SPORTS HYSICAL HERAPYCopyr~ght 1987 by The Orthopaedic and Sports Physical Therapy Sections of theAmerican Physlcal Therapy Association
the Long Sitting Test onSubjects with lliosacral Dysfunction*
TERRY BEMIS, CPT, BS, OTR, MPT,t MONTE DANIEL, lLT, BA, MS, MPTt
This study investigated the use of the long sitting test as an indicator of iliosacraldysfunction. Fifty-one subjects between the ages of
were assigned toeither an experimental group or control group through a screening procedure. The 30subjects in the control group had even posterior superior iliac spine (PSIS) heightsand negative standing and sitting flexion tests. The
1 subjects in the experimentalgroup had uneven PSIS heights, positive standing flexion tests, and negative sittingflexion tests. Measurements were taken of the change in the subjects' malleoli asthey moved from a supine to a sitting position. Additional suppkmental andconfirmational tests were then administered. The results of the long sitting test foriliosacral dysfunction were found to be significant at the 0.01 level. Possibleinfluences on this test indicated by the confirmational and supplemental tests werealso explored.
The selection of an effective manual physicaltherapy procedure depends upon the correct di-agnosis of the dysfunction. Multiple clinical testsassist the physical therapist in formulating a par-ticular diagnosis. A clinical test frequently per-formed by orthopaedic physical therapists in theevaluation of iliosacral dysfunctions is the longsitting test (LST).Numerous studies have documented the pres-ence of motion at the sacroiliac
The movements, which are minimal and involun-tary, may include the sacrum moving between theinnominates or the innominates moving on thesacrum. Although the sacral movements can becomplex, as they can occur around five axes ofmotion, the prirlciple movement of the innomi-nates is r~tation.~ he manner in which thesacrum and innominates move on each otherforms the basis upon which sacroiliac or iliosacraldysfunction is diagnosed.Sacroiliac dysfunction suggests an abnormalmotion of the sacrum within the ilia, and specificclinical findings include forward and backwardsacral torsions and unilateral fle~ion.'~.'~itchellg
he opinions or assertions contained herein are the private views ofthe authors and are not to
construed as official Oras reflecting thevlews of the Department of the Army or the Department of Defense.
U.S. Army/Baylor University, Master of Physical Therapy Program,Academy of Health Sciences, Fort Sam Houston. San Antonio, TX78240.
states that muscles, fascia, ligaments and otherstructures of the spinal mechanism produce andmaintain these dysfunctions. A positive sittingflexion test indicates that a sacroiliac dysfunctionis present.lliosacral dysfunctions consist of abnormal mo-tions of the ilia moving on the sacrum, and areoften produced and maintained by tissues of thelower extremities and abd~men.~inimal diag-nostic criteria for establishing the presence of aniliosacral dysfunction includes the presence ofuneven posterior superior iliac spine (PSIS)heights, a positive standing flexion test, and anegative sitting flexion test.l5 The diagnostic se-quence follows this order: the presence of unevenPSIS would suggest that a lesion is present; thestanding flexion test would reveal which side thelesion is on; and the sitting flexion test would ruleout sacroiliac dysfunction. The most common
iosacral dysfunctions are classified as either an-terior or posterior
inn om in ate^.^^^^'^-^^
An anteriarinnominate indicates that the innominate is fixedin a position of forward rotation (high PSIS), anda posterior innominate suggests a fixed backwardrotation of the innominate (low PSIS).The long sitting test is also commonly used asan indicator of iliosacral dysf~nction.'.~*'~.'~
perform the test, the subject lies supine on aplinth while the therapist compares the relative