2ILIAC BONE 中英文.ppt

1、Structural Osteopathy Iliac bone,TakeCare Osteopathic Academy Milano - Italy,结构性整骨术 髂骨,TakeCare 米兰整骨学院 Milano - 意大利,1,General considerations 总论,The normalization of the pelvic girdle is an essential step in the osteopathic approach. 矫正骨盆带是整骨方法的一个重要步骤。,Cranio-sacral field: synergistic mobility of the

2、 skull and sacrum, main points of insertion of the dura mater. 颅骶领域：颅骨和骶骨的同步移动，它们是硬脑膜两个主要的嵌入点 Mechanics of the pelvis: 4 bones arranged in “mechanical assembly”, placed between spine and lower limbs. 盆骨的结构：4块骨头以特殊的力学结构排列于脊柱与与下肢之间。,2,Ascending and descending mechanical chains: ascending and downward

3、forces of gravity materialize the resistance to the ground. 上行和下行的力学链: 向上的力和向下的重力演化为对地面的抵抗 Visceral field: pelvis represents the base on which peritoneal organs rest. 内脏领域:骨盆承载和支撑着腹腔器官。 Reproductive system: pelvis is “the temple of reproductive organs and the development site of a new life” 生殖系统：骨盆是

4、“生殖器官的宫殿”，是“孕育新生命的摇篮”,3,Sacro-Iliac joint (SIJ) 骶髂关节 (SIJ),ARTRODIA (synovial joint, flat surfaces, only slipping movement permitted) ARTRODIA (滑膜关节，表面平坦，仅允许滑动) Presence of cartilage, capsule, synovial and ligamentous apparatus 软骨、关节囊、滑膜和韧带等结构 Sacral auricle: empty track, concave. 骶骨耳状面：空隙, 凹面. Divi

5、ded into: 可分为: SHORT ARM (upper portion): directed down, forward, inside 短臂（上部）： 方向下前内向 LONG ARM (lower portion): directed down, back, inside 长臂（下部）：方向下后内向,Possible causes of SIJ block: 引起骶髂关节障碍的原因可能是： Altered static due to trauma (of lower limbs, pelvis, spine, during pregnancy or childbirth.) 外伤（下

6、肢、骨盆、脊柱、妊娠或分娩）改变机体稳定性 Inner organs reflected projections 内部器官的异常 Dura mater tensions 硬脑膜紧张,4,Axes of movement 运动轴向,Flexion Extension movement occurs around medium transverse sacral axis, S2 level, in corrispondence of interosseus ligament 屈伸运动围绕着S2水平骶骨中间横轴，同时伴有骨间韧带的运动,5,Pelvic Physiology 骨盆生理机能,Beca

7、use of the free movements of the sacrum between the 2 iliac bones and the shape of the sacral wedge, the downward force will tend to drive the sacrum forward. 由于骶骨在两块髂骨间的自由运动，以及骶骨的楔形形状，向下的力将推动骶骨往前。 Then pubic symphysis form the frontal restraint of sacrum; note that interpubic ligaments are very pow

8、erful.接着耻骨联合形成“骶骨前限制”；应注意，耻骨间韧带非常强大。,6,Oblique axes 斜轴,Two diagonal axes cross the sacrum, called “torsion axes”, from the base to the contralateral apex (or Inferior Lateral Angle). 从基底到对侧顶点（或下侧角）穿过骶骨的两条对角轴称为“扭转轴” Around them takes the twisting motion of the march 行走时的扭转运动即发生于此,对角线,矢状轴,对角线,耳状面,7,Ax

9、es of movement 运动轴向,During the march, the sacrum rotates around the vertical axis 行走时，骶骨绕垂直轴旋转,垂直轴,横轴,矢状轴,8,Muscles acting on SIJ 骶髂关节的肌肉作用,9,Symphysis Pubis 耻骨联合,Symphisys belongs to the pelvic chain joint. 耻骨联合属于骨盆关节链。 This means that pelvic movements always affect on it and vice versa. 这意味着，它一直受骨

10、盆运动的影响，反之亦然。 There are 3 axes around which the movements take place. 它可绕3个轴向进行运动。,10,Sacro coccygeal joint 骶尾关节,Around the transverse axis (S2 level) occurs flexion-extension movements 绕横轴 (S2平面)进行屈-伸运动 Coccyx dysfunctions (usually ventral) depends on: 尾骨功能障碍 (常见于腹部) 来源于: Trauma of childbirth 分娩的创伤

