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Sacral Sag and Fascial Drag – Pelvis
It is well to interpret my use of the word “drag”:
To drag is to draw with difficulty against active or passive resistance. WGS
Introduction
Natural Agencies for Healing:
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x
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Potency of the Tide
Primary Respiratory Mechanism
Secondary Respiratory Mechanism
Ligamentous and Membranous Articular Mechanisms
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Review
The concept of Sacral Sag originates in the observation that anatomic physiology peripheral to
the cranium can alter the fluctuation of the CSF-Potency of the Tide, (a primary natural agent for
self healing) in the posterior cranial fossa, subsequent to and/or simultaneous with altered
function of: the mobility of the Reciprocal Tension Membrane; the pineal slack tension
regulating, gear shifting accommodation of the motility of the neural tube; and the ligamentous
and membranous components of osseous mobility (drag).
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Then again, sag rhymes with drag; and sags and fascial drags lead to chronic rags.
Contributions of Thought 2nd p. 284
The cerebro-spinal fluid is the highest known element in the human body, and unless this
substance is produced in abundance, a disabled condition of the body will remain. … this
great River of Life must be tapped, and the withering fields irrigated or the harvest of
health will be forever lost.
Philosophy of Osteopathy p. 39
The Main Street
Anterior and Posterior Longitudinal Spinal Ligaments
Prevertebral fascia
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Pelvis and Sacrum: Where It All Comes Together
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The Old Age Center
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Respiratory Diaphragm
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Pelvic Diaphragm
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Suspended Sacrum
Anterior convergence
…I prefer the sag description (to “anterior sacrum”) because the sacrum is suspended
between the two ilia and relatively corresponds to another unit of the cranial-respiratory
mechanism...the sphenoid bone which is suspended between and beneath two frontal bones.
Sag also has my preference because there are no muscular agencies from the sacrum to the
ilia to initiate articular mobility and none to be found from bone to bone in the cranial unit.
Contributions of Thought 2nd p. 284
There is a movement that operates through the reciprocal tension membrane. See how the
dural membrane connects up all the parts, including the sacrum, as an interosseous
membrane. TSO p. 22
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Manual Procedures:
Sacral Sag-Anterior Sacral Alae Method COT p 286
Burruano Personal Collection
x
x
x
x
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x
Operator seated in front and below the patient (PT)
Operator thumbs along iliac crest and inside working toward the posterior ilia and sacral
ala
PT bends forward, arms over physician’s back advancing operator’s thumbs (glove on
hand)
Operator uses h/h knees to bring PT’s legs together spreading PT’s ilia
Augmentation/cooperation with PT breathing I/E to BLT
Operator holds contact at sacrum while PT is instructed to sit up without extending
lumbar spine
(Another description:)
The specific procedure that Dr Sutherland demonstrated ... is carried out with the patient seated
across the table with his arms resting on the shoulders of the operator who is seated in front of
him. The operator’s thumbs are on and parallel to the crests of the ilia, their tips just clear of the
lateral borders of the quadratus lumborum muscles. Gently moving the patient form side to side,
the thumbs work their way medially and downward, anterior and close to the iliacus muscles.
The tissues of the body wall anterior to the sacral ala are compressed, as the patient slumps
forward and the lumbar spine assumes a posterior convexity. He is instructed to exhale and hold
the breath while the thenar eminences of the operator hold the crests of the ilia laterally to spread
the pelvis. As the patient inhales and raises his shoulders the thumbs lift and rotate the sacrum
into its respiratory flexion position assisting the natural movement that occurs in inhalation. It
should be recognized that the function of the operator is not to forcibly correct the lesion but to
guide and assist the inherent forces in their effort to lift the sacrum from the position of lesion
into its normal relationship. (Lippincott, H 1965)
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Lumbar Pelvic-Differential Method COT p 288
Vertical Axis of the sacrum
x
x
x
x
x
x
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x
The patient is seated on the table
The operator is on a chair in front of him, cupping PT’s heels with thumbs at lateral
malleolus.
PT’s legs are lifted to engage ischial tuberosities with table
Operator pushes/pulls on PT’s legs to test ease of motion at SI
Operator holds leg position – BLT - in direction of ease
PT turns torso in direction of ease to point of BLT observed by operator
PT assists with respiratory cooperation
PT turns back to straight (turns lumbar-sacrum) while operator holds pelvis position
Sacral Sag- The “simple” Sacral Method
x
x
x
x
x
x
The patient is seated across the table, operator cupping heels, lifts PT’s legs as above- knees
straight.
Operator holds the ilia posteriorly by a backward pressure (of operator) on the leg / ankles
PT slumps forward until the ilia start to participate in the motion
Respiratory cooperation - exhalation until it is necessary to inhale
PT inhales and raises shoulders
Operator holds the ilia forward while the sacral base moves upward and back.
Optional:
Ischial Rectal Fossa Lift
Standing SI Technique
Seated Lap Technique
Haltof A. Collection of Cranial Bone Photographs for Teaching. Cir 1990
Lippincott, H. AAO 1965 Yearbook Volume II, The Depressed Sacrum. American Academy of
Osteopathy 2000.
Sutherland, W. Contributions of Thought 2nd Ed. Rudra Press; 1998.
Sutherland, W. Teachings in the Science of Osteopathy Rudra Press; 1990.
Williams P, Warwick R Dyson M, Bannister L. Gray’s Anatomy 37th Edition. UK:
Churchill Livingstone; 1989
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