11.2 Sacroiliac joint
Right innominate posterior
1 Patient positioning
Lower body. Straighten the patient’s lower leg and ensure that the leg and spine are in a straight line, in a neutral position. Flex the patient’s upper hip to approximately 90°. Flex the patient’s upper knee and place the heel of the foot just anterior to the knee of the lower leg. The lower leg and spine should form as near a straight line as possible with no flexion at the lower hip or knee.
Upper body. Gently extend the patient’s upper shoulder and place the patient’s right forearm on the lower ribs. Using your left hand to palpate the L5–S1 interspinous space, introduce right rotation of the patient’s trunk, down to and including the L5–S1 segment. This is achieved by gently holding the patient’s left elbow with your right hand and pulling it towards you, but also in a cephalad direction towards the head end of the couch. Be careful not to introduce any flexion to the spine during this movement. Now modify the pectoral hold by positioning the patient’s upper arm behind the thorax.
2 Operator stance
Stand close to the couch with your feet spread and one leg behind the other. Ensure that the patient’s upper knee is placed between your legs. This will enable you to make the necessary adjustments to achieve the appropriate pre-thrust tension (Fig. 11.4). Maintain an upright posture, facing in the direction of the patient’s upper body.
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