 158
passive ROM for internal rotation, 158
pathological end feel, 156
pathology, 163
pelvic, hip, and lumbar motion guidelines, 155
quadrant test, 159
screening, 156
HVT. See High-velocity thrust (HVT)
Hydraulic amplifier, 46
Idiopathic LLD, 85
ILA. See Inferior lateral angle (ILA)
Iliac crest, 13
Iliopsoas, 125. See also Muscle energy technique (MET)
assessment of, 126
MET treatment of, 127–128
modified Thomas test, 126
Iliosacral dysfunction, 206, 229–230. See also Pelvic girdle dysfunctions; Pelvis assessment
anteriorly/posteriorly rotated innominate, 230–232
innominate out-flare/in-flare, 234–235
left anteriorly rotated innominate, 248–249
left iliosacral in-flare, 254
left posteriorly rotated innominate, 250
left superior shear, 253
right anteriorly rotated innominate, 247–250
right iliosacral out-flare, 253
right posteriorly rotated innominate, 251
right superior shear, 252
superior/inferior shear, 232–234
treatment protocol for, 247
Iliotibial band (ITB), 10, 77, 124, 140. See also Muscle energy technique (MET)
assessment of, 141
MET treatment of, 142–143
Ober’s test, 141–142
Inferior lateral angle (ILA), 10, 27, 216
Inferior transverse sacral axis, 27
Innominate bone, 12, 13. See also Pelvic girdle
coccyx, 15
ilium, 13
ischium, 14
pubis, 14
sacrum, 14–15
Intervertebral discs, 188. See also Lumbar spine
degenerative disc disease, 190–191
disc herniation, 188
intervertebral foramen, 188
Intervertebral foramen, 188. See also Intervertebral discs
Ischium, 14. See also Innominate bone
Lateral sling, 47
and anterior oblique sling, 57
and posterior oblique sling, 58
Laws of spinal mechanics, 98
cervical spine, 104
ERS dysfunction, 107–111
FRS dysfunction, 111–115
lumbar spine, 104
NR(L), 116
NR(R), 116
spinal engine theory, 100–101
spinal mechanics, 98–99, 102–103
thoracic spine, 104
vertebra position, 104–106
viewing perspective, 103
Left oblique sacral axis, 27
Left-on-left (L-on-L), 10
Left-on-right (L-on-R), 10, 30
sacral torsion, 30
Leg length discrepancy (LLD), 10, 82. See also Standing balance test
ASIS, 82
assessment, 85
external rotation with STJ pronation, 91
external rotation with STJ supination, 92
foot and ankle position, 86
foot in over-pronation, 90
functional LLD, 84
functional scoliosis compensation, 88
and gait cycle, 89
and gluteal muscles, 93
idiopathic LLD, 85
internal rotation with STJ pronation, 92
left leg compensations, 93
left long-leg syndrome vs. right short-leg syndrome, 85
LLD compensations, 89–90
over-pronation syndrome, 90–93
and pelvis, 86–87
positions of medial malleoli, 83, 84
structural LLD, 84
supine to long sitting test, 83
and trunk and head, 88
types of, 84
Leg length measurement, 82
from ASIS to umbilicus, 83
by palpation, 82
sacral motion, 28
sacral torsion, 28
from umbilicus to medial malleolus, 83
L-on-L. See Left-on-left (L-on-L)
L-on-R. See Left-on-right (L-on-R)
Lumbar flexion test, 221. See also Pelvis assessment
Lumbar side bending test, 214. See also Pelvis assessment
anatomy, 187
as cause of pelvis dysfunctions, 191–192
dysfunction treatment protocol, 263–267
facet joints, 190
intervertebral discs, 188–189
Magnetic resonance imaging (MRI), 10, 98
Mens active straight leg raise test, 203–205. See also Pelvis assessment
MET. See Muscle energy technique (MET)
Middle transverse sacral axis (MTA), 10, 27
Modified Thomas test, 126, 130, 162
Movement-based exercise, 49, 71–72
anterior rotation, 58
bend high to low, 66
bend low to high, 67
bend to extend with rotation, 51, 56
bend to extend with rotation on unstable base, 65
combined push–pull, 60
