I believe that pain is a product of dysfunctional athrokinematic coupling. In particular the lumbo sacral coupling biomechanics is able to objectively demonstrate dyfunctional patterns that should be used to determine appropriate treatment.

To do this the patient is positioned in prone. The therapist starts with stabilising the sacrum over S2/3 and performs hip flexion.

Limitation of hip flexion will determine the side to continue assessment.

Take up the slack, reaching the barrier of hip flexion a spring test is performed over the ishial tuberosity. (a hard end feel is abnormal a springy end feel is normal).

The next step is to apply sustained pressure over the ishial tuberosity while performing hip IR / ER. The osteokinematics of the ishial tuberosity should inflare with hip ER and outflare with hip IR . limitation into direction determines treatment.

Then sustained pressure is applied over the ipsilateral ILA adjacent to the sacral hiatus. hip IR /ER is performed and the osteokinematics of the sacral ILA should cause derotation of the ipsilateral ILA with hip ER and ILA prominence with hip IR.

The sacral base is assessed with sustained pressure over the ipsilateral region while hip ER / IR is performed. the osteokinematics of the ipsilateral sacral base should increase in prominence with hip ER and derotate with hip IR.

Finally the lumbar segments are assessed with sustained pressure over the Wikipedia reference-linkfacet joints of each level while performing hip ER and IR. The osteokinemeatics of lumbar coupling are derotation with hip ER and prominence with hip IR.

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