11、Dysfunctions of the spine 脊柱功能障碍 Fall on the coccyx 跌倒所致尾骨损伤 Trauma of the skull 颅骨外伤,11,POSTERIOR Contact Points,Iliac Crest 髂嵴,Posterior Superior Iliac Spine,Ischial Tuberosity 坐骨结节,Sacral Base,Iinferior Lateral Angle,后方韧带附着,髂后上棘,骶骨底,下外侧角,12,ANTERIOR contact points,Anterior Superior Iliac Spine,Pu

12、bis,Greater Trochanter,Iliac Crest 髂嵴,前方韧带附着,髂前上棘,大转子,耻骨,13,Cranio-Sacral Physiology 颅-骶生理机能,Cranium and Sacrum are mechanically connected by the spinal dura mater, that fits on occipitum, C1-2 and over the back of the body of S2. 颅骨和骶骨由硬脊膜力学性连接，起于枕骨、C1-2，止于S2的椎体背部。 The tension of the dura mater cau

13、sed by the mobility of the skull produces the sacral flexion-extension around the upper transverse axis, S1 level. 颅骨移动引起的硬脑膜紧张，使得骶骨围绕S1平面的上部横轴进行屈伸运动。 During the flexion of the skull, the dura is tense and the bases of the sacrum are posterior. 颅骨屈曲时，硬脑膜紧张，骶骨底后移。 During flexion of the sacrum, the il

14、iac bones perform External Rotation 骶骨屈曲时，髂骨外旋。,14,The osteopathic dysfunction is named in the direction of the greatest amplitude of mobility.,OSTEOPATHIC DISFUNCTIONS,整骨治疗中的功能障碍,整骨治疗中的功能障碍即在于最大的运动幅度处,15,Ilio-sacral dysfunctions 髂-骶功能障碍,Standing Flexion Test 站立位屈曲测试 Sitting Flexion Test 坐位屈曲测试 Stor

15、k test (One-legged test) Stork测试 (单腿测试) Standing Diagnosis, by contact points to denominate a dysfunction 站立位诊断，以压痛点命名功能障碍 F.AB.E.RE. Test F.AB.E.RE. 测试 Downing test Downing 测试,How to test ilio-sacral dysfunctions 如何检查髂-骶功能障碍,16,PATIENT: 患者: Parallel feet, about as wide shoulders 双脚平行，与肩同宽 - Body we

16、ight equally distributed on two feet, knees straight 膝盖伸直，身体重量平均分布于双脚 - Start flexion from the head and get up to the maximum. 从头部开始屈曲，达到最大限度后起身,OSTEOPATH: 治疗师: - Hands on the iliac crests 双手置于髂嵴部位 - Inches below the PSIS 髂后上棘以下几英寸 - Evaluate height of PSIS 评估髂后上棘的高度 - Ask to flex torso 要求患者躯干屈曲 - T

17、humb more attracted upwardindicates the side of the ileosacral lesion 拇指上移，则该侧出现髂骶功能障碍,Standing Flexion Test 站立位屈曲测试,Sensible test, but non-specific (shows theres a dysfunction but not which one). Highlights ascending problem (starting from bottom, hip, leg, knee or ankle).,感知测试，非特异性 （显示存在功能障碍，但不指明具

18、体位置）。 强调上升性问题（从最底部开始，髋，腿，膝或踝）,17,INTERPRETATION 结果解释 Positive Test 测试阳性 - Thumb upward indicates positivity. 拇指转为上翘，则结果为阳性 - if a PSIS starts first (the one that starts first is positive), indicates that theres a restriction of movement between sacrum and iliac (missing the latency time related to t

19、he tensioning of the soft tissue structures) 如果一侧髂后上棘移动（该侧结果为阳性），则骶骨和髂骨间存在运动限制（缺少软组织结构紧张的缓冲时间）Thumb raises more indicates an ilio-sacral malfunction, thats low possibility of movement of iliac with respect to sacrum. 若拇指向上位移，则显示机体出现骶髂功能障碍, 髂骨运动的相对骶骨的运动性很低。 Negative Test 测试阴性 PSIS start together 髂后上棘

