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THEJOURNAL OF ORTHOPAED~C AND SPORTS PHYSICAL THERAPY
Copyr~ghtO 1987 by The Orthopaedic and Sports Physical Therapy Sections of the
American Physlcal Therapy Association

Validation of the Long Sitting Test on


Subjects 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 iliosacral
dysfunction. Fifty-one subjects between the ages of 18 and 37 were assigned to
either an experimental group or control group through a screening procedure. The 30
subjects in the control group had even posterior superior iliac spine (PSIS) heights
and negative standing and sitting flexion tests. The 2 1 subjects in the experimental
group had uneven PSIS heights, positive standing flexion tests, and negative sitting
flexion tests. Measurements were taken of the change in the subjects' malleoli as
they moved from a supine to a sitting position. Additional suppkmental and
confirmational tests were then administered. The results of the long sitting test for
iliosacral dysfunction were found to be significant at the 0.01 level. Possible
influences on this test indicated by the confirmational and supplemental tests were
also explored.

The selection of an effective manual physical states that muscles, fascia, ligaments and other
therapy procedure depends upon the correct di- structures of the spinal mechanism produce and
agnosis of the dysfunction. Multiple clinical tests maintain these dysfunctions. A positive sitting
assist the physical therapist in formulating a par- flexion test indicates that a sacroiliac dysfunction
ticular diagnosis. A clinical test frequently per- is present.
formed by orthopaedic physical therapists in the lliosacral dysfunctions consist of abnormal mo-
evaluation of iliosacral dysfunctions is the long tions of the ilia moving on the sacrum, and are
sitting test (LST). often produced and maintained by tissues of the
Numerous studies have documented the pres- lower extremities and a b d ~ m e n .Minimal
~ diag-
ence of motion at the sacroiliac joint^.^^^^^^^^'^^'^ nostic criteria for establishing the presence of an
The movements, which are minimal and involun- iliosacral dysfunction includes the presence of
tary, may include the sacrum moving between the uneven posterior superior iliac spine (PSIS)
innominates or the innominates moving on the heights, a positive standing flexion test, and a
sacrum. Although the sacral movements can be negative sitting flexion test.l5 The diagnostic se-
complex, as they can occur around five axes of quence follows this order: the presence of uneven
motion, the prirlciple movement of the innomi- PSIS would suggest that a lesion is present; the
nates is r ~ t a t i o n . ~The manner in which the standing flexion test would reveal which side the
sacrum and innominates move on each other lesion is on; and the sitting flexion test would rule
forms the basis upon which sacroiliac or iliosacral out sacroiliac dysfunction. The most common il-
dysfunction is diagnosed. iosacral dysfunctions are classified as either an-
Sacroiliac dysfunction suggests an abnormal terior or posterior inn om in ate^.^^^^'^-^^ An anteriar
motion of the sacrum within the ilia, and specific innominate indicates that the innominate is fixed
clinical findings include forward and backward in a position of forward rotation (high PSIS), and
sacral torsions and unilateral f l e ~ i o n . ' ~Mitchellg
.'~ a posterior innominate suggests a fixed backward
rotation of the innominate (low PSIS).
' The opinions or assertions contained herein are the private views of
the authors and are not to be construed as official Or as reflecting the
The long sitting test is also commonly used as
vlews of the Department of the Army or the Department of Defense. an indicator of iliosacral dysf~nction.'.~*'~.'~ To
t U.S. Army/Baylor University, Master of Physical Therapy Program, perform the test, the subject lies supine on a
Academy of Health Sciences, Fort Sam Houston. San Antonio, TX
78240. plinth while the therapist compares the relative
JOSPT January 1987 LONG SITTING TEST

