There are three major approaches to spinal analysis: segmental, tonal, and postural. In this month's column, I will be dealing with the segmental analysis to the pediatric pelvis. Specifically the functional, dynamic segmental approach.

It was the strong conviction of the medical community for many years that there was no normal sacroiliac or pubic motion in the absence of disease of pregnancy and that the sacrum and innominates moved as a whole. This opinion was disputed by empirical evidence submitted by chiropractic and osteopathic physicians since the turn of the century.

In recent years, the allopathic assumption has been proven a fallacy through cineroentgenographic studies and reports submitted by objective scientists. Only since the 1970s has sacral motion been recognized in allopathic literature -- an embarrassment never mentioned. (Schafer RC, Faye LJ: "Motion Palpation and Chiropractic Technic," ed 2. Huntington Beach, The Motion Palpation Institute, 1990, pp. 244-265.)

The sacrum's motion is multi-directional for 1-3mm as it "floats" within the pelvic ring. This motion is passive during the non weight-bearing positions and is a consequence of trunk or hip motion and must be able to simultaneously accommodate both of these motions. Sacroiliac motion occurs upward, downward, forward, backward and about a transverse axis to allow pelvic tilting.

According to Illi, the only vertebrate with a movable sacroiliac articulation is the human being. This movement of the sacroiliac joint is the effect of bipedism. Faye mentions that since the sacroiliac joints form their shape as a child matures as a biped, it is absolutely necessary that all children be examined periodically to assure normal sacroiliac function. He states: "Sacroiliac dysfunction in the young leads to abnormal gait and muscle development." (ibid)

When the articulations are mobile, the motions of the pelvis are always coupled. Thus, there is not one particular normal movement of the sacrum upon the ilia. The movement of the ilia is relative to the sacrum and each other.

Analysis

When palpating an infant, the parent can hold the child under the axilla. The doctor can then grasp the infant around the ilia and place one thumb on the sacrum S2 tubercle and the other on the PSIS. The doctor is then able to flex and extend the infants pelvis and feel for proper motion.

Upon flexion of the innominate, you are feeling for posterior inferior movement of the ipsilateral PSIS in relation to the S2 tubercle. You may also attempt to palpate the lower joint by dropping down to the PIIS and S3 tubercle as you would in an adult, however, this may be unnecessary depending upon the age of the infant.

In the child, you may initially palpate with the child seated by pushing forward on the PSIS, PIIS and on the sacrum. Feel for the forward movement of the joint.

In the standing position, you will be placing your thumb on the right PSIS and wrapping your hand around the right innominate to stabilize. Your left thumb will be placed on the S2 tubercle with your hand wrapping around the left innominate to stabilize. Have the child lift his or her right leg with the knee extended to approximately 45 degrees. Feel for the right PSIS to drop posterior and inferior. Then have the child lift his or her left leg and feel for the child's S2 tubercle to drop inferior.

Next, drop to the inferior joint by placing your right thumb on the PIIS and your left thumb on the S3 tubercle. Once again, have the child lift each leg and feel for the proper movement. Now, reverse your hands to the upper joint on the left and repeat the process.

If the normal movement of the sacroiliac joint is absent or altered, it is indicative of a fixation or pathomechanics. This area should be considered for an adjustment in conjunction with any other areas of subluxation. Using your clinical knowledge, determine which areas are primary and which are compensatory prior to adjusting.

This type of analysis is very specific as well as quick and easy to perform. This simple procedure is known as "Gillet's Standing Straight-Leg-Raising Test." This test enables you to characterize the functional component of the pediatric patients pelvis. Through performing this test you will feel more certain in locating the areas of subluxation and have the clinical competence to confidently adjust pediatric patients.