Back on to my Marion Clark inspired posts. I may get in to deeper detail on the innominates later as Clark had a lot of detail on the innominate complex! For the moment I want to give a big picture view of the innominates so that the mechanics are understood thus the lesions can be explained.
The innominates are made up of the ilium, ischium, and pubis which fuse through development to become one unit on each side. The innominates articulate directly with the femur, the sacrum, and each other at the pubic symphysis. Due to the size of the innominates versus the relatively small articulating surfaces coupled with large and heavy musculature makes for a lesion in waiting. The force that is produced from either the upper body or the lower body is transmitted directly through the innominates and, again, produces strong impetus for a bony lesion. As in everything in Osteopathy a lesion of the innominate(s) can be causative or reflexive – the sacrum, the femur, or the fourth (through the iliolumbar ligament) and fifth lumbar segment can be a fairly direct impetus for a bony lesion of the innominate.
Instead of going through all of the muscles, nerves, arteries (check here and here for abdominal vasculature), and veins associated with the innominate right now I have linked to general overviews of the areas by clicking on the previous words (not absolutely the most descriptive but the links give a general picture of what is going on).
What do I want to say about an innominate lesion? I want to say that many current Osteopaths have their reasoning a little backwards. The problem is not the mobile/anterior right innominate in 80% of people that is the problem – that is the easiest sign to find of the problem. The problem is the fibrotic and posterior left innominate. The side of true dysfunction is usually the side that doesn’t move the way it is intended to.
The innominates are representative of the base of the body. Due to the musculature and the fact that all force eventually ends up in the innominates they are often in trouble but easily corrected. It takes very little input to correct the innominates (as students of the CAO know). The other point is that when the innominates are corrected first (this is a PRINCIPLE – they are the base) many other lesions are either taken care of or much easier to remove. A very clear example is a lesion of L4 or L5 – any lesion of the innominate MUST be a lesion of L4 due to the iliolumbar ligament and any lesion of the innominate will also cause a lesion of the sacrum that will take L5 with it as will the lesion of L4. Too many words – innominate lesions are lesions to the pelvic complex (the whole thing), the sacrum, L4 and L5, and the femur (I could keep going here but you get the picture).
Want to talk about visceral work? Level the innominates so that the viscera are properly suspended in the pelvis and the lumbar spine is straight then correct through the thoracic spine to remove sympathetic tone and you have probably done your job. The principles will never fail you. The innominate correction is a very big deal and without it any Osteopathic treatment (or any treatment of anything) will not be fully effective.
Want another reason that the innominates are a big deal? They are where you excrete waste – have a mechanical strain that makes excretion difficult and you have the basis for disease through toxicity staying in the system.
Sorry I am not as in depth with the Marion Clark material here, but MAKE SURE YOU CORRECT THE INNOMINATES EVERY TIME (at least that is my 2 cents).