Weekly Focus - Category II

Category II/ Heel Lifts

Dr. Dejarnette classified three different types of sacroiliac problems.  The Category II is a bony misalignment between the ilium and sacrum.  Dr. Dejarnette was a contemporary of Dr. Goodheart Sr., and this led Dr. Goodheart Jr. to be very interested in the SOT Categories.  The Category II lesion may be corrected with an osseous adjustment or blocking procedure.

Indications:

• The patient may have lateral sway
• Can be associated with a spheno-basilar fault

Therapy Localization:

• With the patient in a supine position, the patient contacts first one sacroiliac joint and then the other and a strong muscle is tested for weakening (one hand to one joint)
• In SOT technique, they talk about the arm fossa test.  This is a test of a straight arm and therapy localization to the inguinal ligament,
• The upper portion (fossa) of the ligament (by the ASIS)
• The lower part (fossa) of the ligament (by the pubic bone)
• PI ilium
  • Will show tenderness at the insertion of the sartorius and gracilis as well as the first rib head
  • Will also show a short leg
  • The weakness of the sartorius, gracilis or rectus femoris should be expected
  • Upper fossa weakening on the arm fossa test
  • Involves the upper SI joint
  • Flexion malposition of the pelvis

• AS Ilium
• Will show tenderness on the lower IT band above the knee, as well as the first rib and obturator foramen.
• The weakness of the biceps femoris and the vastus lateralis and occasionally abdominal defects
• Lower fossa weakening on the arm fossa test
• Will show long leg
• Involves the lower SI joint
• Extension malposition of the pelvis

• In Ilium
• The weakness of the transverse and oblique abdominals
• The weakness of the arm fossa test will be negated by a breath held out
• Ex Ilium
  • The weakness of the gluteus medius/minimus
  • The weakness of the arm fossa test will be negated by a breath held in

Correction:

• Maybe done with a high-velocity osseous adjustment:
• Challenge and adjust as normal

Blocking Procedure:

1. TL the entire SI joint against a strong indicator muscle. The weakening of the strong muscle will determine the side of the lesion.
2. The weakening of indicator muscle will:

• Test the possible associated muscle for an AS or PI ilium.
• Perform the arm fossa test to determine upper or lower fossa weakness.
• UMS: Upper fossa, Medial knee pain, Short Leg = PI
• LLL: Lower fossa, Lateral thigh pain, Long Leg = AS
• If all aspects correlate, then, continue to the correction

1. Osseous adjustments are done in your typical fashion

• If a breath held on inspiration negates the arm fossa test, then an EX is indicated
• If a breath held on expiration negates the arm fossa test, then an IN is indicated.

SOT blocking procedures are a powerful non-traumatic way to correct this problem

• Place the involved side block first
• PI side: the block will be placed at the level of the PSIS at 90° to the spine
• AS: side the block will be placed at the level of the ischial tuberosity at approximately 45° to the spine “facing” the opposite block
• This should negate the arm fossa test
• The procedure is complete when all arm fossa test is weak
• Both blocks should be removed simultaneously