Sacrum evaluation

The aim of palpation of the pelvis is to identify prominent bony structures that may obstruct labor. The examiner evaluates the angle of the pubic arch (> 90°), the promontory (cannot be reached), the anterior surface of the sacrum (smooth), the coccy-gis (not prominent and elastic), and the ischial spines (not prominent). 

Additionally the axial load transferred from the disc to sacrum was taken into account. Finally we evaluated the shear force and distribution between disc and facet joint (Fig. 6). 

Other symptoms such as headache, nausea, dizziness, or paresthesias may be present. Because the entire body is involved with the forces that cause the hyperflexion and hyperextension, it is important, to evaluate the entire spine. The sacrum is frequently involved in somatic dysfunction. If the sacral dysfunction is not treated, it tends to maintain disability in cases that fail to respond to treatment. Dysfunctions of the cranium are commonly present after an accelera-tion/deceleration injury. The occiput and sacrum tend to exhibit the same restrictions to motion. The temporal bones are especially vulnerable to the forces transmitted through the sternocleidomastoid muscles. 

The lumbar spine consists of five vertebrae, the largest in size is the spinal column. Most congenital anomalies occur to the fifth lumbar vertebra. Both the thoracic spine and the sacrum and pelvis have significant effects on the posture and function of the lumbar spine. When performing an evaluation of the lumbar spine, it is necessary to include these areas in the examination. 

Mitchell FLJr. Mitchell PCK. The Musde Biergy Manual vdnne /// Evaluation and Treatment of the Pelvis and Sacrum. East Lansing. Ml MET Press. 1999. 

Proper sacral and pelvic joint motion should be achieved in all gait, posture, and spinal motion problems. Because the sacrum Is closely associated with cranial motion, the sacrum must be evaluated as pan of the cranial motion evaluation. Lower extremity dysfunction often results from or may cause pelvic dysfunctions. 

The bursitis has as its cause trauma to the area, acute or chronic, as well as any dysfunction affecting the ischium or the structurai integrity of the knee joint. The patient reports pain at the medial aspect of the knee, but careful palpation will elicit point tenderness below the knee joint that is very specific and localized in its nature. The pain will be made worse with contraction of the semitendinous, sartorius, and gracilis muscles. An evaluation for somatic dysfunctions of the pelvis, sacrum, and lumbar region, as well as the postural balance of the lower extremity, must be performed. Treatment can be a local injection of a steroid, a prescription for a NS AID, ice, exercises, and osteopathic manipulative treatment (OMT) of all somatic dysfunctions, including knee, hip. and pelvic region. 

Because the temporal bone is intimately involved in most TMJ cases, it must be evaluated and treated for any motion restriction found (see Section X, Cranial Osteopathy). Because the motion of the sacrum is closely related to motion of the cranium, evaluation and treatment of the sacrum may provide important help as well. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

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