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Sacrum Diagnosis

Mary Goldman 11/2008

Basic background facts


The standing flexion test reflects both sacrum
and pelvis, but the seated flexion test reflects
just the sacrum
Prominent sacral base is the more posterior,
but a deep sacral base may be the cause of a
prominent sacral base on the other side (so the
prominent side is not protuberant in this case)
The prominent ILA is also the lower ILA

Types of sacral somatic


dysfunction
Bilateral flexion/extension (normal seated
flexion test)
Sacral Torsion
Unilateral sacrum
Marginal sacrum is not tested on boards
and is a rare finding

Flexion tests
If standing is positive on the same side
as the seated, the sacrum may be the
only abnormal, so treat sacrum and
recheck
If standing is positive on the opposite
side of the seated test, treat pelvis and
then sacrum
Some schools treat the pubes or the
lumbar spine first

Diagnosing sacral
torsion vs unilateral
sacrum
All torsions have an oblique axis, but the
sacral base and ILA prominents are on
the SAME side
All unilateral have a transverse axis, but
the prominents are on opposite corners

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

UNILATERAL

SAME SIDE

OPPOSITE CORNERS

One more time


TORSION

Oblique axis

Prominents
on same side

UNILATERAL

Transverse
axis

Prominents
on opposite
corners

Seated flexion test is


TORSION

Opposite of
the axis

UNILATERAL

Same side as
the axis

Why?
Axis is named
at the base of
the sacrum

Treatment plan
Sacral
Somatic dysfunction

lay on side
of axis

lay prone

TORSION

UNILATERAL

flexion
L on L, R on R

Treat face down


if feet off table

extension
L on R, R on L

Treat face up
if feet off table

flexion

extension

Treat leg
turned in

Treat leg
turned out