Sacral balancing

The osieopathic manipulative treatment of L.D. was performed while she was sleeping. Palpation for cranial motion and treatment with cranial techniques is difficult in an infant because they are, for the most part, continuously moving. For this reason, it is best to conduct a cranial examination and treatment as the infant is asleep or being fed. The dysfunctions found on the osteopathic examination of L.D. were addressed with balancing of membranous tension, decompression ofthe occipital condyles, and other cranial techniques, as well as sacral balancing. At the conclusion ofthe cranial treatment, L.D. was able to latch-on successfully to her mother s... 

Sympathetic and parasympathetic nerves innervate the penis. In the flaccid state, OC2-adrenergic receptors mediate tonic contraction of the arterial and corporal smooth muscles. This maintains high penile arterial resistance and a balance exists between blood flow into and out of the corpora. With sexual stimulation, nerve impulses from the brain travel down the spinal cord to the thoracolumbar ganglia.3 A decrease in sympathetic tone and an increase in parasympathetic activity then occurs, causing a net increase in blood flow into the erectile tissue. Erections may also occur as a result of a sacral nerve reflex arc while patients are sleeping (nocturnal erections). 

When such good correlations are not checked (excessive kyphosis, insufficient lordosis, excessive sacral slope, lack of hip extension), GF falls in front of the hip axis, and muscle activity is necessary to ensure balance, which is uneconomic (see Figs. 13 and 14). 

The characteristic of dysplastic high grade slips is not the anterior translation of L5, but really rotation of L5 around the sacral dome, with the lum-bo-sacral kyphosis, and associated perturbation of sagittal alignment. The gravity line still falls through the lumbo-sacral junction and close to the posterior centre of the femoral heads. Little adaptation has to be done to keep the sagittal balance, and the problem is purely localised at the lumbosacral junction. 

On the other hand, in dysplastic forms, progressive slippage of L5 around the dome creates an acute lumbo-sacral kyphosis. To preserve balance of the trunk and to try to maintain the gravity line between the two feet, secondary phenomena appeared hyperlordosis of the lumbar spine above... 

Another element is the structural long lordosis above the spondylolisthesis. In some cases, even the correction of the lumbo-sacral kyphosis has a limited effect on the lordosis above. True lordotic structural fixed deformity in the vertebral body and the disc could not be modified in this specific condition. The lordotic spine seems to be part of the primary condition of the sagittal balance and not only of the secondary changes due to spondylolisthesis progression. 

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