Patient and Practitioner set-up
- The patient should be lying supine.
- The table should be low enough for the practitioner to press into the patient's opposite-side ASIS, with the practitioner's chest over the patient's torso and arm straight.
Passive Motion Assessment
- It is strongly recommended that the Brookbush/Grieve (172) Recommended Cluster is used to determine the side likely to be stiff.
- SIJ unilateral posterior to anterior mobilizations may be used as an additional assessment to confirm findings from the Brookbush/Grieve cluster.
Lockout Position:
- The patient is going to be asked to slide toward the practitioner on the table.
- The ankle closest to the opposite side of the table is going to be placed over the ankle closer to the practitioner, and the patient is side-bent away from the practitioner in "smile away" position.
- This position theoretically "lock's out" or "prepares" the SIJ for manipulation from the bottom up. The torso is then rotated toward the practitioner to lock all of the segments above the SIJ.
- The practitioner is then going to place the palm of the hand closest to the patient's feet, over the patient's opposite ASIS. It is important to attempt to use the softest part of the hand (inter-thenar groove) over a large area to reduce the amount of discomfort that can be felt from pressing directly into the ASIS
- The practitioner will then ask the patient to interlock their fingers and place their hands behind their head.
- Note, it may be helpful if the patient chooses to interlace their fingers so that fingertips touch opposite hand web space, and not web space to web space. If the fingers are interlaced too far it may be impossible to slide the practitioner's arm through the arm and forearm of the patient.
- The practitioner will then slide the hand closest to the patient's head, over the patient's arm closest to the opposite side of the table, and back through the gap between their arm and forearm, so that the back of the practitioner's hand lies on the patient's sternum. (This feels a little awkward at first, but it makes lock-out position more comfortable)
- Maintaining pressure over the ASIS, the practitioner will then rotate the patient's torso toward them, until any further rotation causes the patient's pelvis to press firmly into the practitioner's palm.
- Note: At this point the practitioner's arm closest to the patient's head should be near straight and it may be possible to slide the practitioner's arm further through the patient's arm, and actually grab the side of the table to stabilize during the thrust portion of the technique.
- Once, end-range rotation is reached, with the smile-away position of the body maintained, lock-out position has been achieved.
High-Velocity Thrust
Important Note: 90% of the manipulation technique is set-up. If you have not achieved lock-out in the previous steps, having great "thrust technique" will be rendered useless.
- The manipulation comes primarily from using the weight of the torso to press firmly into the ASIS with the straight arm, down toward the table. The arm that was used to rotate that torso must maintain that rotation; it may be necessary for the practitioner to simultaneously add a little force pulling the patient's torso toward them if they cannot hold onto the table for extra support.
- Visualize the small, rapid motion (maybe 3 - 5".). The practitioner is trying to force the ilium to rotate or glide on the sacrum.
- Ensure the patient is not guarding.
- Tip: have the patient take a deep breath or wiggle their toes. The goal is to ensure that patient allows you to passively press through the resistance barrier created by the stiff joint.
- Quickly, thrust the patient into the new position, attempting to use body-weight and not arm strength.
- Slowly and gently release pressure, by standing up, tipping the patient back into supine, and giving the patient a minute to "catch their breath".
