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Sacro Occipital Technique

SOT is a powerful but gentle chiropractic technique that is a holistic approach to treating the entire body. It uses the body’s own weight and gravitational pull, combined with precise manipulation to first balance the pelvis, and then align the remainder of the spine. It is differentiated from many of the other techniques by unique and characteristic diagnostic and treatment designed to identify and correct specific abnormalities in function of the human body. Another part of SOT is Chiropractic Manipulative Reflex Technique (CMRT). CMRT provides specific diagnostic and treatment procedures involving manual stimulation of the vital organs.

The diagnosis of many of these abnormalities and the specific corrections are identified by methods and terminology often confusing to many health care providers, as well as many chiropractors in general, due to the changing and dynamic nature of the technique itself. It is an ever evolving and expanding body of research and treatment that has been explained in over 130 different books and manuals by its developer Major Bertrand DeJarnette as well as books and manuals by those who have studied and added to the principles of the technique since its inception in 1934. This vast knowledge and diversity result in personal styles of each practitioner resulting from his instructor’s approach, the personal experience of each doctor with the technique and the changes in the technique as it evolved.

SOT Treatment Protocols

Our office uses the work of DeJarnette as the basis of our diagnosis and treatment procedures although the teachings and research of other doctors has become part of our treatment protocol as well. Most of these are based on or are compatible with the principles of diagnosis and treatment of DeJarnette.

SOT adjustments each have their own indicators directing how and when to perform them. Because the body is a dynamic organism it is possible to find indicators in and for many different adjustments on any one visit. As a general rule, the body will respond best if you can find and perform the adjustment that is the lowest force that permits the body to move toward self-healing.

This is the art of chiropractic that cannot be written in textbooks because it can vary from patient to patient. The protocols listed here are basic and different adjustments can be added and removed by indicator on a patient by patient basis.

With minor exceptions, in our office SOT treatments will fall into seven general systems.

  1. Category I
  2. Category II
  3. Category III
  4. Cranial
  5. Trapezius Fibers
  6. Occipital Fibers
  7. Extremities

Determining the Category of the patient starts treatment protocols. It is very rare or impossible for a patient with an active complaint not to have category indicators. Treatment protocol will start with the procedure for that category.

Auxiliary adjustments and treatments from the four other systems can stand alone or integrated into the category protocols. These can be evaluated for effectiveness in every case although direct physiological relationships between systems make some adjustments very synergistic.


General diagnosis is through physical examination as taught in chiropractic colleges and standard examination techniques and practices accepted as standard of care for chiropractic physicians in the state of Missouri. Specific examination requirements are established and published by CMS to determine level of service and are held as a standard for various specialties. This office may use one of three different examination requirements, the general multi-system exam, the musculoskeletal exam or the neurological exam. The requirements for each of these are in the appendix of this manual.

To determine an SOT category diagnosis there are specific SOT indicators that need to be examined. Some standard orthopedic tests can be helpful in determining category involvement.

Key Concepts in Sacro Occipital Technique

SOT Category System

The SOT category system establishes three areas where the primary dysfunction of a patient might occur. Every patient has possible dysfunction in all three areas but the goal is to choose the category most relevant and therefore most likely to result in improvement in the patient’s condition.

Each of the three categories has specific physical causes and correspondingly specific treatments to correct those causes.

SOT has auxiliary treatments that are often immediately helpful with patients of certain categories, and less so with patients of other categories, but often they are helpful in treatments of all patients.

The three categories are:

  • Category I– The term used to denote the structural components of the axial skeleton and the related central nervous system neurology and peripheral nervous system neurology that correspond to the function, adaptation and compensation of distortion with relationship to the cranial sacral respiratory mechanism. Anatomically, this includes the movable bones of the cranium, the pelvis and all spinal vertebrae, as well as the dura and all of its connections. Specifically in the pelvis is the synovial cartilage portion of the sacroiliac joint. All functional neurology is also involved.
  • Category II– The term used do denote the weightbearing mechanisms, neurologically and structurally, of the human. This includes the pelvis, specifically the hyaline cartilage portion of the sacroiliac joint, as well as all of the weightbearing articulations of the spine. The cranial sutural system is part of the Category II complex, as is the TMJ (temporomandibular joint). Proprioceptive neurology is also involved. The weightbearing functions of the lower extremities and all gravitationally influenced musculature are part of this system.
  • Category III – This is the term to denote the connective tissue portions of the structural system. This involves disks as well as ligaments and cartilage of the axial skeleton and does not involve specific neurological systems. The dural stresses created by dysfunction of the Category III system implicate tensions into the mid-section of the cranium sagitally, implicating the parietal bones and sagittal suture.