combined push–pull on one leg, 61
core ball squat, 54
exercise variations, 60
lateral sling and anterior oblique sling, 57
lateral sling and posterior oblique sling, 58
oblique sling—anterior rotation on one leg, 69
oblique sling—anterior rotation on unstable base, 68
posterior rotation, 59
primary movement pattern, 51
progressive exercise, 50
pull on unstable base, 64
push on unstable base, 63
push with lunge, 62
repetition, 50
rotation while kneeling, 70
set, 50
single arm bend low to high, 67
MRI. See Magnetic resonance imaging (MRI)
MTA. See Middle transverse sacral axis (MTA)
Multifidus, 46
Muscle activity before and after stretching, 43
Muscle dysfunction factors, 48–49
Muscle energy technique (MET), 10, 44, 118
acute and chronic conditions, 122
adductors, 132–134
basic reflex arc, 120
benefits of, 118
hamstrings, 135–139
iliopsoas, 125–128
iliotibial band, 140–143
increasing joint mobility, 119
method of application, 122
muscle preparation for stretching, 119
muscle strengthening, 119
and pelvis muscles, 124
physiological effects of, 119–120
PIR example, 122–123
piriformis, 144–148
PIR vs. RI, 122
point of bind, 122
procedure, 121
quadratus lumborum, 149–151
rectus femoris, 129–131
RI example, 124
tensor fasciae latae, 140–143
tone restoration, 118–119
Muscle imbalance effects, 44
Musculoskeletal deterioration, 44
Neutral mechanics, 102–103. See also Spinal mechanics
Non-neutral mechanics, 103
NR (neutral, rotation), 10
Nutation, 22–23
OAJ. See Occipitoatlantal joint (OAJ)
Ober’s test, 141–142
Oblique sling—anterior rotation
on one leg, 69
on unstable base, 68
Occipitoatlantal joint (OAJ), 10, 88, 104
Osteo-articular-ligamentous system, 35
Osteophytes, 189
Outer core stabilization exercise sheet, 275–278
Over-pronation syndrome, 90–93
Pain
source, 39
Palpatory assessment, 216. See also Pelvis assessment
Patrick’s test. See FABER—test
Pelvic force couple, 37
Pelvic girdle, 12. See also Sacroiliac joints (SIJs or SI joint)
iliofemoral joint, 12
iliosacral motion, 23–24
motion types, 22
nutation, 22–23
sacroiliac motion, 22
symphysis pubis motion, 24–25
Pelvic girdle dysfunctions, 229. See also Pelvis assessment
iliosacral dysfunction, 229–235
sacroiliac dysfunction, 235–238
symphysis pubis dysfunction, 238–240
Pelvic girdle pain (PGP), 10, 203
Pelvic rotation test, 215–216. See also Pelvis assessment
Pelvis. See also Sacral axis; Sacroiliac motion
motion, 22
stability, 37
Pelvis assessment, 200. See also Pelvic girdle dysfunctions
anterior/forward fixed sacral dysfunction, 221
anterior view, 202–203
ASIS, 225
backward bending test, 207–208
false-positive result, 207
gluteal fold and ischial tuberosity, 216
greater trochanter, 224
hip extension test, 213
ILA of sacrum, 217
lumbar flexion test, 221
lumbar side bending test, 214
lumbar spine, 222–224
medial malleolus, 226
mens active straight leg raise test, 203–205
out-flare/in-flare, 228–229
palpatory assessment, 216
pelvic balance test, 200
pelvic rotation test, 215–216
posterior/backward fixed sacral torsion, 220
posterior view, 201–202
procedure, 200
PSIS, 217
pubic tubercle and inguinal ligament, 225
sacral rotation, 218–219
sacral sulcus, 218
sacrotuberous ligament, 217
seated forward flexion test, 208–210
sphinx test, 220–221
spring test, 222
standing forward flexion test, 205–207
stork test, 210–212
supine to long sitting test, 226–227
true LLD, 228
upslip, 228
Pelvis treatment, 242
for iliosacral dysfunctions, 247–253
for lumbar spine dysfunctions, 263–267
for sacroiliac dysfunctions, 254–262
strategy, 242–243
