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Illi reported that sacroiliac fixation of any degree inhibits the compensatory torsion capacity of the spinal segments. An adaptive lumbar scoliosis away from the side of pain, leading to compensatory biomechanical changes in the thoracic and cervical regions. According to Boorsma, the boot-shaped design of the sacral facets is typically deep, oblique, and mobile, and it is especially related to a hyperlordotic spine.
The postpartum symphysis pubis often remains hypermobile as described by Sandoz in the Annals of the Swiss Chiropractors' Association.
The base of the sacrum tends to pivot posteriorly during inspiration (or increased intra-abdominal pressure) and anteriorly during expiration of 1–7 mm.
In the neutral standing position, the ASISs normally lie in the same vertical plane as that of the symphysis pubis.
In all low-back pain cases, it is essential to test for hamstring, quadriceps, and psoas length.
The picture on the left is the best picture I have found that displays the Modified Thomas Test.
If the psoas is shortened, it pulls the thigh into (some degree of) flexion, so the thigh cannot fully extend. The picture on the left is the best picture I have found that displays the Straight Leg Raise (SLR) (although I fail to see the need for bondage).
Post-isometric Relaxation (PIR) is an effective and well-tolerated method for returning shortened muscles back to normal resting length.
Then ask the patient to try to raise that knee towards their chest…at about 50% of their strength level.
Slow and progressive, a light over-pressure, held for 30 seconds, helps to disengage the retained actin-myosin bonds that are associated with muscle shortening.
The positioning in this picture is terrible, with the the doctor facing the patient’s feet (not to mention the questionable hand on their rump).
Note that you can gain extra leverage in the flexible patient by also gently lifting their thigh off the table (with your other hand), while still maintaining full-flexion at the knee.
As shown in the SLR photo above, bring the straightened leg as high as possible (without lifting sacrum off the table) and then place their ankle (or mid-calf) on your shoulder. Remember to keep the patient’s knee “locked” in full extension (as shown in the SLR photo above), otherwise the clever patient will bend at the knee to reduce their discomfort. Sub-maximal contraction of a muscle for (at least) 30 seconds will inhibit the fast-twitch response of muscle, blocking their ability to resist you during the stretching phase of PIR.
Because of this phenomena, it has been suggested that PIR can provide a 30% “better stretch” than stretching without first exhausting the muscle.


I have found that patients hold their pelvic adjustments longer and better if you first address any shortening found in these 3 muscles.
To reveal these movements in the sitting position, it is necessary to concentrate the motion in the region to be studied. It is for this reason Gillet taught three 30-second-hold stretches to his patients with sacroiliac fixations. We know today that there are relatively few total fixations of the articular type at the sacroiliacs. In a certain number of purely muscular fixations, the contracted or hypertonic muscle will have a tendency to degenerate and become fibrosed.
According to Gillet, no other area of the axial skeleton is prone to fixation from ligamentous shortening more than the sacroiliac articulations. This motion can be felt and seen when the palpating thumbs are put in contact with the sacrum and ilium on the weight-bearing side.
Schafer's books are now available on CDs, with all proceeds being donated to chiropractic research. Each half of the pelvic girdle consists of the ilium, ischium, and pubic bones that are three separate bones during early life that, through custom, retain their separate identity in adulthood even though they become completely fused and function as one bone.
Shortening of any of these muscles should be treated with PNF or spray-and-stretch techniques as a pre- or post-manipulative procedure. Because portions of the quads originate on the pelvis, a shortened quads also distorts normal pelvic motion.
If the hamstrings are normal length, the leg should passively flex to at least 90°, without lifting sacrum off the table. They found that after 6-12 treatments, athletes continued to maintain their improvements, even after 12 months. The doctor faces the patient, stabilizing the bent knee (and flexed hip) to the patient’s chest. They will contract the psoas for 30 seconds…and half way through the contraction, ask them to take a deep breath and hold it, while maintaining the contraction. When the patient is prone, you should be able to passively flex the knee until the heel can touch the buttocks.
If you reverse your position, and stand facing their head, you can use a straight-arm stabilization at the ankle during the contraction phase. Then, ask the patient to try to straighten their leg, at 50% of their maximum ability, for 30 seconds. Ask them try to lower the leg as 50% maximum for 30 seconds…with the deep breath at half way through the contraction.


The two ilia assume a slanting position toward the convexity of the lumbar curve, with the related side of the pubis gliding upward and laterally. The sacrum can move in spite of certain fixations of the lumbars or of the ilia to each other at the pubis. The pubic articulation can also appear to be in total fixation, which is also due, it would seem, to shortened ligaments. This is probably because few occupations require pelvic motion throughout the maximum range of possible motion.
This is another example of the hypermobility that usually accompanies partial fixations (ligamentous or muscular). There must be palpable-visible movement at all points when each knee is raised to be sure that these articulations are completeIy free of fixation. Although the hip joint is classically considered part of the lower extremity from an anatomical viewpoint, it is so closely linked functionally to the innominates, sacrum, and lumbar spine that it must be considered in any discussion of the pelvis. Recalling that the origin of the psoas includes the lower thoracic vertebra, the lumbar segments I-IV, and the neighboring intervertebral discs, you can see why shortness would destabilize the lumbar and pelvic joints.
Knowing that the hams originate on the ischial tuberosity, shortness of the hams can also distort pelvic mechanics. This is quite remarkable, considering that they continued to train at Olympic levels (numerous hours per day, day after day) for a whole year. Then place the free hand on the dependent knee and gently push down, until you reach the “barrier” (passive end-range).
Also, note that the patient should be closer to the end of the table, to facilitate unobstructed extension at the hip. As with the psoas (and all PIR work), after 15 seconds, ask them to take a deep breath and hold it, while still contracting the quads.
Also… if the psoas is in contraction, the gluts may become inhibited by reciprocal inhibition.
Craig Liebenson and all the instructors of the Rehabilitation Diplomate Program, developed by Craig and LACC (now SCUHS), for their combined wisdom!



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