Which statement best describes the line of drive for sacral misalignments P-L/P-R?

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

Answer: (C)

For sacral misalignments labeled P-L or P-R, the correction needs a thrust that moves the sacral base from posterior to anterior while introducing a rotation. The sacrum in these cases is not just shifted forward or sideways; it often has a torsional component that must be addressed to bring the base and the ilia back into proper alignment. A posterior-to-anterior thrust with an applied torque provides both the primary directional force to bring the base forward and the rotational component to realign the sacrum in three dimensions.

A purely P-A thrust without any rotation may reduce the backward displacement but often won’t resolve the rotational asymmetry that accompanies these unilateral misalignments. Conversely, directing the thrust strictly through the joint plane (medial-lateral) or limiting it to P-A alone misses the essential rotational correction. Therefore, combining a P-A line of drive with torque precisely tackles the misalignment’s mixed sagittal and rotational elements, making it the best description for these sacral patterns.