The concept of upslipped and downslipped innominate dysfunction has been a part of osteopathic teaching for more than 50 years. In more recent years, the terminology has evolved into superior and inferior innominate shears. The assumption that these somatic dysfunctions result from vertical shearing at the sacroiliac (SI) joint is evaluated in light of new research on sacroiliac motion and stability and the authors’ clinical experiences. The authors propose that the apparent superior or inferior shift of an innominate is better accounted for by sidebending of the innominate at the sacroiliac joint. Altered treatments based on this new understanding are presented.

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Competing Interests

Financial disclosures: None reported. Dr Van Buskirk serves on the American Academy of Osteopathy’s Board of Governors.