20、同步移动,Standing Flexion Test 站立位屈曲测试,18,Specific test for the ileum 针对髂骨的具体性测试 (tells us the side of the iliac dysfunction) （可检测哪一侧出现髂骨功能障碍）,OSTEOPATH 治疗师 - Hands contact the iliac crests 双手触摸髂嵴 - A thumb on the sacral base 一侧拇指置于骶骨底 - A thumb on the ipsilateral PSIS (on the side where patient flex lo

21、wer limb) 另一拇指置于同侧（患者下肢屈曲的一侧）的髂后上棘 NOTE: The test must be done bilaterall 注意:：该测试必须双侧进行 - Ask the patient to flex lower limb and then rest to the floor 要求患者屈曲下肢，站立于地板 - Test slowly 缓慢进行 - In case of balance problems, provide support 若患者有平衡障碍，给予一定支撑,Stork Test (one-legged) Stork 测试（单腿）,PATIENT 患者 - S

22、tanding, lower limbs straight 站立，下肢伸直,19,POSITIV TEST 测试阳性(Establishes the ileo-sacral side of the lesion) （确定哪一侧出现骶髂功能障碍） PSIS ascends with respect to the ipsilateral sacral base PSIS remains the same (no movement) 髂后上棘相对于同侧骶骨底有所上升 髂后上棘拇指保持不变（没有移动） NEGATIV TEST 测试阴性 Thumb on the PSIS goes down comp

23、ared with the thumb on the ipsilateral sacral base (the joint is free; response is normal) 相对骶骨底拇指，髂后上棘拇指下移 （关节自由；反应正常）,Stork Test Stork 测试,20,INTERPRETATION 结果阐释 Positiv test: 测试阳性： Thumb that raises more indicates a sacro-iliac dysfunction 拇指上移过多，则存在骶-髂功能障碍,Sitting Flexion Test 坐位屈曲测试,21,Discrimin

24、ating the origin of the problem: If STANDING F.T. Is positive (+) and SITTING F.T. Is negative (-): problem comes from the bottom (ileo-sacral origin) If SITTING F.T. Is positive (+) and STANDING F.T. Is negative (-): problem comes from the top (sacro-iliac problem). With patient sitting, it exclude

25、s the influence of lower limbs to which the positivity (+) indicates a problem atthe sacroiliac (not ilio-sacral),How to evaluate Standing and Sitting Flexion Tests,23,判别问题的根源： 如果站立位屈曲测试阳性(+) ，坐位屈曲测试阴性(-): 问题来源于底部（由髂至骶） 如果坐位屈曲测试阳性(+) ，站立位屈曲测试阴性(-): 问题来源于顶部 （由骶至髂）。 患者处于坐位，排除下肢的影响，阳性结果(+)表明问题出现在骶髂关节（而

26、非由髂至骶）,如何评估站立位和坐位屈曲测试,24,F = Flexion + AB = Abduction + ER = External Rotation E = Extension of the hip,EXECUTION - Patient supine; - Operator on the side to evaluate - Flex the hip (opposite heel to knee level) - Ask your patient to let drop the knee to the ground, gently push the knee toward the c

27、ouch - Repeat the procedure with the opposite leg and compare the mobility,POSITIV TEST Hip pathology is revealed with a rmovement restriction or pain during the test NEGATIV TEST No restriction or pain If no problems at the hip, go on with Downing Test,F. AB.ER.E. TEST,25,F = 屈曲 + AB = 外展 + ER = 外旋

28、 E = 髋伸,操作 - 患者仰卧； - 治疗师位于一侧进行评估 - 屈曲髋关节 (脚后跟到对侧膝关节水平） - 要求患者膝盖下压，朝床垫方向轻压膝关节 - 另一侧下肢重复上述过程，并对比活动度,阳性测试 测试过程中出现运动限制或疼痛，则存在髋关节疾病 阴性测试 未出现运动限制或疼痛 若髋关节没有问题，继续进行 Downing测试,F. AB.ER.E. 测试,26,DOWNING Test,By this test is only possible to diagnose typical iliac dysfunctions, that is ANTERIOR and POSTERIOR R

29、OTATION (front and rear conversion) Negative test in case of atypical iliac dysfunctions. Aim of the test is to induce a forwards (elongation test of the lower limb) or a backwards iliac conversion (shortening test o the lower limb), by using the stretch/detension of hip joint ligaments.,DOWNING测试只能

