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Sacral Torsion & Pelvic Shear Flowchart

Seated vs. Standing Flexion → Spring/Sphinx Test → L5 Rules → Innominate Shears & Muscle Energy Setups.

L5 Opposite Rule 100% COMLEX High-Yield
Step 1: Axis Side Seated Flexion
Opposite Axis is on the OPPOSITE side!
Golden Rule: Positive right seated flexion → Left oblique axis (L on L or R on L).
Step 2: Direction Spring / Sphinx
Spring (-) Good spring = Forward (L/L, R/R)
Poor Spring (+) / Worsens: Backward torsion (L on R, R on L) or unilateral extension.
L5 & Sacral Coupling Laws Guaranteed Board Question
Opposite Rotation, Same Sidebending
Rotation is OPPOSITE:

L5 rotates in the opposite direction of sacral rotation. Example: Left-on-Left torsion → Sacrum rotated left → L5 rotated right.

Sidebending is SAME as AXIS:

L5 sidebends toward the same side as the sacral oblique axis. Example: Left oblique axis → L5 sidebent left (SLRR).

The 4 Sacral Torsions Master Matrix Diagnostic Table
Sulcus vs. ILA
Left-on-Left (L on L) Forward Torsion
• Seated Flexion: Positive on Right (Opposite of Left axis).
• Spring / Sphinx: Good spring (negative) / Asymmetry improves.
• Deep Sulcus: Right base anterior / deep.
• Posterior / Inferior ILA: Left ILA prominent.
• L5 Diagnosis: Neutral, Sidebent Left, Rotated Right (N SLRR).
Right-on-Right (R on R) Forward Torsion
• Seated Flexion: Positive on Left (Opposite of Right axis).
• Spring / Sphinx: Good spring (negative) / Asymmetry improves.
• Deep Sulcus: Left base anterior / deep.
• Posterior / Inferior ILA: Right ILA prominent.
• L5 Diagnosis: Neutral, Sidebent Right, Rotated Left (N SRRL).
Right-on-Left (R on L) Backward Torsion
• Seated Flexion: Positive on Right (Opposite of Left axis).
• Spring / Sphinx: Poor spring / no spring (positive) / Asymmetry worsens.
• Posterior Sulcus: Left sacral base stuck posterior / shallow right.
• Posterior / Inferior ILA: Right ILA prominent.
• L5 Diagnosis: Non-neutral, Sidebent Left, Rotated Left (E/F SLRL).
Left-on-Right (L on R) Backward Torsion
• Seated Flexion: Positive on Left (Opposite of Right axis).
• Spring / Sphinx: Poor spring / no spring (positive) / Asymmetry worsens.
• Posterior Sulcus: Right sacral base stuck posterior / shallow left.
• Posterior / Inferior ILA: Left ILA prominent.
• L5 Diagnosis: Non-neutral, Sidebent Right, Rotated Right (E/F SRRR).
Innominate Dysfunctions (Standing Flexion Test (+)) Iliosacral
ASIS vs. PSIS
Anterior Innominate

ASIS inferior, PSIS superior. Short leg on dysfunction side. MET Muscle: Hamstrings.

Posterior Innominate

ASIS superior, PSIS inferior. Long leg on dysfunction side. MET Muscle: Rectus femoris / Quads.

Superior Shear (Upslip)

ASIS & PSIS both superior. Positive standing flexion. Rx: Direct leg traction with internal rotation.