Sacrum somatic dysfunction

Examination of his back and lower extremities revealed that the patieni had restriction of his right sacrum, somatic dysfunctions at the level of his first and fifth lumbar segments, and severe restriction of passive motion of his right hip in all directions. 

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. 

This section describes muscle energy techniques for sacrum and pelvic somatic dysfunctions. 

This chapter describes Still techniques for treating somatic dysfunctions of the sacrum and pelvis. There are several systems of diagnosis, but the techniques described in this chapter are related to the systems that are used in this textbook. There are also seated techniques described, albeit less effective than the supine ones described. Because of the complexity, interested students should refer to Dr. Van Buskirk s more thorough book and chapters for other techniques and diagnoses. 

Somatic dysfunctions of the sacrum and pelvis are common and are among the most common causes of low back and pelvic pain. The articulation of L5 -S1, the sacroiliac joints, and the pubic articulation are all sources of pain resulting from dysfunctions. These are described in detail In previous chapters. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

Physical examination revealed a slightly obese woman in obvious discomfort. She preferred to stand rather than sit on the examination table. The sacrum was freely movable and no somatic dysfunctions of the lumbar spine were noted. The coccyx was markedly lender to palpation and ihe soft tissues around il were tense and lender. There was a high flare-out tender point on the posterior surface of ihe sacrum. Rectal examination confirmed tenderness of the coccyx, but it was not severe enough to indicate a fracture and the coccyx was not dislocated. 

Somatic dysfunctions related to hip joint dysfunction may involve the lower spine, sacrum, ilium, acetabulofemoral joint, femoral shaft, and the knee joint. 

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. 

A diagnosis was made of plantar fascial strain and multiple somatic dysfunctions ofthe sacrum and lumbar area. The patient received osteopathic manipulation, which included specific treatment to the fascia of the foot involved, as well as the prescription for exercises to increase motion of her foot and ankle, strengthening of the muscles, and NSAIDs. She was educated about the proper fitting of her shoes to prevent further changes of her toes. The calcaneal valgus was to receive further treatment at the next visit... 

A structural examination revealed severe hypertonicity of his right back, from his upper thoracic region down to his sacrum. In addition there was a somatic dysfunction present at T8-T9, and a reduction of cranial-sacral rhythm. 

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