positions of the medial malleoli. The subject then METHOD


pulls himself to the long sitting position, being
careful not to deviate from the midline. The ther- Subjects
apist again compares the positions of the malleoli The subjects were 28 men and 23 women,
to each other. The overall movement of the medial ranging in age from 18-37 years (X = 26.9). They
malleolus on the side of the positive standing were selected from a larger sample of active duty
flexion test is then determined. If an anterior in- military personnel assigned to the Academy of
nominate is present, an apparent leg shortening Health Sciences, Fort Sam Houston, TX. Based
occurs as the malleolus moves from a longer to a upon screening results, volunteers were divided
shorter position in comparison to the contralateral into a control group consisting of 30 normals and
medial malleolus. A posterior innominate would an experimental group of 21 iliosacral dysfunc-
produce an apparent leg lengthening as the mal- tions.
leolus moves from a shorter to a longer position.
The mechanism for the apparent changes in leg Screening Procedure
length depends on the position of the acetabulum
on the side of the iliosacral dysfun~tion.~,"In a While standing, the volunteer's bare feet were
supine subject with a posterior innominate, the neutrally positioned 15 cm apart on a gridded
acetabulum is positioned anterior-superior to the base to ensure standardization of lower extremity
"normal" position resulting in a shortened leg. As alignment, and to prevent leg lengthening or short-
the subject assumes a sitting position, the ace- ening influences from either internal or external
tabulum moves around an arc of motion ending in rotation of the hips. The researchers then pal-
a position which is inferior to the normal and pated and documented the heights of the iliac
results in an apparent long leg. The opposite is crests, PSIS, and ASlS as either high or low.
true for an anterior innominate (Fig. 1). While the subject remained in the standardized
In addition to the clinical findings cited above, position, the standing flexion test was performed.
other physical signs of an iliosacral dysfunction After palpating the inferior aspect of each PSlS
have been r e p ~ r t e d . ' ~ ~ ~In~ an
. ~ ~anterior
' ~ . ' ~ in- (Fig. 2), the researcher observed the excursion of
nominate the anterior-superior iliac spine (ASIS) is his fingers on the PSlS as the subject bent for-
low in comparison to the contralateral ASIS; the
medial sacral sulcus, formed by the ilium overlap-
ping the sacrum, is shallow; and the iliac crest is
lower on the same side as the dysfunction. In a
posterior innominate, the ASlS is high, the medial
sacral sulcus deeper, and the iliac crest higher.

ln the supone position : Posterior


rotation 01 the ilium on the sacrum
would shorten the l e g on that

. .

/ /In the lona sitting ooaition the r e v e r s e occurs:

Fig. 1 . The long sitting test to determine iliosacral dysfunction


(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 one


PSlS moved more superiorly than the other, the
test was considered to be positive for that ~ i d e . ~ , ' ~
Next, the sitting flexion test was performed.
The subject was seated on a low stool to "seat
the pelvis." The researcher again palpated the
PSlS (Fia.
, " 41 and observed the excursion of his
r

fingers as the subject bent forward (Fig. 5). If one


PSlS moved more superiorly than the other, the
test was considered positive for that ~ i d e . ~ . ' ~
Those subjects with equal PSlS heights and
negative standing and sitting flexion test results
were placed in the control group. Subjects who
met the minimal criteria for iliosacral dysfunction
(unequal PSlS heights, a positive standing flexion
test and a negative sitting flexion test) were
placed in the experimental group. Those subjects
displaying other combinations of these clinical
findings were excluded from the study (Fig. 6).

Experimental Procedure
The second phase of the study was conducted
immediately following classificationof the subjects Fig. 4. The sitting flexion test, erect position.
as either control or experimental. The subject was
positioned supine on a plinth which had a lami-
nated 16 x 20 inch sheet of plywood clamped to
its foot. A sheet of standard 8 x 11 inch metric-
scaled graph paper was mounted on the center

Fig. 5 . The sitting flexion test, flexed position.

of the board. After positioning the subject with his


ankles over the paper grid, the most inferior bor-
der of each medial malleolus was marked as a
reference point.
To ensure a neutral alignment of the pelvis on
the 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
JOSPT January 1987 LONG SITTING TEST 339
Screening

1. Palpation of PSIS, ASIS, and iliac crests


2. Standing flexion test
3. Sitting flexion test

Experimental Group Inconsistent Findings Control Group

1. Unequal PSIS (Not included in study) 1. Equal PSIS


2. Positive standing 2. Negative standing
flexion test flexion test
3. Negative sitting 3. Negative sitting
flexion test flexion test

Experimental Procedure

1. Long sitting test

Confirmational and Supplemental


Testing
Fig. 6. Flow chart.

