anterior innominate rotation on the right

This patient has a typical history and physical examination consistent with Mechanical Low Back Pain.

The osteopathic examination reveals the diagnosis of an anterior innominate rotation on the right.

• The first step in making this diagnosis is determining the side of the dysfunction. The patient's history points toward a right sided dysfunction, however the discomfort does not always correlate with the side of dysfunction. It is important to not just chase pain complaints, but to thoroughly evaluate the musculoskeletal system for somatic dysfunction.

The side of dysfunction in innominate dysfunctions can be determined using the standing flexion test.

• This is done by putting your thumbs on the underside of the PSIS and having the patient bend forward at the waist.
  • If asymmetry in motion is detected, the side with the PSIS that moves more cephalad is considered the positive side, and is the side of the somatic dysfunction.
  • The practitioner must then evaluate for symmetry or asymmetry between the bilateral ASISs and PSISs and assess for leg length discrepancies.
  • In an anteriorly rotated innominate, the ipsilateral ASIS will be inferior while the ipsilateral PSIS will be superior.
  • There will also be an apparent long leg ipsilaterally.