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Sacral Torsion

What Is It, Causes, Treatment, and More

Author: Corinne Tarantino, MPH

Editors: Ahaana Singh, Ian Mannarino, MD, MBA

Illustrator: Jillian Dunbar


What is sacral torsion?

Sacral torsion is the rotation of the sacrum -- the fused, bottom five vertebrae of the spinal column -- along the sacroiliac joint where the pelvis and the sacrum meet. The rotation of the upper part of the sacrum may occur towards the front side of the body (i.e., anterior), while the bottom part of the sacrum  will rotate towards the back side of the body (i.e., posterior). Sacral torsion may cause some low back pain or limit lower back movement.

What causes sacral torsion?

Sacral torsion may spontaneously occur due to a variety of movements. Anterior torsions are often caused by walking, and posterior torsions are most commonly caused by bending, lifting, or twisting. Sacral torsion may also occur from limited movement in the joints, known as hypomobility, which usually results from the joint being too tight.

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How is sacral torsion diagnosed and treated?

Sacral torsions are commonly diagnosed by a review of medical history and a physical examination. During the physical exam, some tests may be performed, like a seated flexion test, in which a person is asked to sit and bend forward while the clinician feels for abnormal sacral movement. After diagnosis, sacral torsion may be treated with some spinal manipulation, such as rotating the body in certain positions. Sacral torsion may also be treated with medications, including anti-inflammatory medicines or steroid injections. If pain persists, radiofrequency ablation may be considered, which is a minimally invasive procedure in which heat is used to stop nerves in the area from sending pain signals.

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Related links

Anatomy of the pelvic girdle
Lower back pain: Clinical practice
Back pain: Pathology review
Anatomy of the pelvic cavity

Resources for research and reference

Buchanan, B., & Varacallo, M. (2020, August 11). Sacroiliitis. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448141/ 

Cho, S. (2018). Lumbo-Pelvic-Hip Complex (LPHC) approach using sacral JET for lumbogenic pain. Alternative Medicine & Chiropractic Open Access Journal, 1(2): 1-6. Retrieved from https://chembiopublishers.com/AMCOJ/AMCOJ180006.pdf

Dydyk, A., Forro, S., & Hanna, A. (2020, October 24). Sacroiliac joint injury. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557881/ 

Hesch, J. (2011). Sacral torsions about an oblique axis: A new approach to an old problem. Unpublished manuscript. Retrieved from http://www.heschinstitute.com/uploads/6/0/7/6/6076312/torsion_chapter_092211-2_pages.pdf

Kajiyama, S. (2015, July 27). Treatment of sacroiliac joint dysfunction. Unpublished presentation. Retrieved from https://www.slideshare.net/SatoshiKajiyama/treatment-of-sacroiliacjointdysfunctionnata

McParland, B., & DeLuca, A. (2020, July 21). Osteopathic manipulative treatment: Muscle energy procedure - sacral dysfunctions. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK560580/