Sacral rotation torsions

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. 

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. 

FIG. 60-11 Sacral torsion. (A) Left rotation of sacrum on left oblique axis. (B) Right rotation of sacrum on ieft oblique axis. (C) Saaum on left oblique axis. (D) Right rotation of sacmm on right oblique axis. 

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