Innominate (Pelvic) Dysfunctions

◆Innominate anatomy

• •Each innominate = ilium + ischium + pubis
• •Sacroiliac joint: motion at SI is small but significant
• •Common in low back/SI pain, post-partum, falls onto buttocks

◆Diagnosing innominate dysfunctions

• •Standing flexion test: positive on side of dysfunction (PSIS rises higher on dysfunctional side)
• •Compare landmarks bilaterally: ASIS, PSIS, pubic tubercle, ischial tuberosity, medial malleolus

◆Anterior rotation (forward)

• •ASIS on dysfunctional side: INFERIOR (lower)
• •PSIS on dysfunctional side: SUPERIOR (higher)
• •Leg appears LONGER on affected side
• •Common with hip flexor tightness
• •Treatment: muscle energy — patient supine, extend hip on affected side and pull leg into table (hamstring activation)

◆Posterior rotation (backward)

• •ASIS: SUPERIOR (higher)
• •PSIS: INFERIOR (lower)
• •Leg appears SHORTER on affected side
• •Treatment: muscle energy — patient supine, flex hip on affected side (psoas/quad contraction against resistance)

◆Innominate upslip (superior shear)

• •ASIS, PSIS, ischial tuberosity, and pubic tubercle ALL superior on affected side
• •Leg shorter on affected side
• •Often after fall on buttock
• •Treatment: HVLA (long-axis traction with internal/external rotation) most effective

◆Innominate downslip

• •All landmarks INFERIOR on affected side
• •Leg longer on affected side
• •Less common
• •Treatment: muscle energy or HVLA with traction

◆In-flare / Out-flare

• •In-flare: ASIS closer to midline (medial) on affected side
• •Out-flare: ASIS farther from midline (lateral)
• •Often coexists with rotational dysfunction

◆Pubic shear

• •Superior pubic shear: pubic tubercle superior on affected side; tender on palpation
• •Inferior pubic shear: pubic tubercle inferior
• •Treatment: muscle energy with adductor or abductor contraction; or 'shotgun' technique (resisted abduction → adduction)

Innominate dysfunctions — landmark patterns