for symphysis pubis dysfunctions, 243–246
PGP. See Pelvic girdle pain (PGP)
Phasic muscles, 40, 41, 42, 43
PHC. See Posterior horn cell (PHC)
PIIS. See Posterior inferior iliac spine (PIIS)
PIR. See Post-isometric relaxation (PIR)
Piriformis, 144. See also Muscle energy technique (MET)
hip position assessment, 145
MET treatment of, 146–148
passive assessment of, 145–146
PLS. See Posterior longitudinal sling (PLS)
Posterior horn cell (PHC), 10, 119
Posterior inferior iliac spine (PIIS), 10
Posterior innominate motion, 24
Posterior longitudinal sling (PLS), 10, 47, 75
Posterior oblique
myofascial sling, 35
sling while running, 77
Posterior rotation, 59
Posterior sacroiliac ligament, 37
Posterior superior iliac spine (PSIS), 10, 13, 200
Post-isometric relaxation (PIR), 10, 119, 150
Posture, 39. See also Static stability
core muscle relationships, 45–49, 71–72
forward head posture, 40
muscle activity before and after stretching, 43
muscle imbalance effects, 44
musculoskeletal deterioration, 44
pain source, 39
phasic muscles, 40, 41, 42, 43
postural muscles, 40, 41, 42, 43
Primary movement pattern, 51
Progressive exercise, 50
Prolapsed discs. See Herniated discs
PSIS. See Posterior superior iliac spine (PSIS)
Pubis, 14. See also Innominate bone
on unstable base, 64
with lunge, 62
on unstable base, 63
QL. See Quadratus lumborum (QL)
Quadrant test, 159
Quadratus lumborum (QL), 10, 124, 149. See also Muscle energy technique (MET)
assessment of, 150
MET treatment of, 150–151
PIR method, 150
reciprocal inhibition method, 151
Reciprocal inhibition (RI), 10, 94, 119, 181
method, 151
Rectus femoris, 129. See also Muscle energy technique (MET)
assessment of, 130
MET treatment of, 130–131
modified Thomas test, 130
Repetition, 50
RI. See Reciprocal inhibition (RI)
Right oblique sacral axis, 27
Right-on-left (R-on-L), 10, 31
sacral torsion, 31
Right-on-right (R-on-R), 10
sacral torsion, 29
ROM. See Range of motion (ROM)
R-on-L. See Right-on-left (R-on-L)
R-on-R. See Right-on-right (R-on-R)
while kneeling, 70
Sacral axis, 27. See also Sacrum
anterior innominate motion, 23
backward bending, 26
bilateral motion, 25
flexing towards left, 28
forward bending, 25
inferior lateral angle, 27
inferior transverse sacral axis, 27
left oblique sacral axis, 27
L-on-L sacral torsion, 28
middle transverse sacral axis, 27
posterior innominate motion, 24
right oblique sacral axis, 27
R-on-R sacral torsion, 29
sacral oblique axis, 27
superior transverse sacral axis, 27
symphysis pubis motion, 22, 24
vertical sacral axis, 27
Sacral nutation, 22
and counter-nutation, 36
Sacral oblique axis, 27
Sacral rotation and lumbar counter-rotation, 77, 78
Sacral torsions, 32
Sacroiliac dysfunction, 235. See also Pelvic girdle dysfunctions
anterior/forward sacral torsions, 235
bilateral anterior sacrum, 261
bilaterally nutated/counter-nutated sacrum, 236, 238
bilateral posterior sacrum, 262
fixation, 237–238
L-on-L anterior sacral torsion, 254–256
L-on-R posterior sacral torsion, 258–259
posterior/backward sacral torsion, 236
R-on-L posterior sacral torsion, 259–260
R-on-R anterior sacral torsion, 256–257
treatment protocol for, 254–262
Sacroiliac joints (SIJs or SI joint), 10, 12, 16, 34. See also Pelvic girdle
anatomy, 17–18
force closure mechanism in, 100
function of, 20
iliolumbar ligament, 20
interosseous ligament, 19
ligaments of, 18–20
long dorsal ligament, 19
sacrospinous ligament, 19
sacrotuberous ligament, 19
Sacroiliac joint screening, 194
compression test, 197
distraction test, 198
FABER test, 196
Fortin finger test, 194–195
