11.4 Sacroiliac joint
Sacral base anterior
1 Patient positioning
Lying on the right side with a pillow to support the head and neck.
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 and knee slightly and place the upper leg just anterior to 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 left forearm on the lower ribs. Using your right hand to palpate the L5–S1 interspinous space, introduce left rotation of the patient’s trunk down to and including the L5–S1 segment. This is achieved by gently holding the patient’s right elbow with your left 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. Take up the axillary hold. This arm controls and maintains trunk rotation.
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