5-19 Descended Sacrum's Affect on Brain and Spinal Cord 

the non-physiological sacroiliac lesion represented by the sacrum being inferior in relation to the ilium, has been described with a variety of terms, including inferiorly sheared sacrum, upslipped ilium, downslipped sacrum, descended sacrum, depressed sacrum. The term inferiorly sheared sacrum will be used throughout this paper, for the clarity it brings to the positional relationship of the sacrum and the ilium.

Inferior shearing of sacrum is very common and often found in combination with a posterior innominate. ¹ The sacrum shears inferiorly at the sacroiliac joint, a movement which is not physiologic for that joint. This is why this lesion is considered pathologic rather than physiologic. The axis as well as the soft tissue surrounding the sacroiliac joint is disrupted by the inferiorly sheared sacrum, which can be unilateral or bilateral. The bilaterally inferiorly sheared sacrum is especially common in post partum women.²

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7-4 NeuroAnatomy Study List for Manual Therapists, The Burnham Review

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5-19 Descended Sacrum Paper

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7-13 Sacroiliac Pain and Dysfunctions, The Burnham Review

Accessory Sacroiliac Joints

"During the examination of a large number of hip bones belonging to the anthropological material collected in Nubia by the Archaeological Survey, the writer noticed a curious raised facet situated on the rough non-articular area, immediately behind the auricular surface of the ilium, which articulated, when the sacrum and ilium were in apposition, with a similar but somewhat depressed facet on the posterior surface of the sacrum, just to the outer side of the first posterior sacral foramen, and in the neighbourhood of the rudimentary transverse process of the second sacral vertebra.

Further investigation has shown that this facet is comparatively common, not only in Nubian bones, but also in the large collection of skeletons found in Whitechapel, and now preserved in the Anatomical Department at University College.

Derry, D. E. (1911). "Note on Accessory Articular Facets between the Sacrum and Ilium, and their Significance." J Anat Physiol 45(Pt 3): 202-210 [Full Text] http://www.pubmedcentral.nih.gov/articlerender.fcgi? tool=pubmed&pubmedid=17232882.

14. Halgren,

15. Magoun, Harold Ives, A.B., D.O, F.A.A.O. Osteopathy in the Cranial Field. Pg. 1.

16. D.O., DO Autoregulation Course 2001.

17. Druelle, Philippe.

18. Applied Anatomy of the Lymphatics. pg. 103.

19. Applied Anatomy of the Lymphatics. pg 105.

20. Applied Anatomy of the Lymphatics. pg. 108.

21. Greitz, et al (1992) quoted in Research in Osteopathy James, Jones, D.O.

22. Dolgin, Eric J., D.O. The Osteopathic Home Page .

23. Magoun pg 34

24. Magoun pg 121.

25. Gendrom, Ginnette, DO. CCO Pelvis, Iliac, Hip Joint Course 1997

26. Mitchell, Fred Jr., CCO Muscle Energy Course 2001.

27. Druelle, Philippe, D.O., CCO Course March 2001.

28. Surgical Disorders of the Sacrum. pg 112.

29. Atlas of Gynecological Surgery pg 200

30. Gendron, CCO Course 1998.

31. McConnel. Selected Writings of C.P. c. Sqiiirrel's Tail Press. Columbus, Ohio, 1994

32. Laflamme, Diane. CCO Course 1999.

33. Pg. 222. Richard, Raymond, D. Osteopathic Lesions of the Sacrum. Thorsons Publishing Group. Wellingborough - New York. (1978).

Depressed Sacrum
Objective: To review the anatomy, etiology, and symptoms associated with an anterior-inferior sacral subluxation and to discuss the diagnosis and treatment of this condition using applied kinesiology methods. A historical parallel to the importance of this sacral fault in the writings of William Garner Sutherland, D.O. is presented. Data Source: The following were searched for information relevant to the anterior inferior sacral subluxation: the AK literature, the writings of Major Bertrand DeJarnette, D.O., D.C., William Garner Sutherland, and the Index to Chiropractic Literature. Results: The anterior-inferior sacral subluxation is frequently found in new mothers. Post-partum neurosis and depression are frequently improved by correction of this sacral fault in the literature reviewed. Production of this fault may occur traumatically with falls onto the buttocks, or during delivery of a child when the pelvic diameter is increased and the ligaments of the pelvis are relaxed. Mother’s in the lithotomy position during delivery may strain the sacral base anteriorly and inferiorly, especially when the obstetrician applies traction to the baby’s head. Conclusion: A definitive diagnosis can best be made using the clinical tests described in this paper, and conservative treatment can be effective in treating this musculoskeletal problem of the pelvis. (Cuthbert, 2003). Scott Cuthbert, D. C. (2003). "The anterior-inferior sacrum Sutherland's depressed sacrum revisited." Collected Papers International College of Applied Kinesiology, 2003-2004;1:27-29 ICAK-USA Research(Compilation of Applied Kinesiology Research Papers Published in the Collected Papers of the International College of Applied Kinesiology for the year 2003-2004): from  www.kinesiology.net/Applied_Kinesiology_Collected_Papers.doc.

