Three Categories of Sacral Occipital Lesions (courtesy of:  Howat J. Chiropractic: The Anatomy and Physiology of Sacro Occipital Technique).  

It is theorized that if there is a structural block preventing the normal extension/flexion between the occiput and sacrum, the following subluxations (postural distortions) can result:

Category I Subluxation (typically seen in pediatric patients): a misalignment of the innominates on the sacrum in which one innominate is more anteriorly rotated relative to the ipsilateral innominate (referred to as the sacral boot mechanism):

  • A distortion (twist) occurs in the dural membrane surrounding the brain and spinal cord (see animation below)
  • This twist in the dural membrane results in a sagittal plane rotation of the innominates
  • The sagittal plane rotation of the innominates unlevels the pelvis. This unleveling of the pelvis results in a global postural shift referred to as BioImplosion



Muscles that typically are in spasm:

  • Temporalis 
  • SternoCleido Mastoides 
  • Latissimus Dorsi 
  • Sartorius 
  • Gracilis 

Torsion in the sural membrane tilts the pelvis

  • Neck and/or ear pain 
  • Tinitis 
  • Headaches (lateral) 

The interactions between the two postural distortional patterns result in a skewed postural shift

  • In a pure Category II, Pattern II Subluxation, the pelvis would be tilted to the right
  • Shoulder/arm/hand pain 
  • Chest pain (lateral) 
  • Low Back Pain Thigh pain (lateral) 
  • Knee/ankle/feet problems 

Mixed postural distortional pattern:  

  • PreClinical Clubfoot Deformity  
  • Category II, Pattern II Cranial Sacral Subluxation  

Pattern II (functionally short left leg):

This pattern can reach the level of the foot resulting in foot twist (supinated left foot - pronated right foot)

  • Pattern II: Head tilts right, shoulder drops to the left, the pelvis (sacrum and both innominates) tilts right 

Pattern I (functionally short right leg):

This  pattern can reach the level of the foot resulting in foot twist (supinated right foot - pronated left foot) 

  • TMJ symptoms - TMJ reciprocates with the SI Joint.  The TMJ will change its position to compensate for a Category II Subluxation.  This can result in changes in the occlusion (bite), balance, hearing and neck position.

Common symptoms associated with a Category II Subluxation:


TMJ symptoms - TMJ reciprocates with the SI Joint.  The TMJ will change its position to compensate for a Category II Subluxation.  This can result in changes in the occlusion (bite), balance, hearing and neck position.

Trauma to the occiput (back of the head) can result in a locked saccral nutation (sway back).  If severe enough, will compress the sciatic nerve.

Common symptoms associated with a Category I pelvic rotation:

  1. Visceral disturbances 
  2. Skin Disorders Numbness in the Facial Structures 
  3. Numbness in the extremities 
  4. Low Back Pain 
  5. Anxiety 
  6. Headaches 
  7. Weight Problems 

Category III Subluxation: the sacral iliac ligaments are torn, allowing a greater separation within the weight bearing SI Joint.  This results in degenerative changes within the spinal intervertebral discs.  

Common symptoms associated with a Category III Subluxation:

  • Numbness/ pain and/or burning down back of the leg 
  • Chronic leg tightness 
  • Bowel and/or bladder dysfunction 
  • Pain on sitting/rising Pain on coughing 
  • Coldness in the feet and hands 


Typical body lean patterns seen with a Category I-III Subluxations:

  • Forward (sagittal plane) leans 
  • Lateral (frontal plane) leans  (See Photo Below)

Cranial Sacral Theory

Category II Subluxation:  Sacral iliac ligaments stretch allowing the sacral iliac joint to separate.  This hypermobility of the sacral iliac articulation results in postural distortions: the sacrum slips (tilts) to one side resulting in a functional leg length discrepancy; the spine unbalances and the head tilts to one side.

Classical postural distortional patterns associated with a Category II subluxation:

  • Pattern I:  Head tilts left, shoulder drops to the right, the pelvis (sacrum and both innominates) tilts left