Diagnosing of the sacrum

[nshalaby]

So im reviewing for my OPP final and Im trying to remember what is absolutely needed to diagnose the sacrum. I thought you needed 3 things minimum: spring test (sphinx), ILA position, and sulcus position. Our sacrum exam had many cases with 3 pieces of info and the answer some of the time was not enough information so im wondering again what info you absolutely need as I cannot find it in DiGiovanna. thanks

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[Mehd School]

The must haves for sacral diagnosis:

1. Seated Flexion Test
2. Deep Sacral Sulcus
3. Posterior/Inferior ILA

There are different ways of gathering this information (IE L5 rotated to the left = deep sacral sulcus on the left), but its what you need.

A positive spring or sphinx test only tells you it is an EXTENSION dysfunction. So it could be a left or right unilateral extension, bilateral extension, or a R/L or L/R torsion.

First, your seated flexion test will give you the axis of the dysfunction. Positive seated flexion on the left? Your axis is on the RIGHT. This is the denominator portion of torsions.

ILA gives you your numerator of your torsions. For example: + Seated flexion on left, post/Inferior ILA on left would give you a dx of a L/R so long as your deep sulcus and post ILA are on opposite sides.

ILA and Sulcus deep on the same side? Buddy, you've got yourself a shear. Is your sulcus the same side as your seated flexion test? Thats a unilateral flexion. Is your deep sulcus opposite of your seated flexion? Unilateral extension.

I don't have time to type out the tx's, but hope this helps.

Source: Guy who hates OMM.

 

[hallowmann]

It also depends on the dysfunction, but as far as I understand it, you need a seated flexion test. Some dysfunctions will present with the same sacral landmark findings, so you will need a test to ID side of dysfunction (R vs. L - seated flexion) or type (flex/forward vs. ext/backward - spring/sphinx).

That said, we were told that findings & seated flexion may "contradict" each other, at which point you go with spring + whatever the majority points to.

I also strongly recommend using Saverese to review for OPP as opposed to Digiovanna as its shortened and language/descriptions are a bit better for reviewing things.

 

[Jwalker]

1. seated flexion / spring / sphinx
2. sulci depths
3. ila heights

 

[wjs010]

The must haves for sacral diagnosis:

1. Seated Flexion Test
2. Deep Sacral Sulcus
3. Posterior/Inferior ILA

There are different ways of gathering this information (IE L5 rotated to the left = deep sacral sulcus on the left), but its what you need.

A positive spring or sphinx test only tells you it is an EXTENSION dysfunction. So it could be a left or right unilateral extension, bilateral extension, or a R/L or L/R torsion.

First, your seated flexion test will give you the axis of the dysfunction. Positive seated flexion on the left? Your axis is on the RIGHT. This is the denominator portion of torsions.

ILA gives you your numerator of your torsions. For example: + Seated flexion on left, post/Inferior ILA on left would give you a dx of a L/R so long as your deep sulcus and post ILA are on opposite sides.

ILA and Sulcus deep on the same side? Buddy, you've got yourself a shear. Is your sulcus the same side as your seated flexion test? Thats a unilateral flexion. Is your deep sulcus opposite of your seated flexion? Unilateral extension.

I don't have time to type out the tx's, but hope this helps.

Source: Guy who hates OMM.

Why are you an M1 with this much OMM knowledge?

 

[67552931811]

.

 

[hallowmann]

Why are you an M1 with this much OMM knowledge?

Haha, I was thinking the same thing. I believe I didn't learn sacrum/pelvis until 2nd semester, but first year is kind of a blur for me so I might be wrong.

 

[dfib slim]

Why are you an M1 with this much OMM knowledge?

DCOM hits the sacrum hard and fast first semester.

 

[Life Eternal]

Why are you an M1 with this much OMM knowledge?

I'm a M1 at a different school, sacral dx was the last thing we learned in otm this semester.

 

[Mehd School]

DCOM hits the sacrum hard and fast first semester.

Yep. : /

Why are you an M1 with this much OMM knowledge?

We just had our final a few days ago so it's still pretty fresh. I can't wait to forget all of it.

 

[nshalaby]

Thanks for the responses! Plan to get this final over and forget about the sacrum along with AT Still's birth, death, and first lover until boards!

 

[Mad Jack]

Why are you an M1 with this much OMM knowledge?

Some schools hit OMM harder than others. At my school we are expected to know everything except cranial by the end of first year, and be able to perform full diagnosis and treatment of mock patients for a grade (and actual clinic patients under observation) in second year.

 

[DrEnderW]

Some schools hit OMM harder than others. At my school we are expected to know everything except cranial by the end of first year, and be able to perform full diagnosis and treatment of mock patients for a grade (and actual clinic patients under observation) in second year.

