OMT: pelvis

This is one of the regions I was assigned to assess for my midterm practical last year. I got off to a wonderful start by handing my grading sheet to my preceptor and smashing my elbow into the corner of the table as I turned to face my patient. We had a good laugh over my misery. :O

Diagnosis:

  • Standing flexion test
  • SEAT THE PELVIS
  • ASIS
  • Pubic symphysis
  • Inflare/outflare
  • SEAT THE PELVIS
  • PSIS

Image from “The Pocket Manual of OMT” (2nd ed.).

As usual, ask for contraindications!

  • Any recent injuries? Sprains? Fractures?
  • Cancer? Infection?
  • Arthritis? Joint instability? Hypermobility?

Anterior (aka inferior) innominate ME

  • (Supine) Stand on involved side + flex/adduct the hip to its restrictive barrier.
  • Pull the buttbone (ischial tuberosity) up.
  • Ask pt to push knee into your shoulder for 3-5 seconds against your equal resistance.
  • Allow relaxation + move hip to new barrier.
  • Repeat 3-5x. Retest.

Posterior innominate ME

  • (Supine) Stand on involved side + hold opposite ASIS.
  • Move involved leg off the table + let it drop to its extension barrier. (Since it’s posterior, you want your leg to be more posterior, hence why you drop it off the table.)
  • Ask pt to push thigh upward for 3-5 seconds.
  • Allow relaxation + move hip to new barrier.
  • Repeat 3-5x. Retest.

Anterior innominate thrust, supine

  • Stand at foot of table and grasp leg above malleoli (use both hands).
  • Lift leg to ~30 degrees hip flexion + slightly abduct + internally rotate leg. (Since it’s anterior, you want your leg to be more anterior, hence the flexion.)
  • Ask pt to take deep breath. During exhalation, apply a caudad (towards the feet) tug.
  • Retest.

Posterior (aka superior) innominate thrust, supine

  • (SAME AS ANTERIOR but you don’t flex to 30 degrees.)

Pubic ME, thrust

  • Grasp outside of both (flexed) knees. Ask pt to push knees apart for 3-5 seconds. Relax. Repeat 3-5x.
  • Separate knees but holding inside of knees with hand/elbow of one arm. Ask pt to push knees together for 3-5 seconds. Relax. Repeat 3-5x.
  • Add thrust by applying a short, quick + lateral push at the end.
  • Retest.

Ilium inflare ME

  • (Supine) Stand on opposite side of inflare + flex knee + hip, putting the foot on the table close to the butt.
  • Hold opposite ASIS (the one closest to you) + laterally abduct hip to restrictive barrier.
  • Ask pt to push knee medially for 3-5 seconds. Allow for relaxation.
  • Repeat 3-5x. Retest.

Ilium outflare ME

  • (Supine) Stand on side of outflare + flex knee + hip, putting the foot on the table close to the butt.
  • Pull PSIS laterally while medially adducting the hip.
  • Ask pt to push knee into external rotation for 3-5 seconds. Allow for relaxation.
  • Repeat 3-5x. Retest.
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About Farrah

A frugal, selectively antisocial Family Medicine resident physician with too many interests. Loves...God, family, friends, volunteering and helping others, making others happy, music (especially piano and singing), Tahitian/hula/salsa/pole dancing, aerial silks, learning, writing, cooking, eating, sleeping, lifting weights, playing SNES and DS, photography, editing, window-shopping, gymnastics, kickboxing, BJJ, finding great deals, pyrography, horseback riding, archery, frolicking in the great outdoors...making every moment count.

Posted on February 4, 2014, in School and tagged , , , . Bookmark the permalink. Leave a comment.

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