2. Impairments
• Excessive articular compression
• Fusion (AS)
• Capsular fibrosis
• Over-activation of myofascial system
• Joint fixation (underlying instability)
• Insufficient articular compression
• Ligamentous laxity
• Underactivity of local myofascial system
• ARTT
Asymmetry of position, restricted motion, tissue texture, tenderness
3. Symptoms
• Stiffness and pain with walking
• Pain opposite side with walking – SI
• Pain same side with walking – IS
• Unilateral pain below L5
• Pain with sit to stand
• Coccydynia (torsions)
• Groin pain
6. Active motion tests
• Standing flexion test
• Stork test
Gillet’s test
• Seated flexion test
Piedallu’s test
7. Standing Flexion test
• The patient stands erect, with his feet at shoulder width.
• The therapist stands or squats behind the patient and places his
thumbs directly under each posterior superior iliac spine (PSIS).
• The patient bends forward, starting with flexing the neck, then the
upper thoracic spine to the lumbar spine, and as far as possible while
keeping the knees extended. The therapist will observe each PSIS and
their movement. Each PSIS should move an equal amount in a
superior direction.
8. Standing Flexion test
• If one PSIS moves further cranial than the other, the test is positive.
• The side with the greater movement is the affected side, because an
articular restriction between the ilium and sacrum occurs. The sacrum
will bend forward along with the lumbar spine
9. Stork’s test
• To perform this test, the patient stands while the examiner palpates the posterior
superior iliac spine (PSIS) with one thumb and palpates the base of the sacrum
with the other thumb medial to the PSIS.
• The patient is then instructed to stand on one leg while pulling the hip of the side
being palpated into 90° or more of hip flexion. The test is then repeated on the
other side and compared bilaterally.
• The examiner should compare each side for quality and amplitude of movement
• The test is positive when the PSIS on the ipsilateral side (same side of the body)
of the knee flexion moves minimally in the inferior direction, doesn’t move or is
associated with pain
10. Stork’s test
• The test is positive when the PSIS on the ipsilateral side (same side of
the body) of the knee flexion moves minimally in the inferior
direction, doesn’t move or is associated with pain
11. Passive motion testing
• Osteokinematic
Nutation/counternutation
Anterior/posterior innominate rotation
• Lumbosascral spring test
12. Lumbosacral spring test
• Place hypothenar eminence on lumbosacral junction and apply a
downward force in ventral direction.
• Test is negative if L-s junction spring back or bounce and positive if there is
no springing movement or minimal springing movement.
22. Correction of Bilateral Anterior Nutated
Sacrum
• Patient seated
• Feet apart and legs internally
rotated
• Patient flexes forward
• Therapist hands on sacral apex and
thoracic spine
• Maintain pressure on sacral apex
and resist trunk extension with
full inhalation
23. Correction of Bilateral Posterior Nutated
Sacrum
• Patient seated
• Feet together and legs externally
rotated
• Arms crossed
• therapist hands on sacral base and
across anterior chest
• Maintain pressure on sacral base
and resist trunk flexion with full
exhalation or have patient arch
back by pushing abdomen to
knees
24. Correction of Unilateral Anterior Sacral
Nutation
• Patient prone
• Abduct (15°) and internally rotate left leg
• Therapist right hand on left ILA
• Apply and maintain anterior and superior pressure on left ILA as patient
inhales and holds breath
• Therapist maintains pressure as patient exhales
• Left Unilateral Anterior