Same with mine, we hit OMM hard and in a lot of depth. We essentially cover all subjects aside from cranial and chapmans first year with 2nd year as a review and expansion on specific organ systems. The above sacrum explanation would have been late first or early 2nd semester.

 

[babdoc]

Here's one that an OMM tutor at our school passed out to us. Somewhat of a different flow in the algorithm than it seems most people do but pretty simple. In this approach, all you need is lumbar spring test, side bending, sulci, and seated flexion. By the way, +SB is restriction to side bending/pushing up on the ILA.

 

[touchpause13]

So im reviewing for my OPP final and Im trying to remember what is absolutely needed to diagnose the sacrum. I thought you needed 3 things minimum: spring test (sphinx), ILA position, and sulcus position. Our sacrum exam had many cases with 3 pieces of info and the answer some of the time was not enough information so im wondering again what info you absolutely need as I cannot find it in DiGiovanna. thanks

So you need a seated flexion test to confirm whether or not there is a sacral dysfunction

After you have a position seated flexion test (doesn't matter which side it's on) you do the sulcus. This will give your first name. I think of it as the way that the sacrum is facing.
Then do the ILAs. The side that is posterior/inferior is the one you care about. If it's on the same side as your deep sulcus --> it's either a flexion or extension
If it's on opposite side as your deep sulcus ---> torsion

Now do you sphinx test. How I remember this is that a positive sphinx fukes everything up. (I'll explain more in a bit)

So if you have you a positive sphinx test and you had a torsion - that means that it's going to be backward torsion (which is a fuk up because it's worse for pt, and also more complicated to treat) It also changes the second name. So you found the first name from the deep sulcus (the way the sacrum is facing), the second name is going to be the opposite that of the first name. So what would a right deep sulcus, left inferior/posterior ILA, and positive sphinx be? (answer in white) left on right backward sacral torsion

Things are more simple with a negative sphinx test, so that would give you a forward torsion (again assuming that your deep sulcus and posterior/inferior ILA are on opposite sides) So what would a left deep sulcus, right inferior/posterior ILA, and negative sphinx be? right on right forward sacral torsio

Now on to flexions/extensions. Again, note that extensions are worse (as in for the pt and the treatment is more complex) and your name gets switched with a positive sphinx test. Note that you only have one name this time because the ILA and sulcus are on the same side

So you have a deep sulcus on left, posterior/inferior ILA on left, and a positive sphinx test, what is that? right unnilateral extension
n
You have a deep sulcus on the right, posterior/inferior ILA on the right, and a negative sphinx test, what is that? right unilateral flexion

So just remember - positive sphinx test fuks everything up.

 

[touchpause13]

We were taught that spring test, sacral TPs (2 and 4), and sacral fascial drag are confirmatory tests only.
Cephalad sacral fascial drag: forward torsion/unilateral flexion
Caudad sacral fascial drag: backward torsion/extension
TP2: backward sacral torsions
TP4: unilateral sacral flexion
negative spring test: forward torsion, unilateral sacral flexion, and bilateral flexions
positive spring test (note- this almost never happens IRL) backward torsion, unilateral sacral extension, bilateral extension

Note that forward/flexion tend to go together and that's going to be negative sphinx
backward/extension go to together and that's a positive sphinx

Also you can't really use these to exclude a diagnosis

 

[hallowmann]

...positive spring test (note- this almost never happens IRL) ...

We had this impression too. The funny thing is that the last 3 people I diagnosed sacrum on had positive spring tests (3 different dysfunctions too).

 

[touchpause13]

We had this impression too. The funny thing is that the last 3 people I diagnosed sacrum on had positive spring tests (3 different dysfunctions too).

I had one, but I'm convinced that's because I had low back sx and I think it's just because of the scar tissue back there

Also it pretty much has to be no movement, like some people will be really stiff but still have some give which would count as a negative

 

[ChrisGriffen]

http://didacticsonline.com/videos/

These videos got me through all OPP for M1/2

 

[meliora27]

If this stuff really works, wouldn't it be unconscionable for our allopathic brethren to not know it/use it? I used to always grapple with that thought during M1/M2

 

[hallowmann]

If this stuff really works, wouldn't it be unconscionable for our allopathic brethren to not know it/use it? I used to always grapple with that thought during M1/M2

Don't people grapple with low back pain constantly? I've had people correct sacrum and lower lumbars and it make a huge difference pain-wise ("sacral C" is usually pretty effective). This is one of those things I actually think works. Now whether the names are correctly describing what's "happening" is a different thing though.

 

[bajastapler]

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