Sacro-Occipital Technique

Sacro-Occipital Technique, often called SOT, is a way of examining the pelvis, the low back, and the base of the skull, then choosing care from what that exam shows. I use it along with the other methods in this office. The office serves Ave Maria, Immokalee, and Naples.

Major Bertrand DeJarnette, a chiropractor and osteopath, developed the system. The category method is taught by the Sacro Occipital Research Society International and by SOTO-USA. This page is my explanation for patients.

What the exam is looking for

SOT sorts a visit into one of three categories. The number is a name for the pattern, and the categories are not a sequence I work through in order. Indicators from the exam decide which pattern needs attention that day. Those indicators can change, so the category on a later visit can be different.

The three patterns are a stuck sacroiliac joint with tension in the covering of the spinal cord, a sprain of the weight-bearing part of that joint, and a lower-lumbar disc problem that involves the sciatic nerve.

The blocks

The signature tool is a pair of padded wedges, called blocks. You lie on the table, and I place the wedges under the pelvis. They work as fulcrums. Your body weight and gravity supply the force. This part of the visit does not use a twisting thrust. The category decides whether you lie face down or face up, and the leg-length and other tests decide the angle. I recheck the same indicators after the blocks are in place.

Category I

Category I is a fixation of the front, synovial part of the sacroiliac joint. In this technique that part of the joint is called the boot. The spinal and cranial dura is involved with it, along with the reflexes of the central nervous system.

The main sign is heel tension, and that tension is expected on the side of the shorter leg. Standing sway tends to be forward and back. The first rib still moves on both sides when the head nods.

How the blocks are used

You lie face down. I set the wedges under the front of the hip bones. The shorter leg and the side of heel tension set the angle. The idea is to let the sacrum rock between the hip bones again. That rocking is the lower end of a small motion shared with the base of the skull. Heel tension often eases in the first half minute. The wedges stay for several more minutes so the head end of the same system has time to respond.

Category II

Category II is a problem in the weight-bearing part of the sacroiliac joint. That part of the joint has a cartilage surface, and the usual injury is a tear, sprain, or strain. Because this joint tells the body where the pelvis is in space, the sprain can affect muscles, posture, the jaw, and the seams between the skull bones.

The main test is the arm-fossa test. I contact the ligament at the front of the pelvis while you hold an arm steady. A weight-bearing sacroiliac sprain makes one area of that ligament more sensitive, and the arm gives way there. The upper part of the test matches the shorter leg. The lower part matches the longer leg. Standing sway in this category tends to lean to one side.

How the blocks are used

You lie on your back. The wedges are placed from the short-leg side and from the part of the fossa test that failed, so your weight can seat the sprained weight-bearing joint. I repeat the arm-fossa test. When that test holds, the wedges come out. If this test is the main finding, Category II is the pattern I address first. Blocks meant for the other two categories can disturb a sprained weight-bearing joint.

Category III

Category III begins when pelvic ligaments are torn or stretched and the weight-bearing sacroiliac joint separates. The lower lumbar vertebrae are then loaded past what they can recover from, often at a spot that was already weak. Pressure on a lumbar disc can push the disc toward the sciatic nerve.

People in this category often stand with little sway, sometimes with a lean or a curve. A step-out, toe-out test of the piriformis is restricted on one side, and it may reproduce the pain. The piriformis is a hip muscle that can press on the sciatic nerve when it is guarding a disc injury.

How the blocks are used

You lie face down. The wedge on the shorter-leg side sits under the hip socket and angles across toward the other side. The wedge on the longer-leg side sits higher, under the front of that hip bone, and angles across as well. The idea is to level the pelvis and reduce the extra stretch on the piriformis and the lumbar disc. If a position does not ease the pain, I change the angle and recheck. This is care for a disc and nerve problem. Some disc injuries need imaging or a surgical opinion, and I will say so when the exam calls for it.

The dura mater and the spine

The dura mater is the thick outer membrane around the brain and spinal cord. It is anchored inside the skull, in the upper neck, and at the base of the sacrum. Because of those anchors, the base of the skull and the sacrum pull on the same sheet of tissue. Cerebrospinal fluid circulates inside that sleeve and helps protect and nourish the central nervous system.

SOT describes a cranial sacral respiratory mechanism. The word respiratory here means a small repeating motion, separate from the breath in the lungs. The pieces of that motion are a slight give in the skull seams, a rocking of the sacrum between the two hip bones, tension in the dura where it meets the skull, the upper neck, and the sacral base, and the pulse of cerebrospinal fluid inside the dural sleeve.

Category I is the pattern aimed at that mechanism. When the synovial part of the sacroiliac joint is stuck, the sacrum cannot rock, and the dura is held under extra tension. Category I blocking is meant to restore the sacral end of that motion so the dural tension can change and the base of the skull can follow. Categories II and III are about a sprained weight-bearing joint and a lumbar disc. They still sit on the pelvis, which is the lower anchor of the same membrane.

A visit

After the indicators are collected, I tell you which category fits and whether the blocks are the right next step. The category can change as the findings change.

If you live in Ave Maria, Immokalee, or Naples, call (239) 763-7016 to schedule an appointment.