Sacral Dysfunctions & Torsions

◆Sacral anatomy & motion

• •Sacrum has 3 axes: superior transverse (respiratory), middle transverse (postural), inferior transverse
• •Oblique axes: LEFT oblique axis (LOA) runs L superior to R inferior; RIGHT oblique axis (ROA) runs R sup to L inf
• •Sacral rocking: anterior nutation (counter-nutation) with respiration

◆Sacral torsions (4 types) — named by direction of rotation ON the axis

• •Forward torsions (physiologic): name matches axis — L on L, R on R
• •Backward torsions (non-physiologic): name does NOT match axis — R on L, L on R
• •Forward torsions are more common with normal walking gait
• •Backward torsions are pathologic and often more symptomatic

◆Diagnosing torsions — key findings

• •Seated flexion test: positive on side of restricted axis (the axis that DOES NOT move)
• •L on L: seated flexion positive on R; deep sulcus on R; inferior lateral angle (ILA) posterior on L; sphinx test improves alignment
• •R on R: mirror of L on L (positive seated flex on L, deep sulcus on L, ILA post on R)
• •L on R (backward): seated flex positive on L; deep sulcus on R; ILA post on L; sphinx WORSENS
• •R on L (backward): mirror — seated flex positive on R; deep sulcus on L; ILA post on R
• •Sphinx (prone press-up) test: forward torsions IMPROVE (asymmetry decreases); backward torsions WORSEN

◆Unilateral sacral flexion / extension

• •Unilateral sacral FLEXION: one side of sacral base moves anterior and inferior; deep sulcus + ILA more inferior + posterior on the SAME side; positive seated flex on the same side; sphinx improves
• •Unilateral sacral EXTENSION: one side moves posterior and superior; shallow sulcus + ILA more superior + anterior on that side; sphinx worsens; less common

◆Sacral treatment

• •Muscle energy with respiration: patient inhales (for extension/backward torsion treatment) or exhales (for flexion/forward torsion treatment) while operator engages barrier
• •L on L: position patient in 'Sims' (left lateral recumbent), engage with patient INHALATION/exhalation cycles
• •Backward torsions need a different positioning (often right lateral with knees up)
• •Articulatory rocking, MFR, BLT are alternatives

Sacral torsion findings summary