The Still Technique Manual, Richard L. Van Buskirk, D.O., second edition, 2006, pg. 96-101.
Up Slipped and Down Slipped innominates occur when the entire innominate shears upward or downward at the sacroiliac joint and it will affect all three poles of the SI joint. The sacroiliac joint is L-shaped with a superior branch and an inferior branch meeting in the middle at the level of S2 that represents the transverse axis upon which the sacrum flexes and extends. What Dr. Van Buskirk presents in his text on the Still Technique is that all three of these poles: superior, middle and lower poles of the SI joint need to be released in order to correct an innominate shear. This is done in three steps with the Still Technique.
First, one applies the treatment for the superior pole, which is the same as treating a posterior rotation of an innominate, by fully flexing the hip, adducting the femur with the operating hand on the patient’s knee, and placing the sensing hand/fingers on the superior pole of the SI joint. Once the position of ease is determined, add compressive force between your operating hand and your sensing fingers, and while maintaining this compressive force articulate the leg out into abduction, then extend the leg back out onto the exam table.
Second, apply the treatment for the inferior pole, which again is the same as treating an anterior rotation of an innominate, by flexing the hip, but this time only slightly (45-55 degrees) so you keep the innominate in its position of ease in anterior rotation, and abduct the femur with the operating hand on the patient’s knee and place the sensing hand/fingers on the inferior pole of the SI joint. Once the position of ease is determined, add your compressive force between your operating hand and your sensing fingers and while maintaining the compressive force articulate the leg up further into hip flexion (posterior rotation) and adduction and finally extend the leg back out onto the exam table.
With an up slipped or down slipped innominate the third step is to release the middle pole by going to the foot of the exam table and taking hold of the patient’s lower leg just above the ankle and turning the entire leg up through the hip outward into external rotation and comparing that with internal rotation. Whichever direction the leg moves easier is the direction of ease and that is the position you should take as the starting position. Next, if you are treating an up slipped innominate add steady traction on the entire leg into the pelvis and if you are treating a down slipped innominate add steady compression into the entire leg into the pelvis and while maintaining your traction or compression rotate the leg from the initial position of ease in either internal or external rotation into the restricted position of either internal or external rotation.
These three steps should release all 3 poles of the SI joint and correct both an up slipped or a down slipped innominate which can be difficult dysfunctions to correct. If you are interested in seeing me demonstrate these techniques consider purchasing my latest video course on The Pelvis and remember that all of these video courses are eligible for CME credits to physicians (DO’s and MD’s).