Standing, sitting, or lying prone
If you wish to palpate on the skin, provide a private room. If you think this is necessary, the patient is asked if he/she is willing to lower his/her pants, if needed, for direct palpation of the sacrum or for intervention. While the skin can not be viewed with clothes covering the area, the sacrum can be palpated to assess motion and pain response over clothing. For intervention, realignment of the sacrum may be possible over clothing.
Posterior to the patient.
May I touch the back of your hip bones? (or point to the area). As I guide with my hands, please tilt your pelvis forward and back, let your hip drop to the left and then to the right, and turn your pelvis to the left and to the right (or demonstrate, which is much easier).
There is controversy regarding the normal amount of motion between the sacrum and ilium, ranging in opinion
from no motion to palpable and at times even observable motion. The motions of the sacrum are listed below as they would occur with concurrent simultaneous motion of the ilium.
With the patient relaxed and after asking permission to touch, gently place your fingers on the sacrum. Either demonstrate or guide the patient to do the following motions while noting the motion of the sacrum by guiding the motion of the pelvis. With a secure and stable sacroiliac joint, the sacrum closely follows the motion of the pelvis. Motions of the sacrum would be described as:
If motion at the sacroiliac joint were defined (rather than motion of the sacrum), the same motions as those listed above would be defined as occurring between the sacrum and the ilium, i.e. with motion at the sacroiliac joint, without concurrent and/or the same degree of simultaneous motion of the ilium.
If the sacroiliac joint were not secure and not stable, sacroiliac motion would be pronounced and could result in pelvic obliquity, a difference in functional lower limb length, etc. The sacrum can slip upward, slip downward, tilt to the right or left, and rotate to the right or left excessively in relationship to the ilium.
With the patient relaxed and after asking permission to touch, gently place your fingers on the sacrum. Either demonstrate or guide the patient to do the following motions while noting the motion of the sacrum by guiding the motion of the pelvis. With a secure and stable sacroiliac joint, the sacrum closely follows the motion of the pelvis. Motions of the sacrum would be described as:
- sacral flexion or nutation while tilting the pelvis forward in anterior pelvic tilt
- sacral extension or counternutation while tilting the pelvis backward in posterior pelvic tilt
- lateral tilt or lateral flexion or side bend to the left while letting the left side of the pelvis drop and tilting the superior aspect of the pelvis to the left
- lateral tilt or lateral flexion or side bend to the right while letting the right side of the pelvis drop and tilting the superior aspect of the pelvis to the right
- rotation of the sacrum to the left while turning the anterior aspect of the pelvis to the left
- rotation of the sacrum to the right while turning the anterior aspect of the pelvis to the right
If motion at the sacroiliac joint were defined (rather than motion of the sacrum), the same motions as those listed above would be defined as occurring between the sacrum and the ilium, i.e. with motion at the sacroiliac joint, without concurrent and/or the same degree of simultaneous motion of the ilium.
If the sacroiliac joint were not secure and not stable, sacroiliac motion would be pronounced and could result in pelvic obliquity, a difference in functional lower limb length, etc. The sacrum can slip upward, slip downward, tilt to the right or left, and rotate to the right or left excessively in relationship to the ilium.
VH ñ Sacroiliac joint