I'll use S.O.A.P format and give a conclusion explaining the treatment.

Structural Compensation with a Somato-Emotional etiology.

A 42 year old male presented at my clinic with a chief complaint of left sacro-iliac pain.

S- The client informed me he had this pain since he was in his twenties and he had many forms of physical therapy over the years. His pain was aggravated physically by recreational sports, such as, tennis, running and cycling. It was aggravated emotionally whenever he traveled and/or had to debate with his partner over the sleeping arrangements.  His pain was eased by anti-inflammatories, pain medication and rest. He claimed the pain was a dull ache except when it was emotionally aggravated and it than became sharp and throbbing. He scored low on the pro-inflammatory food checklist suggesting that his diet wasn't contributing to his chronic pain.

O - Upon gross examination there was an obvious left rotation to his pelvis and his lower limbs also rotated to the left . His sacrum presented with a unilateral left flexion and/or a unilateral right extension. Examination of his myofascial energy at the vertex of the cranium rotated to the right - inherent self correction. He had a right cranial sphenoid torsion. This unique structural presentation and the aggravation of pain in an emotional setting suggested a somato-emotional cause. It is also uncommon to find a structure of this nature rotated to one side in both lower limbs.  He later informed me that his bed was situated to the right of his bedroom door and that his father was physically abusive to him when he was drunk. Is it possible his body developed an unconscious defensive posture to rotate to the left in fear and preparation to his father's assaults? 

P - Counseling helped this fellow with the somato-emotional aspect of his pain. I performed muscle energy techniques and myofascial release to help him unwind back to a neutral position. Cranial-sacral also corrected the right torsion and the sacrum.

Discussion: This is another example of a patient who had a structural torsion that was treated many times with physical therapies which gave him minimal relieve. It was a good example of treating the whole person and not just the area of pain. I have always found the sacrum a challenging area to correct and have discovered over the years that pain in this area often has a physical, emotional and metabolic cause. His unique presentation of a left rotation in the pelvis and lower limbs was a red flag. The aggravation of pain when deciding exactly what side of the bed he would sleep on suggested a somato-emotional component. His upper body had a powerful energy myofascial rotation to the right which suggested a trauma of many years and, of course, his bodies inherent healing abilities trying to correct it. Myofascial compensations of this severe nature commonly start in childhood.   I believed he had to be rotating his body to the left for long periods of time, even at the unconscious level. I treated him five times and he continued his counseling. His pain resolved almost completely as he had developed physical changes to the left sacro-iliac joint from years of structural compensation that still contributed to minor pain.