Sacral rotation dysfunction

Dysfunctions of motion created by the sacrum moving on the ilium are commonly unilateral anterior or posterior sacral dysfunctions, a unilateral shear of the sacrum along the articulation or oblique rotational sacral dysfunctions. If the fifth lumbar vertebra is not involved in the oblique rotation, the dysfunction is described as a sacral rotation dysfunction. if the fifth lumbar vertebra rotates in a direction opposite that of the sacrum, it is described as a sacral torsion. 

Posterior Iliac Somatic Dysfunction/ Unilateral Sacral Shear/Forward Sacral Rotations and Torsions... 

Anterior Iliac Somatic Dysfunction/ Backward Sacral Rotation or Torsion... 

This left-on-left sacral torsional pattern. It is not pathological or dysfunctional because it is temporary and instantaneous and the adaptive motion of the lumbar region is for the side-bending and rotation to occur in opposite directions. 

Unilateral erector spinae contraction will cause lateral flexion to the side of contraction, scoliosis with convexity to the opposite side, and extension of the spine. The patient walks with a stiff back, with no lumbar rotation or flexion. The spinal areas involved are usually at the fourth or flfth lumbar and first sacral segments. An acute anterior sacrum dysfunction on the same side may also be present. If findings include a raised iliac crest height, lumbar scoliotic convexity, and sciatic pain distribution, all on the same side, the prognosis for a speedy recovery is often good. If the pain is on the other side, the cause may be a prolapsed disk or some other serious pathologic condition, and both physician and patient may be in for a difficult time. 

The tests for pelvic dysfunctions have fair specificity and variable sensitivity. The presence of a sacral dysfunction can obscure or exaggerate the findings for pelvic dysfunction. The standing flexion test can be falsely positive if there is an overwhelmingly positive seated flexion test and sacroiliac dysfunction. The depth of the sacral sulcus is not specific to pelvic dysfunction because a deep sulcus can also indicate a forward sacral torsion with the axis opposite to the deep sulcus, a unilateral sacral shear, as well as a posteriorly rotated ilium on the same side. A shallow sulcus can also indicate sacral dysfunction in addition to an anterior rotated ilium on that side. 

The lateral rotator muscles of the hip include the piriformis and the obturator internus. The piriformis muscle has its medial attachment to the lateral border of the sacrum and is often involved in sacral dysfunctions. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

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