Spinal Cord Injury
Colin (2007). "The Power of Tragedy: CenterIMT." March: http://ballincolin.spaces.live.com/blog/cns!87CFB6635194DB24!1502.entry.

Sacral Dysfunction
This paper presents a conceptual framework for the etiological factors that result in sacral somatic dysfunctions. The author points to the likely multi-etiological factors that result in sacral somatic dysfunctions. These factors include ligamentous laxity of the sacroiliac articulation and somatic dysfunction of the multifidus, piriformis, erector spinae and biceps femoris muscles. The most important factors seem to be the ligamentous laxity and the multifidus somatic dysfunction. Definitive diagnosis of the etiological factors of sacral somatic dysfunctions is key to their treatment. Further study is obviously needed in this area. (Danto,2003). Danto, J. (2003). "Etiological factors in sacral somatic dysfunctions." The AAO Journal: A Publication of the American Academy of Osteopathy Spr;13(1):25-29: from http://ostmed.hsc.unt.edu/scripts/starfinder.exe/524/ostmedbasic.txt 

Cranial Sacral Therapy
Caperonis, D. (2002). "I tried craniosacral therapy: I hoped this hands-on treatment would erase my head and neck tension. Here's what happened at my first session - test run (a treatment with Lissa Wheller, IMTC)." Natural Health Jan-Feb: found at: http://www.findarticles.com/p/articles/mi_m0NAH/is_1_32/ai_81391084.

Biomechanical Space
Spondylolytic defects at L5 are influenced by insufficient differential spacing between the inferior articular facets of L4 and superior facets of S1. These structures then impinge on the intervening L5 pars interarticularis during hyperlordosis, contributing to fracture and resorption of the pars. OBJECTIVES: Articular facet spacing was evaluated on clinical radiographs of normal and spondylolytic patients. SUMMARY OF BACKGROUND DATA: Spondylolysis ranges from a hairline fracture through the pars to a complete pseudarthrotic defect. Insufficient increase in the distance between articular facets from L4-L5 to L5-S1 has been associated with chronic lytic defects in a skeletal sample. METHODS: Anteroposterior radiographs of 39 patients with L5-S1 spondylolysis were compared with radiographs from 42 normal individuals. Differences in transverse distances between lumbar articular facets and pedicles were compared using 2-tailed t tests. RESULTS: Patients with spondylolysis exhibited a smaller increase in interfacet distance from the L3-L4 facet joints to the L5-S1 joints than do normal patients, even relative to vertebral size. CONCLUSIONS: Spondylolytic fractures at L5 are influenced by an inadequate increase in interfacet distances between adjacent vertebrae. Individuals lacking sufficient increase in lower lumbar transverse interfacet dimensions are at greater risk of developing and maintaining spondylolytic defects. (Ward,2007). Ward, C. V., B. Latimer, et al. (2007). "Radiographic assessment of lumbar facet distance spacing and spondylolysis." Spine 32(2): E85-8. [PubMed Abstract]

Dural Tensions
  "The existence of the membranes around the brain and spinal cord is well documented in anatomic research and utilized in medical practice. This entire membranous envelope functions as a unit and is called the Reciprocal Tension Membrane (RTM).
   Every medical student and anatomist who has dissected the central nervous system has seen this membrane. Every physician who has performed a lumbar puncture (spinal tap) has felt the "pop" as the needle penetrates the dural membrane to sample Cerbrospinal Fluid (CSF).
  Kostopoulos and Keramidas1 in their research on cadavers, suggest that there is an association between treatment of the cranial bones and the movement of cranial dural membranes.
  Zanakis et al.2 identified a possible connection between cranial and sacral motion. Cranial bone motion was recorded via Infrared skin markers positioned on the subject’s head with simultaneous palpation of the sacrum. A 92% correlation between the perception of sacral movement and cranial bone motion was demonstrated. Given the relatively small number of subjects, larger follow up studies need to be performed to establish statistical significance.
  There is no doubt as to the existence of the continuity of dural membranes around the central nervous system (brain and spinal cord). Over 75 years of effective clinical application of Osteopathy in the Cranial Field (OCF) leaves little question as to the validity of this phenomenon. Due to the small number of studies, further research is prudent.
  Kostopoulos DC, Keramidas G. Changes in elongation of falx cerebri during craniosacral therapy techniques applied on the skull of an embalmed cadaver. J Craniomand Pract 1992;10:9-12.
  Zanakis MF, Dimeo J, Madoma S, et al. Objective measurement of the CRI with manipulation and palpation of the sacrum [abstract]. J Am Osteopath Assoc 1996;96(9):55.
  The Cranial Academy (2005). "Research: Dural Mobility - The Reciprocal Tension Membrane." from www.cranialacademy.org/researchRTM.html  

