What is Sacro Occipital Technique? (SOT)

As a chiropractor deeply involved in the advancement of the Sacro Occipital Technique (SOT) in Europe, I have witnessed firsthand the transformative impact this method can have on our health and wellbeing. 

In this article, I aim to shed light on the intricacies of SOT, a technique that has become a cornerstone of my practice and a key to unlocking the potential for greater health in my patients. 

My journey as the President of SOT Europe has not only deepened my expertise but also reinforced my belief in the profound benefits of this chiropractic method.

An Overview of Sacro Occipital Technique

The Sacro Occipital Technique, commonly referred to as SOT, is a comprehensive, gentle, and innovative chiropractic method. The name comes from the intricate relationship between the sacrum (base of the spine) and the occiput (base of the skull). 

SOT focuses on the spine, pelvis and cranium. These structures house the nervous system which is surrounded by the Dural-Meningeal System and Cerebral Spinal Fluid (CSF).  The technique recognises the interconnectedness of these systems and how they can be disrupted.

How is SOT different?

SOT chiropractors require extensive knowledge of anatomy related to the pelvis, spine, and cranium and the specific forces are transmitted through the body. 

Like a suspension bridge, our bodies respond to loads placed on it. When a part of the bridge is weakened, the entire structure adapts to these loads. Similarly, the human body has a “moving architecture” that adapts and compensates for strains.

The stresses we place on the body, be it occupational, stress-related, posture habits, or sporting activities, are part of normal life. 

How well your body responds to such stress depends on many factors: birth trauma, cranio-dental issues, previous injuries, posture type, breathing patterns, stress levels, sedentary lifestyle, and poor diet.

SOT chiropractors understand how different layers of the body’s anatomy, from muscle to fascia to joints and the dura, respond to subluxation patterns. 

They use a specific SOT category system developed by Major DeJarnette to identify and treat various subluxation/postural distortion patterns.

In the next sections, we will delve deeper into the principles of SOT, its categories, specific techniques, and the immense benefits it offers to those seeking chiropractic care.

The 3 SOT Categories

SOT chiropractors use a category system to understand how your body adapts or compensates for the many life stresses that may present as specific postures or symptoms.  These 3 categories describe alterations to the pelvis but it is important to keep bearing in mind how altered pelvic alignment/movement can negatively affect the diaphragm, rib-cage, shoulders, neck and jaw.  Three different categories describe three different compensation patterns, and guide the chiropractor to the most appropriate and unique method for correction for each individual’s needs. 

This categorisation is central to SOT’s approach to chiropractic care, ensuring tailored treatment for effective relief and health improvement.

The three SOT categories are:

  1. Category One: Directly related to diaphragm and breathing patterns. Cat 1 describes a bilaterally restricted/fixed sacroiliac joints/sacrum, negatively influencing cerebrospinal fluid dynamics. This can lead to various musculoskeletal problems and various symptoms due to nerve function issues.
  2. Category Two: Might follow an unresolved Category One issue.  Cat2 is considered a hypermobile or ‘sprained’ sacroiliac joint. This instability affects joint position sense (proprioception) and can impact major joints, including the lower back, neck, jaw, and any of the extremity joints.
  3. Category Three: Often a progression from Category Two, a compensation pattern from the pelvis influencing the spinal joints, possibly a failure of spinal discs, might lead to nerve irritation and potential symptoms like low back pain or sciatica.

The SOT Modules Explained

Learning SOT consists of different chiropractic technique modules. The SOT modules together offer a comprehensive approach to treating various health conditions. 

The first three modules, Categories 1,2 & 3, provide a framework from which the chiropractor can assess and correct the pelvis as the foundational structure of the spine and pelvis, and then several other auxiliary techniques exist to support this adjustment. 

Each technique is designed to address specific aspects of the body and nervous system, allowing practitioners to tailor treatment to individual needs, including extremity joint alignment to cranial adjustments, fascial release to ensure organ function, and paediatric care. 

This versatility ensures that patients receive targeted, effective treatment for a wide range of health issues.

The auxiliary techniques are:

