Sacrum DiagnosisSacrum Diagnosis

Mary Goldman 11/2008Mary Goldman 11/2008

Basic background factsBasic background facts

The standing flexion test reflects both sacrum The standing flexion test reflects both sacrum and pelvis, but the seated flexion test reflects and pelvis, but the seated flexion test reflects just the sacrumjust the sacrum

Prominent sacral base is the more posterior, Prominent sacral base is the more posterior, but a deep sacral base may be the cause of a but a deep sacral base may be the cause of a prominent sacral base on the other side (so the prominent sacral base on the other side (so the prominent side is not protuberant in this case)prominent side is not protuberant in this case)

The prominent ILA is also the lower ILAThe prominent ILA is also the lower ILA

Types of sacral somatic Types of sacral somatic dysfunctiondysfunction

Bilateral flexion/extension (normal seated Bilateral flexion/extension (normal seated flexion test)flexion test)

Sacral TorsionSacral Torsion Unilateral sacrumUnilateral sacrum Marginal sacrum is not tested on boards Marginal sacrum is not tested on boards

and is a rare findingand is a rare finding

Flexion testsFlexion tests

If standing is positive on the same side If standing is positive on the same side as the seated, the sacrum may be the as the seated, the sacrum may be the only abnormal, so treat sacrum and only abnormal, so treat sacrum and recheckrecheck

If standing is positive on the opposite If standing is positive on the opposite side of the seated test, treat pelvis and side of the seated test, treat pelvis and then sacrumthen sacrum

Some schools treat the pubes or the Some schools treat the pubes or the lumbar spine firstlumbar spine first

Diagnosing sacral torsion Diagnosing sacral torsion vs unilateral sacrumvs unilateral sacrum

All torsions have an oblique axis, but the All torsions have an oblique axis, but the sacral base and ILA prominents are on sacral base and ILA prominents are on the SAME sidethe SAME side

All unilateral have a transverse axis, but All unilateral have a transverse axis, but the prominents are on opposite cornersthe prominents are on opposite corners

Picture that!Picture that!Prominent sacral base & ILA do not follow pattern of axisProminent sacral base & ILA do not follow pattern of axis

TORSION UNILATERAL

SAME SIDE OPPOSITE CORNERS

One more timeOne more time

TORSIONTORSION Oblique axisOblique axis Prominents Prominents

on same sideon same side

UNILATERALUNILATERAL Transverse Transverse

axisaxis

ProminentsProminents

on oppositeon opposite

cornerscorners

Seated flexion test isSeated flexion test is

TORSIONTORSION Opposite ofOpposite of

the axisthe axis

Why?Why?

Axis is named Axis is named at the base of at the base of the sacrumthe sacrum

UNILATERALUNILATERAL Same side asSame side as

the axisthe axis

Treatment planTreatment planSacral

Somatic dysfunction

TORSION UNILATERAL

flexion

extensionL on R, R on L

flexionL on L, R on R

extension

Treat face downif feet off table

Treat face up if feet off table

Treat leg turned in

Treat legturned out

lay on sideof axis lay prone