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Validacion Del Long Sitting Test

Validacion Del Long Sitting Test

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0196-6011 87/0807-0336$02.00/0THEJOURNAL
F
ORTHOPAED~C
ND
SPORTS HYSICAL HERAPYCopyr~ght 1987 by The Orthopaedic and Sports Physical Therapy Sections of theAmerican Physlcal Therapy Association
Validation
of
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
18
and
37
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
2
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
joint^.^^^^^^^^'^^'^
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
be
construed as official Oras reflecting thevlews of the Department of the Army or the Department of Defense.
t
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
il-
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.'.~*'~.'~
o
perform the test, the subject lies supine on aplinth while the therapist compares the relative
 
JOSPT January
1987
LONG SITTING TEST
positions of the medial malleoli. The subject thenpulls himself to the long sitting position, beingcareful not to deviate from the midline. The ther-apist again compares the positions of the malleolito each other. The overall movement of the medialmalleolus on the side of the positive standingflexion test is then determined. If an anterior in-nominate is present, an apparent leg shorteningoccurs as the malleolus moves from a longer to ashorter position in comparison to the contralateralmedial malleolus. A posterior innominate wouldproduce an apparent leg lengthening as themal-leolus moves from a shorter to a longer position.The mechanism for the apparent changes in leglength depends on the position of the acetabulumon the side of the iliosacral dysfun~tion.~,"n asupine subject with a posterior innominate, theacetabulum is positioned anterior-superior to the"normal" position resulting in a shortened leg. Asthe subject assumes a sitting position, the ace-tabulum moves around an arc of motion ending ina position which is inferior to the normal andresults in an apparent long leg. The opposite istrue for an anterior innominate (Fig.
1).
In addition to the clinical findings cited above,other physical signs of an iliosacral dysfunctionhave been rep~rted.'~~~~.~~'~.'~n an anterior in-nominate the anterior-superior iliac spine (ASIS) islow in comparison to the contralateralASIS; themedial sacral sulcus, formed by the ilium overlap-ping the sacrum, is shallow; and the iliac crest islower on the same side as the dysfunction. In aposterior innominate, the ASlS is high, the medialsacral sulcus deeper, and the iliac crest higher.
ln the supone position
:
Posteriorrotation 01 the ilium on the sacrumwould shorten the leg on that
.
.
/
/In the lona sitting ooaition the reverse occurs:
Fig.
1.
The long sitting test to determine iliosacral dysfunction
METHOD
Subjects
The subjects were 28 men and 23 women,ranging in age from 18-37 years
(X
=
26.9).
Theywere selected from a larger sample of active dutymilitary personnel assigned to the Academy ofHealth Sciences, Fort Sam Houston, TX. Basedupon screening results, volunteers were dividedinto a control group consisting of 30 normals andan experimental group of 21 iliosacral dysfunc-tions.
Screening Procedure
While standing, the volunteer's bare feet wereneutrally positioned 15 cm apart on a griddedbase to ensure standardization of lower extremityalignment, and to prevent leg lengthening or short-ening influences from either internal or externalrotation of the hips. The researchers then pal-pated and documented the heights of the iliaccrests, PSIS, and ASlS as either high or low.While the subject remained in the standardizedposition, the standing flexion test was performed.After palpating the inferior aspect of each PSlS(Fig.
2),
the researcher observed the excursion ofhis fingers on the PSlS as the subject bent for-
(from Saunderslz).
Fig.
2.
The standing flexion test, erect position.
 
338
BEMlS AND DANIEL
JOSPT
Vol.
8,
No.
7
ward to the limit of trunk flexion (Fig. 3). If onePSlS moved more superiorly than the other, thetest was considered to be positive for that ~ide.~,'~Next, the sitting flexion test was performed.The subject was seated on a low stool to "seatthe pelvis." The researcher again palpated thePSlS (Fia.
41
and observed the excursion of his
"
r
fingers as the subject bent forward (Fig.
5).
If onePSlS moved more superiorly than the other, thetest was considered positive for that ~ide.~.'~Those subjects with equal PSlS heights andnegative standing and sitting flexion test resultswere placed in the control group. Subjects whomet the minimal criteria for iliosacral dysfunction(unequal PSlS heights, a positive standing flexiontest and a negative sitting flexion test) wereplaced in the experimental group. Those subjectsdisplaying other combinations of these clinicalfindings were excluded from the study (Fig. 6).
Experimental Procedure
The second phase of the study was conductedimmediately following classification of the subjectsas either control or experimental. The subject waspositioned supine on a plinth which had a lami-nated 16
x
20
inch sheet of plywood clamped toits foot. A sheet of standard
8
x
11 inch metric-scaled graph paper was mounted on the center
Fig.
4.
The sitting flexion test, erect position.
Fig.
5.
The sitting flexion test, flexed position.
of the board. After positioning the subject with hisankles over the paper grid, the most inferior bor-der of each medial malleolus was marked as areference point.To ensure a neutral alignment of the pelvis onthe plinth, the subject performed a bridging tech-nique which consisted of flexing his knees to place
Fig.
3.The standing flexion test, flexed pos~t~on.
his feet flat on the plinth, extending his hips to lift

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