Sacroiliac Joint
   Sacroiliac joint dysfunction is one of the proved causes of sacroiliac joint syndrome. We are talking about the restricted mobility of sacrum opposite to ilium the type of "reversible blockage of movement". Main characteristics of dysfunction are as follows: restricted "joint play", referred pain, normal radiological finding, normal lab results and disappearance of clinical symptoms after deblocking of articular bodies. Pain from a blocked joint can be referred to lower back, buttocks, hip, groin, thigh, calf and lower part of abdomen. Dispersion of painful regions is a consequence of a complex and variable innervation of articular capsule. Blocked position of articular bodies and protracted tension of articular capsule causes a stimulus of nociceptors by which a capsule is protected. Nociceptive activity is manifested with referred pains in innervational region of stimulated sensitive nerves. In the article, besides the clinical manifestations, there is described a diagnostics and manual therapy of dysfunction. Springing tests by means of which a passive mobility ("joint play") is being tested, are most valuable in dysfunction diagnostics. Manual therapy (mobilization/manipulation) is indicated and efficacious with the patients suffering from dysfunction. (Grgic,2005). Grgic, V. (2005). "[The sacroiliac joint dysfunction: clinical manifestations, diagnostics and manual therapy]." Lijec Vjesn 127(1-2): 30-5. [PubMed Abstract]

Back Pain
Giammatteo, S. W. (2005). "Relevance of ATM with Neurologically Impaired Adults." from http://www.backproject.com/articles/articles_neuro_applicability.html.

Down Syndrome and the Sacrum
   A four year-old child with Down Syndrome was evaluated for OMT treatment. He was noted to be socially withdrawn and have muscular and speech abnormalities. Numerous restrictions were noted in his spine and extremities. PRM evaluation revealed an inferior vertical strain with the sacrum stuck in extension phase. Monthly treatments included Myofascial release of the lower extremities and cranio-sacral techniques to restore sacral respiratory motion. With treatment, the patient showed improved motor coordination followed by a more outgoing social behavior with family and friends. The patient now participates in family responsibilities. Funk, S. (2000). "Osteopathic manipulative treatment and Down's syndrome." JAOA: The Journal of the American Osteopathic Association Sum;10(2):36-37: from http://ostmed.hsc.unt.edu/scripts/starfinder.exe/524/ostmedbasic.txt

Headaches
   Cephalgia is a common complaint that can be successfully treated using osteopathic manipulative treatment (OMT). The patient presented in this case was a 29 year old female with the chief complaint of chronic cephalgia. The history of the chief complaint includes headaches that occur intermittently, approximately two or three times per week, for the last year. Significant findings on physical exam included deviation of the mandible, mild postural changes, and segmental dysfunctions in the sacrum, lumbars, thoracics, ribs, cervicals, and cranium. Various treatment modalities employed for this patient were delineated and incorporated myofascial release (MFR), high velocity low amplitude (HVLA), direct inhibition with respiratory force, direct operator springing, and osteopathy in the cranial field (OCF). Course of treatment included follow-up visits at four and eight weeks. The patient experienced improvement including fewer headaches at 4 weeks and resolution by week eight. The discussion emphasizes the importance of treating the venous and lymphatic systems to improve flow and alleviate congestion within the cranium. (Brown,2000). Brown, C. (2000). "Case study: OMT and chronic cephalgia." JAOA: The Journal of the American Osteopathic Association Spr;10(1):29, 38-39: from http://ostmed.hsc.unt.edu/scripts/starfinder.exe/524/ostmedbasic.txt.

The medical literature is replete with case reports of the syndrome known as autonomic dysreflexia. Although the majority of cases are known to be induced by either bladder or bowel distention. there does exist a small number of cases in which the inciting stimulus is more obscure. In such cases, a comprehensive medical evaluation is necessary to ensure proper identification of the source of irritation and the appropriate medical management of the patient. We present a patient with a heretofore unreported suspected etiology of autonomic dysreflexia, axial loading of a sacral stress fracture. Beard, J. P., W. H. Wade, et al. (1996). "Sacral insufficiency stress fracture as etiology of positional autonomic dysreflexia: case report." Paraplegia 34(3): 173-5.

Mitchell, F. L. and P. K. G. Mitchell (1995). The muscle energy manual. East Lansing, Mich., MET Press.

Walker, J. M. (1992). "The sacroiliac joint: a critical review." Phys Ther 72(12): 903-16 from www.ptjournal.org/cgi/reprint/72/12/903.

Richard, R. (1986). Osteopathic lesions of the sacrum. Wellingborough, England, Thorsons Publishing Group.

Frymann, V. (1966). "Relation of disturbances of craniosacral mechanisms to symptomatology of the newborn: study of 1,250 infants." J Am Osteopath Assoc 65(10): 1059-75.

Weisl, H. (1954). "The articular surfaces of the sacro-iliac joint and their relation to the movements of the sacrum." Acta Anat (Basel) 22(1): 1-14.

Derry, D. E. (1911). "Note on Accessory Articular Facets between the Sacrum and Ilium, and their Significance." J Anat Physiol 45(Pt 3): 202-210 [Full Text] http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17232882.