Sacral Nutation Block
Assessment of the Sacro-illiac Joint
The SNB was developed by the Australian Institute of Sport (AIS) Physical Therapies Department to assist manual therapists in assessment of the sacro-iliac joint as well as mobilisation of limited sacral nutation in appropriate patients. It can provide a means of self mobilisation of sacral nutation for appropriate patients. The SNB may also be used in the stabilisation/mobilisation of other spinal and peripheral joints
Indications for use:
- Sacroiliac nutation assessment.
- Mobilisation of restricted sacro-iliac nutation
Contraindications of use:
- Inflammatory sacro-iliac conditions such as, active Ankylosing Spondylitis or Reiter's Syndrome.
- Instability or hypermobility syndromes of the sacro iliac joint
- Note: Use of the SNB may lead to exacerbation of these conditions.
The effective angle of sacral support for the SNB has been set at 15 degrees of flexion (nutation) from neutral. Unpublished data indicates that the neutral sacral position of elite rowers in the standing position ranged from 8-18 degrees. This data was obtained utilising an inclinometer on the posterior sacrum.
Treating Position
- Ideally use a firm, flat surface (firm treatment couch, carpeted floor).
- The patient sits in long sitting, with the therapist positioning the upper edge of the SNB 1-2 cm below the posterior superior iliac spines as shown.
- The therapist assists the patient to recline to supine ensuring all of the posterior sacrum is in contact with SNB. Some adjustment may be required for optimal positioning.
- Patient assumes a crook lying with hips flexed to 45 degrees.
Assessment
- The relative amount of ilio-sacral posterior rotation (unilateral sacro-iliac nutation) can be determined by the therapist performing a combined posterior rotation/shear of the inominate at the ASIS, in the plane of the sacroiliac joint.
Mobilising Technique
- The therapist mobilises posterior iliac rotation (unilateral nutation) in the plane of the sacro-iliac joint.
- The therapist may instruct the patient to perform self mobilisation of sacral nutation as a home exercise by crook lying or supine lying with the SNB positioned as above. The patient mobilises by posteriorly tilting the pelvis
- It may be useful to follow-up the mobilisation with the patient in standing. Weight bearing on alternate legs for 20 -30 seconds with spine slightly extended can help to 'bed in' nutation.
- The patient can follow this up by emphasising nutation in walking.
- Neural mobilisation (slides/glides) of the sciatic nerve performed whilst having the patient positioned on the SNB may be a useful adjunct to other lumbo-sacral or neuro-meningeal mobilisation techniques where indicated.
Disclaimer
This information has been provided solely as general guideline and is not professional advice and should not be relied upon by either therapists or patients as professional advice. A qualified manual therapist must make his or her own determination in each case as to the suitability of the use of the SNB and application of these guidelines
The SNB is supplied for use under the guidance of a qualified manual therapist (Doctor, Physiotherapist, Chiropractor or Osteopath) who should determine suitability in each case.
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