Sphinx position involves having the patient lie prone, then prop themselves up on their elbows to extend the lumbar spine and flex the sacrum (Figure 1). This can be very uncomfortable for extended or backward torsion sacral dysfunctions. See "Diagnosing sacral somatic dysfunction."

Sims position is a modified version of lateral recumbent. Have the patient lie in the lateral recumbent position, then rotate their torso toward the table so their chest lies against the table. For treating forward sacral torsions, the patient should be lying on their front (Sims position). For treating backward sacral torsions, the patient should be lying on their back (lateral recumbent with torso rotated back to lock out their lumbosacral junction).

Figure 1. Effects of sacral extension and flexion on the lumbar spine.

MUSCLE ENERGY OF SACRAL SOMATIC DYSFUNCTION
DIAGNOSIS	TREATMENT
Bilateral sacral flexion	With patient prone, abduct and internally rotate bilateral lower extremities until motion is felt at SI joint (disengaging it) Instruct patient to inhale while pushing on bilateral ILAs (promoting sacral extension) Instruct patient to exhale while maintaining posterior-anterior pressure on bilateral ILAs (resisting sacral flexion), repeat 3–5 times
Unilateral sacral flexion	With patient prone, abduct and internally rotate lower extremity of dysfunctional side until motion is felt at SI joint (disengaging it) Instruct patient to inhale while pushing on ILA of dysfunctional side (promoting sacral extension) Instruct patient to exhale while maintaining posterior-anterior pressure on ILA (resisting sacral flexion), repeat 3–5 times
Bilateral sacral extension	With patent in sphinx position, abduct and internally rotate bilateral lower extremities until motion is felt at SI joint (disengaging it) Instruct patient to exhale while pushing on bilateral sacral base (promoting sacral flexion) Instruct patient to inhale while maintaining posterior-anterior pressure on sacral bases (resisting sacral extension), repeat 3–5 times
Unilateral sacral extension	With patient in sphinx position, abduct and internally rotate lower extremity of dysfunctional side until motion is felt at SI joint (disengaging it) Instruct patient to exhale while pushing on sacral base of dysfunctional side (promoting sacral flexion) Instruct patient to inhale while maintaining posterior-anterior pressure on sacral base (resisting sacral extension), repeat 3–5 times
Forward torsion: L / L or R / R	With patient in Sims position with involved oblique axis down on table (thus rotating L5 toward its restrictive barrier), push patient’s ankles towards floor to side bend toward the restrictive barrier Instruct patient to lift ankles toward ceiling Repeat 3–5 times
Backward torsion: L / R or R / L	With patient in lateral recumbent position (and back rotated into table) with involved oblique axis down on table, extend and push patient’s top leg toward the floor to engage restrictive barrier Instruct patient to lift top leg toward ceiling Repeat 3–5 times

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Illustrator: Abbey Richard

Editor: Robyn Hughes, MScBMC

Key Takeaways

Sacrum muscle energy treatment (MET) is a technique used in manual therapy to improve mobility in the sacrum. This technique involves the patient actively contracting and relaxing specific muscles attached to the sacrum to improve the range of motion and reduce pain. MET is used to relieve conditions like sacroiliac joint dysfunction, lumbar strain, and sciatica. It can also be used for postural imbalances and to improve overall movement patterns.

Sacrum muscle energy treatment

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Notes