the buttocks from the surface, and then relaxing


to allow the buttocks to return to the plinth (Fig.
7). One researcher, stationed at the foot of the
plinth, then grasped the subject's ankles and ex-
tended the legs so that the feet were positioned
neutrally overtthe paper grid (Fig. 8).
A marker, constructed of a 9 x 1 inch plexiglass
strip with a reference line scribed down the center
and bent to a 90° angle, was then positioned so
that the vertical reference line was in line with the
mark on the subject's medial malleolus, and the
horizontal reference line was parallel to the lines
on the grid (Fig. 9). The position was then re-
~ordedon the grid, and the procedure was re- Fig. 7. Bridging technique for neutral alignment of the subject's
peated on the other medial malleolus.' pelvis OH the plinth.
The subject was then asked to pull himself up
to a sitting position without deviating from the
midline while his feet were maintained in the neu-
tral position (Fig. 10).The positions of the medial
malleoli were again recorded on the grid by a
researcher using the plexiglass marker.

Supplemental Data Collection


Following completion of the long sitting test, a
series of confirmational and supplemental tests
were administered for analysis of possible influ-
ences on the experiment. These tests included
palpation of the sacral sulci (Fig. 1 I),sacroiliac
fixation test (Fig. 12),hip range of motion, gross
muscle testing, leg length measurements, the
Thomas test, the Ober test, hamstring flexibility,
SI compression/distraction tests, the FABERE Fig. 8. Researcher extends and positions the subject's legs.
340 BEMlS AND DANIEL JOSPT Vol. 8, No. 7

jects previously classified as normals and whose


LST results dib not reveal a short to long or a
long to short switch in position. Group 2 consisted
of those normals whose LST results produced a
switch from short to long, or long to short. Group
3 included the subjects with iliosacral dysfunction
and whose LST results agreed with their specific
diagnosis of an anterior or posterior innominate.
Group 4 consisted of the subjects with iliosacral
dysfunction, but whose LST results did not cor-
respond with their diagnosis. The final tabulation

Fig. 11. Palpation of depth of sacral sulci

Fig. 10. Subject pulls himself up to long sitting position.

test, and the prone knee flexion test (Figs. 13,


14). (See Appendix I for further test descriptions.)
Any postural or gait deviations were noted in the
comments section of the data collection sheet
(Appendix 11).
Following data collection, the directions and net
movements of the malleoli were tabulated. Based
upon these results, subjects were placed into one
of four groups: Group 1 consisted of those sub- Fig. 12. Sacroiliac fixation test.
JOSPT January 1987 LONG SITTING TEST 341
TABLE 1
Chi-square distribution-observed frequencies
Diagnosis
LST results
Normal lliosacral dysfunction
Switch 5 13
No switch 25 8
Chi-square = 11.07; d.f. = 1; a = 0.01.

RESULTS
The expected contingency table of no differ-
ence between normal and iliosacral dysfunction
Fig. 13. Prone knee flexion test, knees extended.
LST results is presented in Table 3. Since the
critical value of chi-square at CY = 0.01 with 1
degree of freedom (6.64) is less than the tabulated
value of chi-square (11.07), the test concludes
that a difference does exist between groups. A
comparison of observed versus expected fre-
quencies of occurrence reveals a higher frequency
of normals (group 1) and iliosacral dysfunctions
(group 3) producing anticipated LST results than
those that did not (groups 2 and 4).
Except for the means of the net malleoli move-
ments during the LST between the normals in
group 1 and the normals in group 2, there were
no statistically significant differences between
means on LST movements, leg length differences,
and hamstring lengths for any of the groups in
Fig. 14. Prone knee flexion test, knees flexed. this sample. T-test results of mean differences are
presented in Table 4.
placed 25 subjects in group 1, 5 in group 2, 13 in All subjects in this sample were noted as having
group 3, and 8 in group 4. A chi-square distribu- symmetrical AROM, muscle strength, Thomas
tion was used to test the null hypothesis that the test, Ober test, and sacroiliac fixation test results.
LST results and the presence or absence of ilio- Only two subjects, each in group 1, demonstrated
sacral dysfunction are independent. A .2x 2 con- sacroiliac joint pain secondary to the SI compres-
tingency table, shown as Table 1, was established sion/distraction and FABERE tests. Observations
to show the frequency of each occurrence. concerning the presence of a HIC, HASIS, LL,
The total malleolar movement in millimeters, leg SHS, and DSS as they occurred in relationship to
length differences in centimeters, and hamstring the side of the iliosacral dysfunction for those
length difference (HLD) in degrees were also re- subjects classified as anterior and posterior in-
corded. Table 2 shows the mean, standard devia- nominates are listed in Table 5. A chi-square
tion, and variance of each variable for each group. distribution at CY = 0.01 did not reveal statistically
A two-tailed t-test was performed to test for dif- significant differences regarding the frequency of
ferences between variable means. occurrence of any variable between groups.
Supplemental data was analyzed for frequence
of occurrence and for possible effects on the DISCUSSION
experimental tests. Specific frequencies of occur-
rence for high iliac crest (HIC), high ASlS (HASIS), The LST was performed on 30 subjects deter-
deep sacral sulcus (DSS), short hamstring (SHS), mined to have symmetrical pelvic alignment and
and long leg (LL) each on the side of the iliosacral on 21 subjects with iliosacral dysfunction in the
dysfunction were tested for significant differences form of an anterior or posterior innominate. The
using a chi-square distribution. purpose of this investigation was 1) to determine
342 BEMlS AND DANIEL JOSPT Vol. 8,No. 7
TABLE 2
Total malleolar movement (in mm), leg length differences (in cm), and hamstring length differences (in degrees)
Subjects
Group 3 (N = 13) Group 4 (N = 8)
Group 1 (N = 25) Group 2 (N = 5) lliosacral dysfunction lliosacral dysfunction
Normals (no switch) Normals (switch) (switch) (no switch)
ic s2 S ic s2 S x s2 S ic s2 S

