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in the sacrotuberous ligaments' length or tension will be linked to sacral rotation, pelvic torsion, and strain on the sacroiliac joints and low back. Sorting out the root cause of 2 The bilateral arrangement of the sacrotuberous ligaments gives them a key role in stabilizing the sacrum against twisting and tilting. The ligaments can be strained or injured by activities involving twisting or arching the low back; asymmetries will also result from functional issues (habit and posture) or structural issues (such as leg-length difference). Image courtesy Primal Pictures. Used by permission. fibers cross the ischial tuberosity in about 50 percent of people, and are thus continuous with the biceps femoris tendon in the leg.4 Each of these structures continues, in turn, as parts of longer chains. These long connections through the body lend the sacrotuberous ligament (in its central location) its linchpin role in whole-body theories of connective- tissue relationships, such as Thomas Myers' Anatomy Trains model, the ipsilateral longitudinal sling concept in functional medicine, or Serge Gracovetsky's Spinal Engine theory. Functionally, the bilaterally oblique arrangement of the two sacrotuberous ligaments serves to prevent the sacrum from being tipped forward (into anterior nutation) by the downward pressure of the spine. Together with the sacroiliac and sacrospinous ligaments, the sacrotuberous ligaments also stabilize the sacrum against excessive side bending and twisting within the pelvis. Because of this paired, left/right arrangement, a side-to-side imbalance sacrotuberous ligament imbalances can be a chicken-or-egg pursuit: are the ligaments different left and right because of a pelvic torsion, or is their difference causing the pelvic asymmetry? Often, determining cause can be elusive. On the other hand, an injury or an observable structural irregularity (such as an anatomical leg-length difference) can make the root cause of imbalance clearer. The sacrotuberous ligament can be strained or injured in sports and activities that involve arching or twisting the low back, such as basketball, golf, gymnastics, hurdles or jumping, pitching, tennis, or volleyball spiking. Falls onto the buttocks or other direct trauma can strain or tear the sacrotuberous ligament, as well as injure the coccyx. Lifting or bending injuries, repetitive and asymmetrical activities, hamstring tendinitis, and pregnancy can all cause strain and sensitivity as well. The result of any of these impairments is often inflammation, scarring, adhesions, pain, and loss of connective-tissue adaptability. 4 SACRAL BALANCE Even when the cause or source of a left/right sacrotuberous ligament imbalance is not apparent, your work here can nevertheless be helpful in addressing the related conditions listed above. The boney space between the sacrum and the ischial tuberosity is often palpably different left to right, with one side often being more open or wider than the other; this indicates an asymmetrical pelvic pattern, most likely involving sacral side bend or rotation. Sacral biomechanics are complex and quite arcane, and their details are beyond the scope of this article. However, one useful principle is that if the space between two bones (the sacrum and the ischial tuberosity, in this example) is shorter on one side of The sacrotuberous ligament (orange) spans the distance between the posterior superior iliac spine at its upper end, along the lateral side of the sacrum and coccyx, to the ischial tuberosity inferiorly. Comparing the boney space lateral to the sacrum and coccyx can give clues to imbalances in the ligaments. Images courtesy Primal Pictures. All used by permission. 3 Visit the newly designed ABMP.com. Log in. Explore. Enjoy. 115