Cerebrospinal Fluid Flow

Cerebrospinal fluid (CSF) is manufactured within the ventricles of the brain and it is pumped throughout the nervous system by the cranial sacral respiratory mechanism (CRSM). Recent research indicates that the CSRM pumps cerebrospinal fluid through all the nerves of the body, reaching as far as the skin. This system is propelled by the primary respiratory mechanism and includes all the axial skeletal osseous structures (cranium, spine and sacrum), as well as the dura and all of its attachments.

SOT views proper CSF flow as essential to proper health and optimal function. With this viewpoint, there are diagnoses and treatments unique to SOT for conditions impeding this proper flow.

Primary Respiratory Mechanism (PRM)

The term used to denote the reciprocal pumping action of the craniosacral respiratory mechanism, which is independent of diaphragmatic respiration and cardiac rhythms. This pumping action occurs 8-10 times per minute in the normal healthy individual and is considered to be the primary pump of the body.

Cranial Movement

The cranium is made up of movable bones. The dura mater is attached to the interior surface of the bones of the cranial vault. The bones of the cranial vault are joined at the sutures, which are designed to permit motion in specific axis of rotation. This movement affects the pressure within the dura affecting CSF flow.

SOT has diagnostic and treatment procedures to evaluate and return to normal cranial movement toward the goal of optimal health and function.

Neurological Indicators

Neurological indicators of abnormal function determine treatment. If there is normal function, the structure of the body is does not require treatment. A true malposition of a structure would result in altered nervous system function and should have an identifiable indicator directing treatment.

SOT has several neurological signs that can be assisted with structural signs to direct proper treatment.


The term used to denote the adjustment performed using Orthopedic Blocks. Blocking procedure, placement, and objectives vary according to the condition and desired effect.

  • Category I blocking is proposed to specifically affect the synovial cartilage portion of the sacroiliac joint enhancing the cranial respiratory mechanism and its affect on neurological function.
  • Category II blocking is proposed to affect the hyaline cartilage portion of the sacroiliac joint to stabilize the weightbearing nature of this joint providing a functioning foundation for all weightbearing articulations superior to it.
  • Category III blocking is proposed to have its most direct affect on the connective tissue and specifically the intervertebral disks of the lumbar spine.
  • Orthopedic blocking is a single block procedure to assist in the realignment of a specific vertebra usually in the lumbar spine.
  • Sacral Base blocking is proposed to affect the cranial respiratory mechanism by addressing fixations in the dura and stasis of cerebral spinal fluid. The blocking alters the sacral position and the pull of sacrodural attachments to assist in the correction of dural fixation.
  • Sacral blocking uses a different size orthopedic block and is proposed to apply tension to the dura and is often used in conjunction with specific cranial adjustments to affect vertebra in the lumbar spine.

Trapezius Fibers (TF)

Trapezius fibers are a system of seven longitudinal fibers bilaterally in an individual that monitor intervertebral motor unit fixation. This is a neurological indicator initiated by stresses at the pedicle junction. This in turn initiates a neurological response resulting in irritation of the ruffini spray ending in the trapezius muscle. Therefore, it is proposed that analysis of the trapezius muscle fibers is indicative of vertebral fixation through neurological indicators. SOT has a specific adjustment intended to clear this fixation and the neurological indicator.

Chiropractic Manipulative Reflex Technique (CMRT)

The term used to denote the manipulative procedures for the organic systems of man. These procedures are specific for each organ system and vertebral level. They include procedures for the neutralization of the viscero-somatic, somato-visceral and somato-somato reflex arcs involving structure and function of the organic system. Also indicated are specific organ manipulations as well as neurological dysfunction associated with visceral dysfunction and recenter a misaligned vertebral segment and to restore normal function to the specific organ.

Occipital Fibers (OF)

Occipital fibers are system of seven longitudinal fibers on each side of the back of the head imbedded in the aponeurotic attachment of the cervical musculature to the occipital bone. Within each of these fibers is a Golgi tendon organ. This organ receives neurological information concerning balance and responds in order to maintain normal cranial-dural function with respect to various types of vertebral dysfunctions.

Tendon Guard Reflex

The term used to denote the neurological response of the central nervous system to stresses placed on the dural system after the atlas has reached its maximum adaptive potential. In an attempt to restrict stress on the dura, the tendon guard reflex creates extra tension in the gastrocnemius muscle, limiting motion and thereby limiting the range of adaptation necessary for the atlas vertebra. The tendon guard reflex is measured by the heel tension test.

Vasomotor (VM)

Vasomotor is a term used to denote the subluxation and the corrective procedure for the cranial sacral respiratory mechanism fixation of an individual vertebral unit. This test and correction involves neutralization of somato-somato reflexes and involves the response of the recurrent meningeal nerve. The vasomotor subluxation represents an area of cerebrospinal fluid stasis.

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