Sacral Diagnosis - Oblique Axes, Neutral and Non

Checked by dickey
Thur 03/20/03 11am
Dr. Dickey
Mitra Campbell
Proscribe Samera Kasim
Page 1 of 4
Sacral Diagnosis - Oblique Axes, Neutral and Non-Neutral
Today during class, the only new technique learned was the Spring Test. Much of the hour was lecture
style wherein the animations were watched as a demonstration of what the oblique axes look like. Not
all of the animation are able to be played from the powerpoint files on the courses web page, but they
are visible on the VHS tape.
I. Case
The vignette was skipped in class
II. To make a Sacral Diagnosis you will need to know the following:
a. The first 25 minutes of class were spent diagnosing our partners
b. For the practical, we will need to feel very comfortable will all of the following
(which is what’s on the sheet we’re handed each day in class)
c. It should take no more than 10 min
d. Static (Pure) Landmarks
i. these include only motion of the sacrum ONLY:
1. Sacral base
- Ant/ Post
2. ILA
ii. These include only motion of the pelvic bone ONLY:
1. ASIS & PSIS -Sup./Inf.
2. Pubes -Sup./Inf & Ant./Post
iii. Because these involved motion of either the sacrum or the pelvic bone,
they are your most important diagnostic findings.
e. Mixed Landmarks
i. Landmarks that are effected by 2 different bones (ie. The sacrum &
ii. Sacral Sulcus - Deep/Shallow
1. (if the pelvis were posterior, the sulcus would be deep. But if the
sacrum is also posterior, you might find the sulcus to be normal
or even shallow)
iii. STL - Tight/ Loose/ Equal
1. these are less exact because they are effected by both sacral and
pelvic motion
2. they should only be used as a confirmatory finding
3. they are often difficult to diagnose
4. if they are not consistent with your other findings, then this could
f. Motion Testing
i. L5
1. because sacral motion is dictated by L5, diagnosis of L5 can help
determine whether the sacrum is in Neutral or Non neutral
a. ie. Neutral L5 should indicate a neutral sacrum
ii. sacrum
iii. Spring test
III. Sacral Somatic dysfunction
Checked by dickey
Thur 03/20/03 11am
Dr. Dickey
Mitra Campbell
Proscribe Samera Kasim
Page 2 of 4
a. Axis – a plane that cannot move, but about which motion occurs.
b. Takes on 2 forms:
c. Physiologic:
i. Dysfunction that occurs around a Physiologic Axis
1. Vertical
2. Transverse
3. Oblique: Neutral and Non-Neutral
d. Non - physiologic:
i. Dysfunction that does not occur around an axis. Usually caused by
ii. This was what Tuesday’s lecture was about
1. Upslipped Innominate
2. Unilateral Sacral Shear (Unilateral Sacral Flexion)
IV. Spring Test
a. It’s purpose: To be an indicator of whether you are dealing with a NN (backward
torsion) sacral Oblique Axis
V. Why are the Oblique Axes so significant?
a. The walking cycle as it applies to our discussion:
b. From a standing (neutral) position, when you take a step forward, your weight is
shifted onto one lower extremity.
c. This induces spinal column SB to the weight bearing side, and pins the upper
pole of the sacrum on the side of the SB.
d. As the free lower extremity swings forward, it carries the free pole of the sacrum
anterior, creating rotation of the sacrum about the Oblique Axis, towards the
weight bearing extremity
e. From a standing (neutral) position, as you step forward, note how your
body compensates. What does your torso do?
f. Answer: Rotates towards the moving lower extremity (ie.: away from the weight
bearing lower extremity).
g. Bottom Line: Your spine (most notably Lumbar spine) rotates in the opposite
direction of the sacrum in a neutral moving situation.
h. EXTRA NOTES: the sacrum is a suspended, floating structure. Shifting weight
to the Left will impinge the upper L pole nd the lower R pole.
i. If the walking cycle is interrupted, then dysfunction can occur.
VI. Neutral - Left Oblique Axis Findings (LOA)
a. Animation showed what this looks like
b. Sacrum moves forward
c. If you were to place a dot on the front of the sacrum at the upper R pole, it would
turn slightly toward the L as it moves forward. The L inf border moves
backward and slightly inferiorly.
d. Most sacral motion is FB in neutral mechanics
e. Once a L oblique axis is formed, only the R sacral base moves forward.
f. With sacral shear, there is marked inferiorness of the ILA
g. With sacral Torsion, there is marked posteriorness
h. Named various ways:
Checked by dickey
Thur 03/20/03 11am
Dr. Dickey
Mitra Campbell
Proscribe Samera Kasim
Page 3 of 4
i. L on LOA,
ii. RL (rotated Left) on LOA,
iii. L Forward Torsion
Or simply Left on Left
What you’ll find:
i. Lateralization: Left
ii. Landmarks:
iii. Sacral Sulcus: L shallow
iv. Sacral Base:
L posterior
v. ILA:
L Post/ Inf.
1. the finding that is most prominent is written first; if this were a
sacral shear, it would be “Inf/Post”
vi. STL:
L Tight
vii. Motion Testing:
viii. Spring: negative
1. (a negative spring test is indicative of motion. If there is no
motion and they have forward bent somatic dysfunction, then the
test is positive and points toward backward torsion)
ix. L5:
1. notice this is also neutral
x. Sacral Base:
1. you would not expect motion at the L upper (R sacral base) and
R lower poles (R ILA) because these lie along the axis, which
doesn’t move!!
xi. ILA:
L +/- R +/-
VII. Neutral - Right Oblique Axis Findings
a. Animation showed what this looks like
b. Findings are reversed from above
c. Name:
i. R on ROA,
ii. RR on ROA,
iii. R forward torsion
d. or simply “Right on Right”
e. what you’ll find:
i. Lateralization: Right
ii. Landmarks:
Sacral sulcus: R shallow
Sacral base:
R posterior
R Post/Inf.
R tight
iii. Motion Testing:
Spring: negative
Sacral Base:
L +/- R +/VIII. Non-Neutral Sacral Dysfunctions - Left Oblique Axis Findings
Checked by dickey
Thur 03/20/03 11am
Dr. Dickey
Mitra Campbell
Proscribe Samera Kasim
Page 4 of 4
NN occur with either extreme BB or FB greater than 90 degrees.
The sacrum begins to move backward in NN mechancs
Not as common; seen in mailmen, manual labor…
i. R on LOA,
ii. RR on LOA,
iii. L Backward Torsion
e. Lateralization: Left
f. Landmarks:
i. Sacral Sulcus: L Deep
ii. Sacral Base:
L Anterior
iii. ILA:
L Ant/ Sup
iv. STL:
L Loose
g. Motion Testing:
i. Spring: +
ii. L5:
1. also NN
iii. Sacral Base:
LR +/iv. ILA:
R +/1. again, no/little motion detected at the pole that make the axis
(upper L and lower R)
IX. NN: Right Oblique Axis findings
a. Name:
i. L on ROA,
ii. RL on ROA,
iii. R backward Torsion
b. Lateralization: Right
c. Landmarks:
i. Sacral Sulcus: R Deep
ii. Sacral Base:
R Anterior
iii. ILA:
R Ant./Sup.
iv. STL:
R loose
1. when the ILA moves forward, it approaches the ischial
tuberosity and the ligament becomes loose.
d. Motion Testing:
i. Spring: +
ii. L5:
iii. Sacral Base:
L +/- R iv. ILA: L +/- R +
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