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  1. DonTigny, Richard L. PT


Several interactive pelvic axes occur during activities of weight-bearing and ambulation. Flexion and extension of the symmetrical innominates occur on the sacral x-axis with weight-bearing. Normal asymmetric innominate rotation occurs on the innominate axis at the pubic symphysis during weight-bearing with normal ambulation. Oblique sacral movement occurs on an oblique sacral axis concurrent with asymmetric innominate movement. Acute and chronic low back pain is commonly caused by a bilateral symmetrical or oblique anterior innominate rotation on the sacrum on an acetabular axis, usually while lifting, bending, lowering, shoveling, sweeping, a pendulous abdomen, during pregnancy, or with a postural forward head. The innominates are caused to sublux slightly cephalad and laterally on the sacral x-axis at the posterior inferior iliac spine (PIIS). This is a measurable movement that puts a rotational shear on the bilateral sacral x-axis and separates the sacral origins of both the gluteus maximus and the piriformis from their ileal origins resulting in pain across the mid-buttocks into the trochanter, down the tensor fascia lata into the lateral knee causing piriformis syndrome, pain across the buttock from the PIIS to the trochanter, a sciatic neuritis or a pseudosciatica. In all probability, true sciatica is probably not from the disc but rather caused where the sciatic nerve exits just below or sometimes through the compromised piriformis. A specific abdominal pain may also accompany acute or chronic low back pain as may an idiopathic scoliosis. An associated posterior movement of the ischial tuberosities can approximate the distal sacrum, loosen muscles of the pelvic floor, decrease kinetic tension on the sacrotuberous ligaments, and cause some degree of incontinence. Dysfunction is all initiated at the sacral x-axes. This is corrected effectively simply with a manual bilateral posterior innominate rotation that reverses all and various symptoms leaving the patient free of pain. Many areas of dysfunction are described, but not all.