30、诊断典型髂骨功能障碍，即旋前和旋后（前、后转换） 非典型髂骨功能障碍的情况，结果为阴性。 测试的目的是通过髋关节韧带的伸展/ 放松，诱发髂骨向前（下肢伸长测试），或向后变化（下肢缩短测试）,27,PREPARATION: 准备工作： Initially let make a “bridge” move to cancel the tension of both hips. 首先，下肢成“桥”形，消除髋关节紧张 Check lenght of both malleolus at each step 每一步骤均检查脚踝长度,PURPOSE: 目的： Define the ilio-sacral d

31、ysfunction (front or rear conversion) 确定髂-骶 功能障碍（前后转换） In both tests is used the tension of the hip joint ligaments 测试均利用髋关节韧带的张力,DOWNING Test,28,SHORTENING TEST - Make the test after positive Stork test - Posterior iliac conversion (it shortens lower limb) is possible through the stretch of ischio-

32、femoral ligament and detension of all Bertin ligament (both beams, upper and lower, of iliofemoral lig.) - Adbuction stretches ischiofemoral lig and detense upper beam of Bertin lig. - Internal rotation increases the stretch of ischio-femoral ligament and detenses lower beam of Bertin lig.,EVALUATE

33、MALLEOLOUS: If Shorter: iliac free If Equal: anterior iliac dysfunction,- Drive lower limb out of the crib (abduction) - With the caudal hand grasps the ankle bringing the hip in abduction and rotation internal (driving backwards ileum) - Downing-test is valid only with total integrity of the hip (h

34、ighlighted with test F.AB.ER.E.),DOWNING Test,29,缩短测试 - Stork测试为阳性，进行该测试 - 坐骨-股骨韧带的拉伸，以及所有Bertin韧带（髂股韧带的上下部) 的放松，均可能导致后髂转换（下肢缩短） - 外展会拉伸坐股韧带放松Bertin韧带的上部 - 内旋会拉伸坐股韧带放松Bertin韧带的下部,评估脚踝： 变短: 髂骨游离 相同: 前髂功能障碍,- 外展下肢 - 靠近足部的手抓住脚踝使得髋外展和内旋 (向后拉髂骨) - Downing测试只有在髋部全部参与的情况下才有效(与 F.AB.ER.E.测试同结果),DOWNING 测试,3

35、0,ELONGATION TEST: - Iliac Anterior Conversion (extends lower limb) is possible through the tension of the Bertin ligament (ilio-femoral lig.) - Make the test after positive Stork test Execution: - Hip adduction to stretch superiorbeam of the iliofemoral lig. - Hip External Rotation to stetch lower

36、beam of iliofemoral lig.- Hold for 10 seconds- Return the leg in the neutral position and re-evaluate if there was elongation.,EVALUATE MALLEOLOUS: If Longer: iliac free If Equal: posterior iliac dysfunction,- Adduction needs to pass over the knee of lower limb to be tested and this causes little fl

37、exion. - Osteopath grabs ankle with caudal hand while the cranial drives knee in Extrarotation.,31,伸长测试： - 通过Bertin韧带（髂骨-股骨韧带）的张力，可能发生前髂转换（下肢伸长） - Stork测试为阳性，进行该测试 操作： - 髋关节内收，拉伸髂股韧带的上部 - 髋关节外旋，拉伸髂股韧带的下部 - 保持10秒 - 下肢回到中立位，检查是否变长,评估脚踝： 变长:髂骨游离 相同: 后髂功能障碍,- 内收测试需将下肢越过对侧膝关节，这将造成一定的屈曲 - 治疗师用靠近足部的手握住踝关节，

38、靠近头部的手使得膝关节外旋,32,Closing key 关闭关键点,Before starting with the corrective techniques, we must be able to perform the “closing key”. 矫正技术开始前，必须能够关闭关键点 The purpose is to create two blocks (levers), upper and lower, from each side of the joint to be normalized. 目的是产生两个一上一下阻滞点（杠杆），来自要调整的关节,33,Closing key o

39、f the lower block,The patient is in the lateral decubitus position. The dysfunctional segment is positioned above. The osteopath place two fingers on horseback of sacroiliac joint: - Index on sacrum - Thumb on PSIS Osteopath drives a passive hip and knee flexion until feeling the iliac movement with