MM 2.24 6.12 2.47 6.1 6.80 2.61 6.46 22.35 4.73 5.31 26.35 5.13
LLD 0.648 0.20 0.45 0.72 0.24 0.49 0.75 0.34 0.58 1.05 0.29 0.53
HLD 5.76 21.69 4.66 6.00 10.00 3.16 6.00 14.83 3.85 4.00 10.86 3.30

TABLE 3 and deep sulci between anterior and posterior


Chi-square distribution of expected frequencies innominate groups did not produce statistical dif-
Diagnosis ferences. In addition, study results did not appear
LST results
Normal lliosacral dysfunction to be affected by AROM, muscle strength, hip
Switch 10.59 7.41 flexor length, iliotibial band length, or SI joint pain.
NO switch 19.41 13.59 Unfortunately, a comparison of prone knee flexion
Chi-square = 6.635; d.f. = 1; CY = 0.01.
test results-with the LST could not be made
because of testing techniques used.
The possibility of examiner error in this study
if the LST is a valid test for confirming the pres- exists. Classification of subjects as normal or as
ence of iliosacral dysfunction, and 2 ) to explore having an iliosacral dysfunction is based upon the
other factors which might influence test results. palpatory skills of the examiner. Thus, the tests
Study findings revealed that the results of the used to arrive at a diagnosis are quite subjective.
LST confirmed the diagnosis of iliosacral dysfunc- The authors feel that palpationof the medial sacral
tion more times than it did not, and that the sulci was the most subjective of the supplemental
differences evident between the control and ex- tests. Obese subjects and subpcts with the pres-
perimental groups were statistically significant. It ence of nodules in the area of the PSIS made the
did not, however, confirm the diagnosis in all palpation process more complicated.
cases. Possible reasons may include 1 )influences Recommendations for further study include: 1 )
from other structures or 2) examiner error. employment of a standardized x-ray technique for
No statistically significant differences were seen measuring leg length differences and bony land-
in the mean leg lengths of all groups. In addition, marks; 2 ) further assessment of lower extremities
there was no obvious recurrence of a long or to include the presence or absence of genu varus/
short leg on the side of the iliosacral dysfunction. valgus or pronated feet as they may affect leg
Although a clinically accepted method of meas- length; 3) examination by experienced ortho-
uring leg lengths was utilized, the question of paedic physical therapists to compare palpation
accuracy became rapidly apparent in the cases of results; 4 ) inclusion of additional areas of palpa-
innominate rotation. Measuring from either an in- tion such as lumbar transverse processes for the
feriorly or superiorly positioned ASlS leads to presence of lumbar malrotation, inferior lateral
inaccurate leg length measurements. angles of sacrum to further rule out a sacral lesion,
It has been proposed that a short hamstring and pubic tubercle heights for pelvic shifts; and
muscle may produce a posterior innominate. This 5) comparison of LST results with prone knee
study did not show a statistically significant differ- flexion test results.
ence between the mean hamstring lengths of
groups. Although the LST produced a short to CONCLUSION
long switch in three normals and in two anterior
innominates, each on the side of the short ham- There are few well established and researched
string, the frequency of occurrence of a short tests for iliosacral dysfunction. This study sug-
hamstring muscle on the side of the iliosacral gests that the long sitting test is an accurate
dysfunction was not statistically notable. method of predicting such lesions. However, the
Comparisons of iliac crest and ASlS heights test should not be used alone, but in conjunction
JOSPT January 1987 LONG SITTING TEST 343
TABLE 4
Two-tailed t-test results for mean differences
MM LLD HLD
t d.f p t d.f p t d.f p
Group 1 vs group 2 -3.1584 28 0.10 -0.1305 28 0.20 -0.1095 28 0.20
Group 3 vs group 4 0.5239 19 0.20 -1.1677 19 0.20 1.2173 19 0.20
Groups 1 & 2 vs groups 3 & 4 2.9296 49 0.01 1.1604 49 0.20 -0.4785 49 0.20