  1. Extremities: Extremity joints can be influenced by descending distortion patterns from faulty pelvis/spinal/cranial mechanics.  Similarly but in the other direction, an extremity joint can lead to an ascending pattern of disrupted biomechanics.  Techniques that focus on extremity joint mechanics will address alignment and function of the whole musculoskeletal system.
  2. Cranial Techniques: The dural-meningeal connective tissue has strong attachment points to cranial bones. Cranial techniques make hand contact with these bones, applying a directional force and using diaphragmatic breathing to ‘floss’ the entire nervous system and mobilise CSF to support nervous system function.
  3. Chiropractic Manipulative Reflex Technique (CMRT): Recognising that organs exist within a fascia system that has attachments to the spine and pelvis and is therefore influenced by musculoskeletal misalignment patterns.
  4. TMJ Technique: The interconnected nature of the musculoskeletal system can negatively affect the jaw, creating TMJ disorders and related symptoms.
  5. Cranial Specific and Non-Specific Technique: Used for specific cranial conditions and overall health improvement.
  6. Paediatrics: Tailored chiropractic care for infants and children, focusing on the strain of the birth process and resulting developmental issues.  Pregnancy adds large strain on the child bearing pelvis and the associated ligament/muscle tissues.
  7. Sutural Technique & Cranial ROM: Involves releasing dural-meningeal tissue between cranial sutures to improve cranial rhythm and movement.
  8. Intraoral Technique: Primarily used for detailed cranial adjustments through intraoral access.

The Benefits of SOT

The Sacro Occipital Technique (SOT) offers various benefits for the individual in care. SOT practitioners recognise the interconnectedness of all body systems and the influence of structure on function.  This might mean casting a wider, more holistic view of the person to understand their presenting issue.  Focusing on structure and movement, in particular recognising how breathing relies on the diaphragm/pelvis and nervous system regulation.  

SOT provides an approach to care which considers the homeostasis of all body systems.   Addressing not just the obvious symptoms but the underlying compensation patterns leading to misalignment and discomfort. 

SOT’s tailored approach means treatments are customised to individual needs, offering more effective and comprehensive care. This method is particularly beneficial for patients with a chronic issue that hasn’t resolved with other physical therapy modalities.  And for those seeking a low-force yet thorough treatment approach.

Patients undergoing SOT treatments often experience improved joint mobility, a better regulated nervous system which may mean better sleep and less tension held in the body, and relief from chronic pains like low back pain and sciatica. 

What is Craniopathy and its relation to SOT?

Craniopathy, in the context of SOT, is a specialised chiropractic technique focused on the dural-meningeal system which is a connective tissue which supports and houses the delicate brain, spinal cord and nerves that are exiting the spine.  

Think of it like the protective wrapping and strong scaffolding that keeps your nervous system in place.  Within this connective tissue wrapping, the brain, spinal cord and nerve roots are bathed in cerebrospinal fluid (CSF) which keeps the environment of the nervous system healthy, maintaining the correct pressures, providing nutrients and removing waste products.  

These dura and meninges have firm attachment points anchoring to certain bones in the skull (cranial bones) and have attachments to the top two vertebrae and at the bottom of the spine at the sacrum. 

When these bones move, the spinal cord, nerves and brain move. Deviations of these bones from their optimal position will create tension into the dural-meningeal connective tissue, potentially influencing the nerves and the dynamic flow of CSF.  

Cranial work in SOT addresses the intricate relationship between the cranial bones, spinal column, and sacrum, ensuring the dural-meningeal system is free of negative influence to the homeostasis of the delicate nervous system. 

Craniopathy plays a vital role in the broader scope of chiropractic treatments by addressing issues related to the dural-meningeal system, which can have a significant impact on the patient’s overall health and wellbeing. 

This technique is especially important in SOT for its holistic approach to treating interconnected body systems.

The History of SOT

The genesis of SOT dates back to the early 20th century, with its development credited to Dr. Major Bertrand DeJarnette, a visionary in the field of chiropractic. DeJarnette’s observations and subsequent methodologies formed the basis of SOT, a system that has evolved and expanded over decades. 

Dr. Jonathan Howat played a pivotal role in the development of Sacro Occipital Technique (SOT) in Europe. After attending his first SOT seminar in the USA, he entirely shifted his practice in Rhodesia to SOT chiropractic. 

He then moved to the UK and, in 1985, invited instructors from Sacro Occipital Research Society International (SORSI) to the AECC to teach 18 chiropractors, marking the beginning of SOTO in Europe. 

Under his guidance, SOTO Europe experienced significant growth, and he, along with James Rousseau, developed the modular educational system later adopted globally in SOT teachings. 

To conclude: What is SOT?

In summary, the Sacro Occipital Technique (SOT) stands as a comprehensive, holistic approach to chiropractic care, addressing a range of health issues with its unique indicator system for categorisation and adjustment techniques.

Its focus on the interplay between different body systems through tailored treatments like Craniopathy and specific techniques underscores its effectiveness in enhancing overall health and wellbeing. 

SOT’s thoughtful, patient-centric approach not only treats symptoms but also targets the root causes, offering a pathway to improved health and quality of life for patients.

Clare Cullen

Monday to Thursday


Sunday & Holidays


Ewell Chiropractic
9A Cheam Road, Ewell, Epsom KT17 1SP

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Our practice is next to the central car park in the Ewell village if you travel by car. And just a 10-minute wander from both train stations in Ewell.

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