Sacrotuberous Ligament Sprains Sacrotuberous

Unraveling the Mystery
of Low Back Pain #4:
Sacrotuberous Ligament
Sprains
Instructor: Ben Benjamin, Ph.D.
Instructor: Ben Benjamin, Ph.D.
ben@benbenjamin.com
1
SPONSORED BY:
SPONSORED
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
SPONSORED BY:
SPONSORED
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