In Prone Press Up Test, You Can't See Which ILA Translates Anterior to Determine Which Side the Sacrum is Torsioned, You...
A. Evaluate in Sitting Flexion
B. Check R Vs L Piriformis MMT
C. Evaluate in Standing Flexion
***CLINCAL REASONING: I published a paper years ago called “ROOT CAUSE of SACRAL TORSION & SHEAR” detailing an easier way to diagnose and treat, Go to WheltonMethods.com to read my paper!
The answer is “B”, SI joint along with sacral torsion and shear I have found to be the hidden cause of most back pain and a lot of “Radiculopathy.” Years ago, I started to notice a lot of pts,. if not most, that were diagnosed with “Piriformis spasms” were caused by a sacral torsions as the piriformis origin is at the ILA. I started rotating them back and their pain was instantly gone.
In school the teaching of the sacrum and its movements is very complex as it tilts in so many different directions. This can make it very difficult to understand let alone perform an accurate diagnosis!
I hacked it and made an easier way to understand, diagnose and treat that I outlined in my paper I published. Sacral misalignments and pain largely come from a sacral torsion and less commonly an anterior sacral tilt, which is usually caused or exacerbated by a hyperlordosis of the L-spine. Interestingly, I have found the sacrum almost always rotates in the same direction, in a prone press up test with your thumbs on the ILA’s your left thumb almost always translates anteriorly. A simple way to test if you are correct in your assessment is to check the piriformis strength in a supine 90/90 MMT of the piriformis. You will find almost always the right piriformis is significantly weaker in these patients causing the torsion.
Although schools will teach you to check the sacral realignment in sitting and standing and that is supposed to mean something diagnostically, it doesn’t. Try it my way and I believe you will see the evaluation process is made to complex, when it is actually pretty simple!
I have found that SI Jt, sacral torsion/shear is the most common cause of LBP especially when the patient has failed everything. Please save these people! Screen every patient! I have a whole clinic full of these patients and what the medical system has done to them trying to understand the cause of their pain and help them is literally insane!
