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Sacrotuberous Ligament Sprains

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Sacrotuberous Ligament Sprains Unraveling the Mystery of Low Back Pain #4: Sacrotuberous Ligament Sprains Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. [email protected] 1 SPONSOREDSPONSORED BY:BY: Over 30 years of experience building the finest portable treatment tables and accessories. Products that are visually stimulating, ergonomically supportive, and incredibly comfortable. The superior design and engineering capabilities merge to create the ultimate experience for you and your clients. www.oakworks.com 717.235.6807 SPONSOREDSPONSORED BY:BY: Mattes chair Side-lying position system Webinar Goal • Explore the assessment and treatment of sacrotuberous ligament sprains 2 Pretest 1. When there is pain in the back thigh on bending into forward flexion, what are the two most likely injuries? 2. The sacrotuberous ligament refers pain down the anterior thigh and lateral lower leg, and into the great toe. True or False? 3. Extension of the low back stresses the sacrotuberous ligament. True or False? 4. A side-lying position puts the sacrotuberous ligament on the stretch so it is easily treated. True or False? 5. The sacrotuberous ligament is in part attached to the coccyx. True or False? Anatomy Anatomy of the Sacrotuberous Ligament • Thin, fan-shaped 3 Anatomy of the Sacrotuberous Ligament PSIS • Thin, fan-shaped • Attached to PSIS, sacrum, and coccyx Anatomy of the Sacrotuberous Ligament • Thin, fan-shaped • Attached to PSIS, sacrum, and coccyx Anatomy of the Sacrotuberous Ligament • Thin, fan-shaped • Attached to PSIS, sacrum, and coccyx • Inserts into the ischial tuberosity 4 Anatomy of the Sacrotuberous Ligament • Thin, fan-shaped • Attached to PSIS, sacrum, and coccyx • Inserts into the ischial tuberosity • Sometimes connected to biceps femoris Anatomy of the Sacrospinous Ligament • Attached to ischium, sacrum, and coccyx • Fibers intermingle with the sacrotuberous • Sometimes called the sacrosciatic ligaments (sacrospinous = anterior, sacrotuberous = posterior) How These Ligaments Work Together • Prevent posterior rotation of the ilium and sacrum 5 How These Ligaments Work Together • Prevent posterior rotation of the ilium and sacrum • Create boundaries of the lesser sciatic foramen and greater sciatic foramen Anatomy of the Coccyx • Prevent posterior rotation of the ilium and sacrum • Create boundaries of the lesser sciatic foramen and greater sciatic foramen Assessment 6 Test 1: Forward flexion Test 2: Straight leg raising Test 3: Resisted flexion of the knee 7 Theory Assessment Test Results for Sacrotuberous Ligament Injuries • Pain on forward flexion • Unique pain pattern • No pain on straight leg raise or resisted flexion of the knee • Local pain on palpation Causes of Sacrotuberous Ligament Injuries • Usually stretched slowly, sometimes strained in a sudden trauma • Poorly designed exercise program • Lack of exercise • Weak or inflexible hamstrings 8 Patterns of Sacrotuberous Ligament Injuries • Tends to affect both sides, one side more than the other • Often co-occurs with sacroiliac and iliolumbar injuries Treatment Friction Therapy Prone Side-lying Watch the video at the end of the Webinar 9 Friction Therapy • Be sensitive to the client’s comfort level as you work in this area • Obtain informed consent before proceeding Myofascial Therapy Massage Therapy • Buttock, lateral border of the sacrum, and lower attachment at the ischial tuberosity • Hamstrings 10 Primary Low Back Exercises Auxiliary Low Back Exercises • Gentler options • Used until the client can perform forward bending without pain Exercises on All Fours 11 The Cat The Dog Weight Shift 12 Leg, Arm, and Arm/Leg Extension Prone Exercise Leg Extension 13 Supine Exercises Pelvic Tilt & Pelvic Tilt Through the Back Pelvic Clock 14 Questions Facebook.com/DrBenBenjamin Post-test 1. When there is pain in the back thigh on bending into forward flexion, what are the two most likely injuries? 2. The sacrotuberous ligament refers pain down the anterior thigh and lateral lower leg, and into the great toe. True or False? 3. Extension of the low back stresses the sacrotuberous ligament. True or False? 4. A side-lying position puts the sacrotuberous ligament on the stretch so it is easily treated. True or False? 5. The sacrotuberous ligament is in part attached to the coccyx. True or False? 15.
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