40、 respect the sacrum.,患者处侧卧位 存在功能障碍的部位朝上 治疗师将两个手指放在骶髂关节的弯点： - 食指位于骶骨 - 拇指位于髂后上棘 治疗师驱动患者被动地屈伸髋关节和膝关节，直至感觉到髂骨相对于骶骨运动。,34,35,Closing key of the upper block 上肢障碍的关闭关键点,After closing the lower lever, with the cephalic hand through the contralateral upper limb traction, drives a de-rotation of the spine. 在

41、关闭上点后，靠近头部的手通过对上肢的 ，防止脊柱的旋转 The drive must reach out and drag the sacrum without dragging the hipbone. 这样的引导必须拖动骶骨但同时不能拖动髂骨,36,37,Typical iliac dysfunctions,Typical iliac dysfunctions are characterized by a block of iliac bone (compared to the sacrum) in anterior or posterior position, along the axi

42、s of the virtual movement called L.C.A (lower cross-axis), that is formed along the apex of the lower arm and is represented by the contracture of gluteus medius, piriformis muscle and TFL (Tensor Fasciae Latae), with no alteration of bone surfaces (sacro-iliac joint). By convention, the osteopathic

43、 dysfunction is defined in the direction of the greatest amplitude of dysfunctions; so we can distinguished: Anterior and Posterior iliac.,典型的髂骨功能障碍,典型的髂骨功能障碍主要特征为髂骨前部或后部的障碍（相对于骶骨），沿着实际运动轴向的称为L.C.A（低水平轴线）的轴线转动，由下骨臂的顶点构成，臀中肌梨状肌阔筋膜张肌挛缩时发生, 而不改变骨的表面(骶髂关节). 一般约定，整骨的功能障碍由最大运动幅度障碍的方向决定；所以我们可以划分前后髂骨。,38,Il

44、io-sacral Dysfunctions,We can recognize: TYPICAL lesions: anterior / posterior TRAUMATIC lesions: up slip / down slip,髂-骶 功能障碍,我们可以识别： 典型障碍：前部/后部 外伤障碍：上滑/下滑,39,This name defines an iliac bone in dysfunction that constantly remains forwards , not able to move backwards; then possibility of anterior c

45、onversion but not posterior. Anterior rotation in the sagittal plane, external rotation in the frontal plane and front sliding in the horizontal plane The result is a permanent opening of the Great Pelvis and closing of teh Small, due to the obliquity of the short arm (low-forward-out). Palpatory ex

46、amination shows: a lower iliac crest of the dysfunctional side, causing a lengthening of the lower limb So ipsilateral: ASIS will be lower, most anterior and farther from the midline than the contralateral. The pubic branch will be the lower and more anterior with a slight opening of the upper porti

47、on of the symphysis and a slight closing of the lower one, with a constant tension of the fibrous sleeve. The PSIS will be found higher, forward and outward with respect to the contralateral side. The ischial tuberosity will be higher, in behind and inside. The sacroiliac groove is wide and shallow.

48、 The ligaments tense and painful: ilio-lumbar (lower than most), posterior sacrum-iliac lig and upper beam of inter-pubic lig. Big and little sacrum-ischiatic ligaments are released Sore muscles are: gluteus maximus, adductor, hamstring, and rectus abdominis,ANTERIOR ILIAC,41,这是对不能向后运动而保持向前的髂骨的定义，即只

49、能向前而无法向后 矢状面内的前旋，额状面内的外旋和水平面内的向前滑动 这样的结果是大骨盆的一直打开和小骨盆的一直关闭，根据短臂的倾斜下前外向 触诊显示：障碍侧的低髂棘会导致下肢伸长 所以同侧有: 髂前上棘更低，比对侧更向前且远离中线 耻骨支会变得更低更前，同时耻骨联合上部轻微打开下部轻微关闭 且纤维袖张力升高 髂后上棘会更高，相比对侧更向前和外 坐骨结节更高向后和内 骶髂槽线更宽更前 韧带张力升高且疼痛（髋腰部）：骶髂后韧带，耻骨间韧带上部 大小坐骶韧带被放松 疼痛的肌肉有：臀大肌，内收肌，腘绳肌和腹直肌,前髂,42,Anterior conversion of iliac with resp

50、ect to sacrum 髂骨相对于骶骨向前转,Anterior Iliac,前髂,43,Close key.关闭关键点 Grasp the iliac with forearms, placing them above the iliac crest and below the ischial tuberosity, fingers crossed. 前臂抵住髂骨的髂嵴以上、坐骨结节以下部位，手指交叉。 search for the motion or visco-elastic barrier 检查运动或粘弹障碍 Ask 3 seconds inspiratory apnea to te

