This technique is directed at spreading the ischial tuberosities. It separates the sacroiliac joints and allows for better motion of the sacrum between the innominates. It also helps the sacrum to “seat” itself better between the innominates. At times this technique may reduce sacral torsion and flexion dysfunctions. It may be used to improve the function of the urogenital and pelvic diaphragms. It may also be employed in the osteopathic management of cystitis, proctitis, hemorrhoids, constipation, and sacroiliac dysfunction.
Dysfunction: Pelvic diaphragm tension and decreased motion.
Objective: To increase pelvic diaphragm relaxation during respiratory exhalation.
Patient position: Prone, or knee chest position.
Physician position: Standing at the foot end of the table.
Procedure:

1. Have the patient flex their knees to approximately 90 degrees.
2. Ensure the patient’s knees are together and then internally rotate the thighs.
3. Using both hands, place the pads of your thumbs on the medial aspect of the patient’s ischial tuberosities.
4. Apply firm and continuous lateral pressure.
5. Now instruct the patient to cough, allowing the pelvic diaphragm to intermittently relax.
6. Repeat the treatment until a release of the pelvic diaphragm is appreciated.