Low back pain: diagnosis by six newly discovered sacral tender points and treatment with counterstrain

Although counterstrain and exercises reestablished relative lumbar stability in a patient with chronic low back pain and lumbar hypermobility on gross and segmental motion testing, the patient still had tender points in the middle of the sacrum. After initially ignoring these tender points, we tested various release positions in an attempt to relieve the patient's discomfort. Next, we discovered that 14 patients with low back pain had tenderness at one or more of the tender points. Eventually, we discovered what we believe to be six previously undocumented medial sacral tender points. Two are located 1.5 cm directly medial to the inferior aspect of the posterior iliac spine bilaterally; two are located 1 cm medial and 1 cm superior to the inferior lateral angles bilaterally; one lies on the midline between the first and second spinous tubercles of the sacrum; and one lies on the midline on the cephalad-most border of the sacral hiatus. We describe the use of these tender points in diagnosis and their release by counterstrain technique.