1. Sacrum Diagnosis Mary Goldman 11/2008

2. 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

3. 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

4. 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

5. 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

6. Picture that! Prominent sacral base & ILA do not follow pattern of axis TORSIONUNILATERAL SAME SIDEOPPOSITE CORNERS

7. One more time TORSION Oblique axis Prominents on same side UNILATERALTransverse axis axisProminents on opposite corners

8. Seated flexion test is TORSION Opposite of the axis Why? Axis is named at the base of the sacrum UNILATERAL Same side as the axis

9. Treatment plan Sacral Somatic dysfunction TORSION extension L on R, R on L flexion L on L, R on R UNILATERAL flexionextension Treat face down if feet off table Treat face up if feet off table Treat leg turned in Treat leg turned out lay on side of axis lay prone