Sacral Q-bank

The above patient has a bilateral sacral extension (a.ka. sacral base posterior or a posterior sacral base). The seated flexion test will be FALSELY negative-Why? Since both SI joints are restricted, asymmetry will bot be appreciated.

In a patient with a deep left sulcus and a negative lumbosacral spring test, the left portion of the sacrum has moved anterior. Since the above patient has posterior/inferior ILA on the right this indicates that this portion of the sacrum has moved posteriorly. A forward sacral torsion on a right oblique axis (i.e. a right rotation on a right oblique axis) is the only answer that would be consistent with the above findings.

The hamstrings attach to the ischial tuberosity and contraction can cause the innominate to rotate posteriorly.

A right on left sacral torsion would have an L5 that is non-neutral (meaning either flexed or extended), rotated left, sidebent left with a seated flexion test positive on the right (opposite the axis of the torsion)

In sacral torsion (or sacral rotation on an oblique axis) the seated flexion test is positive on the opposite side of the axis. In this case, the right positive seated flexion test indicates a left oblique axis. A positive spring test (aka lumbosacral spring test) indicates that part of the sacral base has moved posterior. Since the left sacral base is anterior (i.e. the left sulcus is deep), then this must indicate that the right sacral base has moved posterior.

The patient is left innominate posterior. A shorter leg on the ipsilateral side will be present in this dysfunction (left leg). Consequently, the contralateral leg will appear longer (right leg).

In a right posterior innominate the standing flexion test is positive on the right, the right ASIS is cephalad, the right PSIS is caudad and there is a relative short leg on the right.

Hip flexors are used to correct the dysfunction. With the patient supine, drop the left leg off the table to engage the restrictive barrier. Instruct the patient to flex their hip against your counterforce for 3-5 seconds.

A bilateral sacral flexion occurs during the delivery phase of childbirth when the sacrum nutates (sacral base moves anteriorly) to allow more space for the fetus to pass through the pelvic outlet into the birth canal.

If a sacral torsion is present, a right sacral base anterior (a deep right sulcus) and a negative lumbosacral spring test indicate a left on left torsion. Using the rules of L5 on the sacrum and Fryette's principles one can figure out the dysfunction of L5. When L5 is rotated, the sacrum rotates in the opposite direction. Sacrum rotated left, L5 must be rotated right. When L5 is sidebent, a sacral oblique axis is engaged on the same side as the sidebending. Sacrum has a left oblique axis, L5 must be sidebent left.

In this position, the patient is lying in the left lateral recumbent position and the torso is turned to the left so the patient is lying face down.

In a psoas syndrome, a high lumbar dysfunction is likely to be present. Specifically, the lumbar dysfunction will be flexed, sidebent, and rotated to the side of the tight psoas. In this case, L1 would be flexed, rotated right, and sidebent right.

Springing is present over the part of the sacrum that has freedom of motion anteriorly. The left inferior lateral angle moves anterior (as the right sacral base moves posterior) and thus will spring freely in a right on left sacral torsion.