Impan01 - Untitled

I really hate the sacrum! And I had a question recently asking how to diagnose it based on L5.🙄

L5 rules:

1) The oblique axis about which the sacrum rotates is on the same side as the side to which L5 is sidebent.

2) The sacrum rotates in the opposite direction from that in which L5 is rotating.

3) The seated flexion test is positive on the side opposite the oblique axis.

Also, these rules only work for sacral torsions.

The naming of the sacral somatic dysfunction is the direction in which the sacrum rotates, then the direction of the oblique axis. So "left on left forward sacral torsion" means the sacrum is rotating left about a left oblique axis. Also, it's a forward sacral torsion if the sacrum is rotating in the same direction as the oblique axis (so left on left and right on right are forward sacral torsions). It's a backward sacral torsion if the sacrum rotates in the opposite direction from the oblique axis (so left on right and right on left are backward sacral torsions). Also a spring test is positive if the sacral base is posterior (which is abnormal). It means when you spring on the sacral base, there's no spring because it's already extended. A negative spring test means the sacral base is anterior so when you spring on it, there is spring; which is the normal finding.

So if L5 is flexed, rotated, and sidebent right, then the sacrum has a right oblique axis (rule 1), is rotating to the left (rule 2), and the seated flexion test is positive on the left (rule 3). So it's a left on right backward sacral torsion.

Type 1 somatic dysfunctions go with forward sacral torsions. Type 2 somatic dysfunctions go with backward sacral torsions. So you can also diagnose L5 based on what the sacral diagnosis is. If it's a forward sacral torsion, then L5 must be neutral, sidebent left, rotated right or neutral, sidebent right, rotated left. More specifically it'd be a group curve (type 1 SD), so for example L3 to L5 would be neutral, sidebent left, rotated right. Recall that type 1 SDs do not have a flexion or extension component (hence “neutral”), sidebending is written before rotation, and sidebending and rotation occur in opposite directions. If it's a backward sacral torsion, then L5 would have a type 2 SD, so for example L5 would be flexed or extended and rotated and sidebent right or flexed or extended and rotated and sidebent left (for type 2 SDs, rotation is written before sidebending and they both occur in the same direction).

I always forget this shit. Ugh.😑

There’s no earthly way of knowing Which direction we are going There’s no knowing where we’re rowing Or which way the river’s flowing Is it raining? Is it snowing? Is a hurricane a-blowing? Not a speck of light is showing So the danger must be growing Are the fires of hell a-glowing? Is the grisly reaper mowing? Yes, the danger must be growing ‘Cause the rowers keep on rowing And they’re certainly not showing Any signs that they are slowing!

Gene Wilder / Mel Stuart’s Willy Wonka & the Chocolate Factory (1971)