sacrotuberous ligament sprains - ben benjaminbenbenjamin.com/webinars/lowbackwebinar4.pdf · 5...

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Unraveling the Mystery of Low Back Pain #4:

Sacrotuberous Ligament Sprains

Unraveling the Mystery of Low Back Pain #4:

Sacrotuberous Ligament Sprains

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

[email protected]@benbenjamin.com

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www.oakworks.com 717.235.6807

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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.

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Side-lying position system

Matteschair

Webinar GoalWebinar Goal

• Explore the assessment and treatment of sacrotuberousligament sprains

• Explore the assessment and treatment of sacrotuberousligament sprains

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PretestPretest

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?






AnatomyAnatomy

Anatomy of the Sacrotuberous Ligament


• Thin, fan-shaped• Thin, fan-shaped

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• Thin, fan-shaped

• Attached to PSIS, sacrum, and coccyx



PSIS











• Inserts into the ischial tuberosity




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• Sometimes connected to biceps femoris




• Sometimes connected to biceps femoris

Anatomy of the Sacrospinous Ligament

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)

• 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


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• Create boundaries of the lesser sciatic foramen and greater sciatic foramen



Anatomy of the CoccyxAnatomy of the Coccyx





AssessmentAssessment

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Test 1: Forward flexionTest 1: Forward flexion

Test 2: Straight leg raisingTest 2: Straight leg raising

Test 3: Resisted flexion of the kneeTest 3: Resisted flexion of the knee

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TheoryTheory

Assessment Test Resultsfor Sacrotuberous Ligament Injuries

Assessment Test Resultsfor 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

• 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

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

• Usually stretched slowly, sometimes strained in a sudden trauma

• Poorly designed exercise program

• Lack of exercise

• Weak or inflexible hamstrings

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Patterns of Sacrotuberous Ligament Injuries

Patterns of Sacrotuberous Ligament Injuries

• Tends to affect both sides, one side more than the other

• Often co-occurs with sacroiliac and iliolumbarinjuries

• Tends to affect both sides, one side more than the other

• Often co-occurs with sacroiliac and iliolumbarinjuries

TreatmentTreatment

Friction Therapy

Watch the video at the end of the Webinar

Friction Therapy

Watch the video at the end of the Webinar

Side-lyingSide-lyingProneProne

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Friction Therapy Friction Therapy

• Be sensitive to the client’s comfort level as you work in this area

• Obtain informed consent before proceeding

• Be sensitive to the client’s comfort level as you work in this area

• Obtain informed consent before proceeding

Myofascial Therapy Myofascial Therapy

Massage Therapy Massage Therapy

• Buttock, lateral border of the sacrum, and lower attachment at the ischial tuberosity

• Hamstrings

• Buttock, lateral border of the sacrum, and lower attachment at the ischial tuberosity

• Hamstrings

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Primary Low Back ExercisesPrimary Low Back Exercises

Auxiliary Low Back ExercisesAuxiliary Low Back Exercises

• Gentler options

• Used until the client can perform forward bending without pain

• Gentler options

• Used until the client can perform forward bending without pain

Exercises on All FoursExercises on All Fours

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The CatThe Cat

The DogThe Dog

Weight ShiftWeight Shift

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Leg, Arm, and Arm/Leg ExtensionLeg, Arm, and Arm/Leg Extension

Prone ExerciseProne Exercise

Leg ExtensionLeg Extension

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Supine ExercisesSupine Exercises

Pelvic Tilt & Pelvic Tilt Through the Back

Pelvic Tilt & Pelvic Tilt Through the Back

Pelvic ClockPelvic Clock

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QuestionsQuestions

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

Post-testPost-test











sacrotuberous ligament sprains - ben benjaminbenbenjamin.com/webinars/lowbackwebinar4.pdf · 5...

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