32-year-old male presents to the urgent care with the complaint of acute onset mid low back pain...
A 32-year-old male presents to the urgent care with the complaint of acute onset mid low back pain. History reveals his symptoms began three hours ago when he was cleaning out his garage and felt an immediate sharp pain in his lower back while moving a heavy box. The pain is described as sharp and stabbing, rated 5/10, and is worse with movement, up to 7/10, especially forward bending and rotation. He denies any radicular symptoms, numbness, weakness, or bowel and bladder dysfunction. Physical examination demonstrates an antalgic gait with a slightly forward posture. Straight leg raise reproduces his back pain. Strength, sensation, and deep tendon reflex testing are all normal. Osteopathic examination reveals L5 is flexed, rotated left, and sidebent left with associated lumbosacral myofascial restrictions.
Based on the osteopathic examination, his sacral somatic dysfunction is most likely a
- left-on-left sacral torsion
- left-on-right sacral torsion
- right unilateral sacral extension
- right-on-left sacral torsion
- right-on-right sacral torsion
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STOPright-on-left sacral torsion
At first glance, you may think there is not enough information to answer this question given that there is no information about a seated flexion test or springing of the sacral bases, however, there is sufficient information to make the diagnosis. The key to answering this question is understanding the lumbosacral biomechanics. This is explained in the rules of sacral torsions, which are as follows:
In this patient's case L5 was flexed, rotated left, and sidebent left.
Using the above rules, we can infer from L5 the sacral somatic dysfunction.
With L5 rotated to the left, we know that the sacrum will rotate right.
With L5 side bent to the left, we know that the sacral oblique axis will be engaged on the left, and a positive seated flexion test would be apparent on the right.
Using this information, we now know that the patient has a right-on-left sacral torsion.
This would be classified as a backward (or posterior) sacral torsion.
Sacral Algorithm