Which of the following is NOT a sacral LOD option?

• A. P-A only
• B. P-A, S-I
• C. P-A, M-L through joint plane
• D. P-A with torque

Answer: (B)

Line of drive for sacral adjustments is chosen to counter the sacrum’s common restriction patterns, which are best addressed with a posterior-to-anterior thrust. The sacral base tends to move anteriorly relative to the ilia when restrictions are present, so a P-A vector is the standard starting point. You can add a medial-lateral component through the joint plane to address sacral torsion, or apply torque to address rotational issues. A vertical superior-inferior component (S-I) isn’t a typical sacral line of drive because it doesn’t align with how sacral restrictions usually manifest or with how the SI joints respond to adjustment forces. Therefore, combining P-A with S-I isn’t considered a sacral LOD option. The other described approaches—P-A only, P-A with medial-lateral through the joint plane, and P-A with torque—are valid ways to address different sacral dysfunction patterns.