Sacral Somatic Dysfunction

Question 1

nutation

Answer 1

nodding forward; anterior movement of the
sacral base around a transverse axis in relation to the ilia, occurring during sphenobasilar extension of the craniosacral
mechanism

Question 2

counternutation

Answer 2

Posterior movement of the sacral base around
a transverse axis in relation to the ilia.
Occurs during sphenobasilar flexion

Question 3

sacral sulci

Answer 3

designated as feeling deep or shallow

Question 4

ILAs

Answer 4

designated as being posterior/inferior or anterior/superior

Question 5

seated flexion test

Answer 5

Contact both PSIS and have your patient bend forward from a seated position. Whichever PSIS
moves first and/or farthest indicates the positive
side.
The side of laterality determined by this test helps decide the laterality of diagnosis

Question 6

lumbar spring test

Answer 6

Springing force anteriorly into the lumbosacral junction
while patient is prone
Hard end feel indicates part of the sacrum is sitting posteriorly and thus is a positive test
No hard end feel indicates part of the sacrum is sitting anteriorly and thus is a negative test

Question 7

four digit contract

Answer 7

Contact each sacral sulci and ILA and feel which feels most deep or shallow (for sacral sulci) and which feels most anterior/superior or
posterior/inferior (for ILA)

Question 8

four digit passive evaluation

Answer 8

Contact one sacral sulcus and the ILA on the contralateral side of the body.
Perform a load and springing force around the oblique axis.
Perform this bilaterally to determine which oblique axis has more ease of motion.

Question 9

respiratory motion

Answer 9

Place cephalad hand over sacrum with thenar and
hypothenar eminence at the sacral base and the fingertips at the apex. Place the other hand on top of your cephalad hand facing the opposite direction.
The sacral base should move posteriorly during inhalation and anteriorly during exhalation

Question 10

side bending passive evaluation

Answer 10

Place palms on the ILA’s and fingertips toward the sacral
sulci.
Direct a cephalad force from the ILA’s
This determines ease or restriction of side bending

Question 11

bilateral flexion

Answer 11

Seated flexion test is negative because the dysfunction is bilateral (no side of laterality)
Lumbar lordosis is increased since the sacrum is sitting anteriorly
Sacral sulcus are deep bilaterally
ILA’s are posterior bilaterally
Lumbar spring test is negative because there is no hard end feel due to the base of the sacrum being held forward
Restricted to inhalation phase
l The sacrum is “stuck” forward, so it doesn’t like to move
posteriorly on inhalation
No restrictions on side bending passive because it is a bilateral
dysfunction
No restrictions on 4 point passive evaluation because it is not a torsion

Question 12

bilateral extension

Answer 12

Seated flexion test is negative because the dysfunction is bilateral (no side of laterality)
Lumbar lordosis is decreased since the sacrum is extended and flattens out the lumbar spine
Sacral sulcus are shallow bilaterally
ILA’s are anterior bilaterally
Lumbar spring test is positive because there is a hard end feel
Restricted to exhalation phase
l The sacrum is “stuck” backward, so it doesn’t like to move anteriorly on exhalation
No restrictions on side bending passive because it is a bilateral
dysfunction
No restrictions on 4 point passive evaluation because it is not a torsion

Question 13

unilateral flexion

Answer 13

Seated flexion test is positive on the involved side
Sacral sulcus is deep on the involved side (explains flexion
compenent)
ILA is inferior on involved side (explains side bending component)
Lumbar spring test is negative because part of the sacrum is held forward.
Respiratory motion is asymmetrical
Side bending passive evaluation is restricted to SB toward the
uninvolved side (ease of motion toward involved side)
4 point passive evaluation has no restrictions because it is not a torsion

Question 14

unilateral extension

Answer 14

Seated flexion test is positive on the involved side
Sacral sulcus is shallow on the involved side (explains extension
compenent)
ILA is superior on involved side (explains side bending component)
Lumbar spring test is positive because part of the sacrum is held backward.
Respiratory motion is asymmetrical
Side bending passive evaluation is restricted to SB toward the
involved side (ease of motion toward uninvolved side)
4 point passive evaluation has no restrictions because it is not a
torsion

Question 15

sacral torsions

Answer 15

Axis is named for the cranial end of the axis left axis has cranial end of axis at upper left
corner of the sacrum sacrum rotates around the axis - which is seen as a diagonal

Question 16

forward torsion

Answer 16

Seated flexion test is positive on the side opposite of the axis
However, pelvic compression test is positive on the side of axis
Sacral sulcus is deep on uninvolved axis side
Shallow on involved axis side
ILA is posterior on side opposite deep sacral sulcus
Lumbar spring test is negative because part of the sacrum is held forward
This is how you tell the difference between a forward and backward torsion
Respiratory motion is asymmetrical
Side bending passive evaluation has no restriction because it is not a unilateral dysfunction
4 point passive evaluation is restricted to posterior rotation around the involved axis

Question 17

backward torsion

Answer 17

Seated flexion test is positive on the side opposite of the axis However, pelvic compression test is positive on the side of axis
Deep on involved axis side Shallow on uninvolved axis side
ILA is posterior on side opposite deep sacral sulcus
Lumbar spring test is positive because part of the sacrum is held backward This is how you tell the difference between a forward and backward torsion
Respiratory motion is asymmetrical
Side bending passive evaluation has no restriction because it is not a unilateral dysfunction
4 point passive evaluation is restricted to anterior rotation around the involved axis