Pelvis muscle energy treatment

Notes

Pelvis

Pelvis muscle energy treatment

MUSCLE ENERGY OF THE PELVIS
SOMATIC DYSFUNCTION
POSITIONING
PATIENT FORCE
Superior innominate shear
  • Patient supine
  • Grasp above the patient’s medial malleolus, abduct and internally rotate the dysfunctional lower extremity, gently add traction
  • Pull dysfunctional hip cephalad (can also have patient push against you with opposite foot) while you resist
Inferior innominate shear
  • Patient prone with dysfunctional side of pelvis off the side of the table
  • Flex and abduct the hip, exert a cephalad and slightly lateral force during inhalation on the ipsilateral ischial tuberosity
  • During inhalation, patient attempts to straighten out ipsilateral arm that is holding the side of the table, resulting in a caudad force on the hip
  • During exhalation, patient relaxes while you take up the slack
Superior pubic shear
  • Patient supine with dysfunctional lower extremity off the edge of the table in hip extension
  • Push down (toward floor) just inferior to the patella
  • Ipsilateral hip flexion and slight adduction while you resist
Inferior pubic shear
  • Patient supine with dysfunctional hip and knee flexed and knee placed in your axilla
  • Place your hand on ipsilateral ischial tuberosity and exert superior and medial force
  • Straighten leg (push knee into your axilla) while you resist movement at the ischial tuberosity
Anterior innominate rotation
  • Patient supine (or prone with lower extremity off the edge of the table) with dysfunctional hip and knee flexed
  • Force hip further into flexion
  • Ipsilateral hip extension while you resist
Posterior innominate rotation
  • Patient prone (or supine with lower extremity off the edge of the table) with dysfunctional side in hip extension 
  • Force hip further into extension
  • Ipsilateral hip flexion while you resist
Innominate outflare
  • Patient supine
  • Instruct patient to cross lower extremity of dysfunctional side over the other (so that foot lies on the lateral side of the “normal” innominate), pull hip across into further adduction
  • Ipsilateral hip abduction and external rotation while you resist
Innominate inflare
  • Patient supine
  • Instruct patient to cross lower extremity of dysfunctional side over the other (so that foot lies on the lateral side of the “normal” innominate), push at medial knee to induce hip external rotation
  • Ipsilateral hip internal rotation while you resist
Pubic compression
  • Patient supine with bilateral hips and knees flexed
  • Place your forearm between the patient’s knees and push them apart
  • Bilateral hip adduction and internal rotation while you resist
Pubic distraction
  • Patient supine with bilateral hips and knees flexed
  • Push the patient’s knees together
  • Bilateral hip abduction and external rotation while you resist
Figure 1. Innominate rotation is diagnosed by evaluating the movement of the ASIS and PSIS. Anterior innominate rotation: ASIS is inferior, PSIS is superior. Posterior innominate rotation: ASIS is superior, PSIS is inferior.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Abbey Richard
Editor: Robyn Hughes, MScBMC

Key Takeaways

Pelvic muscle energy treatment (PMET) is a manual therapy technique involving the use of specific muscle contractions to improve muscle function and mobility in the pelvis. It is based on the idea that the muscles of the pelvis can become restricted in their movement and function, leading to pain and dysfunction. PMET can be used to treat a variety of conditions such as pelvic pain, sacroiliac joint dysfunction, and coccyx pain.