Balanced ligamentous tension of the pelvis is less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. Pelvic diaphragm release is much more frequently taught and tested.

Example: left posterior innominate rotation

1. Sit facing the seated patient and grasp above both of their ankles
2. Slowly push superiorly (position of ease) on the left leg while simultaneously pulling inferiorly (position of ease) on the right leg
3. Instruct the patient to rotate their thoracolumbar region to the left until the left leg begins to draw upward
4. Once a point of balanced tension is achieved in this left rotated position, instruct the patient to inhale deeply and hold for 5–10 seconds to further facilitate the treatment
5. Hold this position until a release is palpated

Note: this can also be performed similarly in the supine position.

1. With the patient lying prone, instruct them to flex their knees to 90º and slightly internally rotate their hips
2. Palpate the ischiorectal fossa (located immediately medial and cephalad to the ischial tuberosities)
3. Apply pressure into the ischiorectal fossa with both thumbs until the restrictive barrier of this pelvic diaphragm is met
4. After this barrier is met, push with both thumbs toward the inferior lateral angles (ILAs) of the sacrum
5. Maintain this pressure until a release is palpated. Asking the patient to cough can help facilitate release of the pelvic diaphragm soft tissue