Gaenslen test, 198
SIJ provocative/screening tests, 196
thigh thrust test, 197
Sacroiliac joint stability, 34, 35. See also Force couple
force closure ligaments, 36
Gmax, 35
osteo-articular-ligamentous system, 35
pelvis stability, 37
posterior oblique myofascial sling, 35
posterior sacroiliac ligament, 37
sacral nutation and counter-nutation, 36
self-locking mechanism, 34
shear in, 35
tension in sacrotuberous ligament, 37
Sacroiliac motion, 22
and iliosacral motion, 25
unilateral motion, 26
Sacrotuberous ligament tension, 37
Sacrum, 14–15. See also Innominate bone; sacral axis
L-on-L sacral motion, 28
L-on-R sacral torsion, 30
neutral position of, 28
non-physiological motion, 30, 31, 32
physiological motion, 32
R-on-L sacral torsion, 31
sacral torsions, 32
and SIJ motion, 77–79
SCM. See Sternocleidomastoid (SCM)
Scoliosis, 102. See also Spinal mechanics
Seated forward flexion test, 208–210. See also Pelvis assessment
Set, 50
SI joint. See Sacroiliac joints (SIJs or SI joint)
SIJs. See Sacroiliac joints (SIJs or SI joint)
Single arm bend low to high, 67
Slipped discs. See Herniated discs
Somatic spinal dysfunctions, 102. See also Spinal mechanics
Sphinx test, 220–221. See also Pelvis assessment
Spinal engine theory, 100. See also Laws of spinal mechanics
closed kinetic chain, 100
force closure mechanism, 100
posterior longitudinal sling, 100
posterior oblique sling, 101
Spinal mechanics, 102. See also Laws of spinal mechanics
Fryette’s laws, 102
law, 103
neutral mechanics, 102–103
non-neutral mechanics, 103
scoliosis, 102
somatic spinal dysfunctions, 102
type I dysfunction, 102
type II dysfunctions, 103
Spinal movements
within vertebral column, 98
Spine, 100
SPJ. See Symphysis pubis joint (SPJ)
Spondylosis, 191
Standing balance test, 94
compensatory Trendelenburg gait, 95
position of PSIS, 95
positive test for weak right Gmed, 94
shift of pelvis, 95
stability on one leg, 95
Trendelenburg gait, 94
Standing forward flexion test, 205–207. See also Pelvis assessment
Static stability, 45
abdominal crunch in transverse plane, 49
anterior oblique sling, 47, 48
hydraulic amplifier, 46
lateral sling, 47
multifidus, 46
muscle dysfunction factors, 48–49
outer core muscle exercise, 49
posterior longitudinal sling, 47
posterior oblique sling, 47, 48
transversus abdominis, 45–46
Sternocleidomastoid (SCM), 10, 88, 183
STJ. See Subtalar joint (STJ)
Stork test, 210–212. See also Pelvis assessment
Structural LLD, 84
Superior transverse sacral axis, 27
Supine to long sitting test, 83, 226–227. See also Pelvis assessment
Symphysis pubis dysfunction (SPD), 10, 24, 238. See also Pelvic girdle dysfunctions
case study, 239
forward flexion tests, 239–240
treatment for, 243–246
Symphysis pubis joint (SPJ), 10, 12, 16, 22, 24
Temporomandibular joint (TMJ), 10, 88
Tensor fasciae latae (TFL), 10, 124, 140. See also Muscle energy technique (MET)
assessment of, 141
MET treatment of, 142–143
Ober’s test, 141–142
Thigh thrust test, 197
Thomas test, 161
Thoracic spine, 104
Thoracolumbar fascia, 182. See also Gluteus medius (Gmed)
TMJ. See Temporomandibular joint (TMJ)
Tonic muscles. See Posture—postural muscles
TP. See Transverse process (TP)
Transverse process (TP), 10, 187
Transversus abdominis (TVA), 10, 37, 45–46
TVA. See Transversus abdominis (TVA)
Type II spinal dysfunctions, 103. See also Spinal mechanics
Type I spinal dysfunction, 102. See also Spinal mechanics
Unilateral motion of sacrum, 26
Vertebra position, 104–106. See also Laws of spinal mechanics
Vertical sacral axis, 27
Zygapophyseal joints. See Facet joints