1. Pelvis
Bracket anatomical and physiological concepts of position & movement
Assess dysfunction using percussion and palpated sense of ease & bind
Five segmental levels of sacrum
Although fused, dysfunction is still expressed segmentally

2. Sacro-pelvic Examination
Standing:
Percussion over lumbar spine & sacrum
Sidelying:
Palpate for ligamentous thickening and changed tension down the line of the S/I joint
Feel for bands of muscular tension through gluteal area
Repeat on other side
Correlate central percussive findings with ligamentous and muscular tension bands

3. Examination Supine & Sitting
Patient lying supine, knees flexed:
Rotary scan through pelvis & spine using hand on side of knee to guide rotation
Move palpating hand down a segment as the rotation is reversed
Confirm findings with patient sitting using trunk to rotate
Single leg or both legs
One knee flexed check for asymmetry
Reverse legs (still palpating the same side)

4. Then Repeat on Opposite Side - Each side is a separate problem
Order of Testing
Scanning
Standing - percussion
Sidelying - soft-tissue test of ligament and muscle
Supine scan - one side at a time
Analysis of segment
Check supine both legs two directions (equivalent to testing rotation sitting)
Check sitting and treat if necessary
Test each leg separately in both directions
Then Repeat on Opposite Side - Each side is a separate problem

5. Examination Objectives
Examiner can scan the sacro-pelvic region using:
Percussion, standing;
Local pressure palpation of ligamentous and gluteal muscular tissues, sidelying;
Spinal rotation supine, introduced from below, and confirm findings in the seated position using motion testing through the shoulders/trunk
Examiner can mark location of a major finding and apply motion tests to compare local response to inversion/eversion of each leg singly

6. Distinguishing sacral from innominate lesions
Sacro-pelvic lesions can have the following components:
Sacral/axial only
Sacral/axial plus lower extremity
Lower extremity only
Lower extremity problems can be:
Unilateral
Bilateral
Resisting in the same direction
Resisting in opposite directions

7. Functional Treatment of Pelvis
Sacral Dysfunction
Resistance to spinal axial rotation
Compliance throughout inversion/eversion of individual legs
No need to involve legs in manipulation
Do sitting or sidelying as thorax/lumbar
Innominate dysfunction one side (compliant one side only)
Treat with patient sidelying and affected leg on top
Treat as if the sacrum is made of mobile segments

8. Disturbed responses in inversion/eversion tests
Resistance/Compliance in contra-lateral leg
What eases ant/post translation? (test sitting)
Ease in post. translation - treat prone (on elbows if necessary)
Ease in ant. translation - treat supine (on elbows if necessary)
Control ipsilateral and palpate contralateral leg
Prone - stand by ipsilateral leg
Supine - stand by contralateral leg
Two directional cues
Both legs compatible (same as) axial rotation
Legs both resisting the same movement

9. Legs compliant with axial movements (legs different from each other)
Functional approach
Position patient according to findings - elevated hips or shoulders
Treat with both legs together
Legs over shoulder
Legs over operator’s knee
Legs over operator’s arm

10. Ease/bind same in both legs
Use an articulatory/muscle energy approach as more practical than a functional technique
Resistance to inversion in each leg
Patient supine actively inverting both legs against operator’s fist
Operator rotates legs towards resistance of axial rotation
Resistance to eversion in each leg
Patient supine actively everts both legs while operator grips knees between hand and forearm

11. Summary of pelvic tests
Findings
Treatment Approach
Axial resistance only
Treat seated (or supine)
Resistance in ipsilateral leg only
Treat lying on contralateral side
Sacro-pelvic disturbance:
One direction compliant
Position and then treat limb identified
Both limbs compliant with axial rotation
Use functional approach through both legs
Both limbs resisting same movement
Direct technique confronting sacral resistance