51、nse hamstring with contemporary 3 seconds downwards push; 3 seconds pause. 要求患者屏气3秒以绷紧绳肌腱，同时治疗师向下施加推力，保持3秒；暂停3秒 Research of new motion barrier. 检查新的运动界限 Repeat 3-4 times. 重复3-4次,ANTERIOR Iliac M.E.T. (muscle energy technique),前髂 M.E.T. (肌肉能量技术),44,The osteopath on the opposite side of the lesion Wit

52、h the caudal hand engages the ischium and research the motion barrier by flexing the hip With the cranial hand is placed anterior to ASIS. Apnea inspiratory. Tension of hip extensors for 3 seconds, pushing the knee against osteopath chest; 3 seconds pause. Research of new motion barrier Repeat 3-4 t

53、imes,ANTERIOR Iliac M.E.T. (muscle energy technique),治疗师位于障碍对侧 靠近足部的手拖住坐骨，通过屈曲髋关节检查运动界限 靠近头部的手置于髂前上棘前部 屏气 髋关节伸肌紧张，保持3秒，膝关节抵住治疗师胸部； 暂停3秒。 检查新的运动界限 重复 3-4 次,前髂 M.E.T. (肌肉能量技术),45,Patient in the lateral decubitus position with the hip bone to treat upwards. The osteopath is placed in front of the patie

54、nt. Close key (the ilium is closed in the lower lever). With caudal hand, contact the ischial tuberosity through the thenar eminence and with cranial hand the ipsilateral shoulder Search for motion barrier, tensioning and thrust. N.B. The push is from bottom to top and from behind forward with rotat

55、ory component in order to obtain the closure of the large pelvis and the opening of the small.,ANTERIOR Iliac HVLA (High Velocity, Low Amplicity),47,患者处侧卧位，需治疗的髋骨向上 治疗师位于患者前 关闭关键点(髂骨关闭在低水平位). 用靠近足部的手通过鱼际触摸坐骨结节；靠近头部的手置于同侧肩部 检查运动界限，保持肌肉张紧并施加推力 注意. 旋转部位施加推力的原则是是自下向上、自后向前，为的是保持大骨盆的关闭和小骨盆的打开,前髂 HVLA (高速，

56、低幅),48,Freedom to make a posterior (rear) conversion. A permanent opening of the small pelvis and closing of the big. Upper iliac crest with consequent short fake limb. So on the side of dysfunction: ASIS will be higher, back and close to the midline compared with the contralateral side. The pubic b

57、ranch will be more backwards and higher with an opening in the lower portion of the pubic symphysis and closing at the top. The PSIS will be lower, more internal and back than the contralateral. The ischial tuberosity will be lower, more posterior and more external with respect to the other. The ile

58、olumbar ligaments are relaxed. Ligaments tense and painful: sacrum-ischiatic (small and large) and interpubic. Sore Muscles: latissimus dorsi, all the muscles of the anterior compartment (small adductor, gracilis, sartorius, quadriceps), gluteus medius and tensor fasciae latae.,POSTERIOR Iliac,49,自由

59、地进行后转 小骨盆长期打开，大骨盆闭合 上髂棘随后造成假性短腿 位于功能障碍一侧： 与对侧相比，髂前上棘更高，靠后，并靠近中线 耻骨支更向后且更高，耻骨联合下部打开，顶部闭合。 与对侧相比，髂后上棘更低，更加靠内、靠后。 与对侧相比，坐骨结节会更低，更加靠外、靠后。 髂腰韧带放松 韧带紧张、疼痛：骶骨-坐骨（小和大）以及耻骨间. 肌肉疼痛：背阔肌，前收全部肌群（小内收肌，股薄肌，缝匠肌，股四头肌），臀中肌及阔筋膜张肌。,后髂,50,Posterior Iliac,后髂,51,The technique is the same as that used for anteriori iliac dysfunction, but in this case it uses the contraction of the quadriceps muscle for driving to correction the dysfunctional iliac. 与治疗前髂功能障碍所用技术相同，但这种情况下，技术利用四头肌收缩调整出现功能障碍的髂骨。,POSTERIOR Iliac M.E.T.,后髂 M.E.T.,52,The patient is in ventral decubitus Osteopath contralat