Why We Need to Stop Believing in Sacral Torsions

Hey Massage Therapy Fam,

If 100 experts all said they could find something that’s hard to detect, and you said, “Okay, prove it,” how many of them would need to consistently agree on where it is and what it is before you would start to believe they might actually be able to find it?

Disclaimer — partly because I want to stay as classy as possible, and partly because I know this post might ruffle a few feathers.

As far as we know, the Earth isn’t flat, and the Tooth Fairy isn’t real. We believe this for couple of reasons, but I think most importantly, because there’s just no evidence to support those claims, and what we do have strongly suggests we shouldn’t believe in such things.

If however, an overwhelming amount of high-quality evidence someday proved otherwise, I’d change my mind — because that’s the right thing to do.

When it comes to being wrong, I’m something of an expert.
In my 45 years on this planet, and nearly 20 years in this profession, I probably could have earned an honorary master’s degree in being wrong. I’ve been wrong a lot.

And honestly? If I’m lucky, I’ll be wrong a lot more.

Why?
Because being wrong is part of growing.
It means you’re still learning.

There’s no shame in being wrong.
But being wrong and clinging to ideas that have no quality support,
is particularly toxic in healthcare because
it’s not our pride that pays the price…
it’s our patients, and the profession as a whole.

So when we discover we’re wrong? Say it.
Shrug it off.
Learn.
Move forward.
And be better.

With that in mind:

The idea that clinicians can accurately assess “sacral torsions” by palpation, and that these findings are meaningful for assessment or treatment is not supported by scientific evidence.

Extensive research shows these assessments lack reliability, accuracy, and clinical usefulness.
So what exactly does that mean?

Here’s why this idea needs to be retired:

1. Palpation Assessment Around the Sacroiliac Joint is Not Reliable

When researchers looked at studies about touching and feeling the sacroiliac joint, they found that people could not agree on what they felt.

• In 28 studies, the agreement between different testers was very low.
• Some people agreed a little, but many did not agree at all.
• None of the studies proved that what the testers felt matched what was really happening inside the joint.

This means: You can’t trust people to feel and find sacral torsions accurately – even if they did exist.

2. Feeling the Spine and SI Joints Isn’t Reliable Either

A big review looked at how good people are at feeling bones and joints by hand.

• They found that even simple things like finding simple bony landmarks are hard to do well.
• People didn’t agree very much, even when looking for sore spots.
• No one way of touching or feeling the back was better than another.

This means: If it’s hard to even find simple landmarks reliably, finding a small twist in the sacrum is even less believable.

3. Tests for the SI Joint Are Not Trustworthy

In a study where different experts tested for sacroiliac problems, they almost never agreed.

• Tests like pushing on the hips or legs didn’t give the same results from practitioner to practitioner.
• The agreement was usually “slight” — which is very low.

This means: Even when experts use the same SIJ tests, they don’t agree — so you definitely can’t trust more complicated ideas like sacral torsions.

4. Even Special Tools Have Trouble Measuring Movement Near the Sacrum

One study used a machine called the SpinalMouse, which measures how the spine moves.

• The sacrum and hips were the hardest area to measure.
• The machine couldn’t measure extension (bending backwards) very reliably there.

This means: If a machine has trouble measuring this area, a person using only their hands definitely can’t do it accurately.

5. Feeling Better After Treatment Doesn’t Mean the Sacrum Was Fixed

Sometimes patients feel better after a therapist works on them. That’s great! But it’s not because the sacrum was “realigned.”

• People feel better because of things like trust, relaxation, nervous system changes, or natural healing.
• There is no proof that bones are moved back into place by manual therapy.

This means: Feeling better is real, but it doesn’t mean your sacrum was twisted or that it was “put back.”

Patients may feel better after hands-on interventions, but improvements are more plausibly explained by:

• Contextual effects (e.g., therapeutic alliance, positive expectation)​
• Neuromodulation, where sensory and motor systems are temporarily altered​
• Reduction of protective muscle tone or changes in interoception​
• Natural variation in symptoms (regression to the mean)​

There is no evidence that “correcting” a “sacral torsion” restores a misaligned structure — because the concept itself is unsupported. it’s broken from go. There’s no value in exploring the application of a broken premise.

Conclusion

Sacral torsion assessments should not be considered meaningful, reliable, or clinically relevant. Pushing on people’s sacrums, backs or pelvises in different ways that relieve aches and pains is good though. Explore, learn, and customize. just dump the wack reasoning and the unjustifiable assessment.

Continuing to teach or advertise these assessments as important perpetuates misinformation and distracts from evidence-based, person-centered care.

If you feel upset by reading this, it’s okay – I did too at one time, but my friend – you need to just let it go. We were wrong, adn it’s okay, but the meaningful question is what do we do now?

If you’re looking for a better story to replace the old one with, please consider taking this course. I know how hard it is to transition to an evidence based practice when you feel like everything is being taken away from you, but let me tell you as someone who’s been there – an evidence based practice is more holistic, and unleashes your creativity as a therapist. The grass IS indeed greener. Link here: https://www.themtnetwork.com/courses/assessment-and-treatment-of-common-musculoskeletal-conditions-an-evidence-based-approach-for-rmts

If your patient feels something change after a manual technique, that’s great — but recognize that what changed was the patient’s experience, not the position of their sacrum.

It’s time to leave sacral torsion behind. They’re not real, and continuing to perpetuate this type of misinformation isn’t good for us as practitioners, the profession as a whole, or the public’s best interest.

Homework if you like:

1. Ko et al., 2010. Intrarater Reliability and Interrater Reliability in Spinal Motion Assessments​22_301
2. Haneline and Young, 2009. A Review of Intraexaminer and Interexaminer Reliability of Static Spinal Palpation: A Literature Synthesis​Reliability-Spinal-Palp…
3. Ribeiro et al., 2021. Validity and Reliability of Palpatory Clinical Tests of Sacroiliac Joint Mobility: A Systematic Review and Meta-analysis​Artigo_Prova_Grfica
4. van Tilburg et al., 2017. Inter-rater Reliability of Diagnostic Criteria for Sacroiliac Joint-, Disc-, and Facet Joint Pain​van-tilburg-et-al-2017-…
5. Anjum et al., 2020. CauseHealth: Rethinking Causality, Complexity and Evidence for the Unique Patient
6. ​Is it time to Reframe the Way we Care for People With Non-Traumatic Musculoskeletal Pain? Lewis, Osullivan, BJSM 2018