Innominate Dysfunction –
Anterior/Posterior Rotation
Michael Ladewski, DO
April 21, 2010
Objectives
Description of Dysfunction
Exam Findings
OMT Options
Innominate Rotation
Entire Innominate
rotates in relation to the
other Innominate
ASIS and PSIS differ
from one side to the
other because of rotation
Innominate Rotation
Subjective Complaints
Unilateral hamstring
tightness / spasm
Sciatica secondary to
piriformis
Inguinal / groin pain
secondary to rectus
femoris dysfunction
Medial knee pain
secondary to sartorious
dysfunction
Standing Flexion Test
Identifies side of
Innominate dysfunction
Examiner’s thumbs
placed on inferior slopes
of PSIS
Patient bends forward at
waist from standing
position
Standing Flexion Test
Positive Test
If one PSIS moves more
superiorly than the other
Test called positive on
side with more movement
Negative Test
If both PSIS move
equally
ASIS Exam / Compression Test
Patient supine
Compare relative
cephalad / caudad
location of each ASIS
Contact both ASIS with
palms
Compress one side while
stabilizing other
Test both sides
ASIS Compression Test
Positive Test
Resistence to springing on
side of dysfunction
compared to other side
Test called positive on
side with resistence
Negative Test
Both sides have equal
resiliency to springing
Example Case
Patient complains of low back / sacral pain
Hamstring tightness on the right
Physical Exam findings
Standing flexion test positive on the right
ASIS Exam – right side caudad when compared to
left
ASIS Compression test positive on right
Diagnosis
Anterior Sacrum Right
OMT Options
Muscle Energy
Directed at restoring normal articular relations
across sacroiliac joint
Uses muscle force to mobilize joint
Patient’s muscles used actively against a counterforce
provided by practitioner
Muscle Energy Techniques
Anterior Innominate 1
Patient is supine
Practitioner positioned on
side of dysfunction
Patient’s leg flexed at hip
and knee
Patient instructed to push
thigh against hand at
distal hamstring /
posterior thigh
Contract for 3 to 5
seconds
Muscle Energy Techniques
Anterior Innominate 1
Patient then relaxes
Innomminate placed into
further posterior rotation
by increasing flexion at
hip
Uses contraction of
hamstrings to posteriorly
rotate Innominate
Repeat 3 to 5 times
Re-evaluate
Muscle Energy Techniques
Anterior Innominate 2
Patient is prone with
dysfunctional side at edge
of table
Flex at knee and hip
Clinician at side of table
with patient’s foot on
thigh
Clinician stabilizes sacrum
and holds knee flexed
Muscle Energy Techniques
Anterior Innominate 2
Clinician passively flexed
hip and knee until
restriction is felt
Athlete instructed to
extend leg and clinician
resists
Relax
Repeat
Re-assess
Same mechanism as 1
Muscle Energy Techniques
Posterior Innominate 1
Patient prone with knee
of dysfunctional side
flexed to 90
Clinician at side opposite
dysfunction
Clinician stabilizes PSIS
and grasps knee
Patient’s hip passively
extended to restriction
Muscle Energy Techniques
Posterior Innominate 1
Patient actively pulls knee
toward table with
resistance by clinician for
3 to 5 seconds
Patient then relaxes
Uses quads to pull
innominate anterior
Relax
Engage barrier
Repeat
Muscle Energy Techniques
Hands On