TABLE 5
Freuuencv of Su~~lemental
Observations lliosacral Dvsfunctions
Anterior innominates
Group 3 Group 4
Same side Opposite side Equal Same side Opposite side Equal
High iliac crest 4 2 0 1 0 1
High ASlS 1 4 1 0 1 1
Long leg 2 4 0 0 2 0
Short hamstring 2 4 0 0 2 0
Deep sulci 4 2 0 2 0 . 0
Posterior innominates
Group 3 Group 4
Same side Opposite side Equal Same side Opposite side Equal
High iliac crest 2 4 1 3 3 0
High ASlS 2 5 0 3 3 0
Long leg 0 6 1 1 5 0
Short hamstring 5 1 1 1 4 1
Deep sulci 1 5 1 1 1 4

with other confirmational data for an accurate Mo.: Mitchell, Moran and Pruzzo Associates, 1979
11. Pitkin HC, Pheasant HC: Sacroarthrogenetictelalgia: II. A study of
diagnosis. sacral mobility. J Bone Joint Surg (Am) 18(2):365-374, 1936
12. Saunders HD: Orthopaedic Physical Therapy: Evaluation and
The authors would like to thank MAJ Woerman and CPT Stratton Treatment of Musculoskeletal Disorders, pp 69-69. Minneapolis:
for their assistance as advisors for this project; Kathleen Daniel for her H. Duane Saunders, Publisher, 1982
many hours of typing; and Emily Bemis for her patience and understand- 13. Solonen KA: The sacroiliac joint in the light of anatomical, roent-
ing. genological, and clinical studies. Acta Orthop Scand (Suppl) 27:l-
115,1957
14. Stoddard A: Conditions of the sacro-iliac joint and their treatment.
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ra~~
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flexion tests. JAOA 77:456-465, 1978
and diagnosis. JAOA 81(10):667-679, 1982
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2. Colachis SC, Worden RE. Bechtol CO, Strohm BR: Movement of
lems. Bull Orthop Section, APTA 3(1):5-9, 1978
the sacroiliac joints in the adult male: a preliminary report. Arch
17. Woerman AL. Binder-MacLeod ST: Leg length discrepancy as-
Phys Med Rehabil44:490-498,1963
sessment: accuracy and precision in five clinical methods of eval-
3. Erhard R, Bowling R: The recognition and management of the
uation. J Orthop sports Phys Ther 5230-239,1984
pelvic component of lowback and sciatic pain. Bull Orthop Section,
APTA 2(3):4-15, 1977
4. Frigerio NA, Stowe RR, Howe JW: Movement of the sacroiliac
joint. Clin Orthop 100:370-377, 1974
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1976
6. Hoppenfeld S: Physical Examination of the Spine and Extremities. APPENDIX 1
New York: Appleton-Century-Crofts,1976
7. Kendall FP. McCreary EK: Muscles: Testing and Function. Balti- Explanation of Confirmational and Supplemental Tests
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Spine 4(2):102-109. 1979
1. Pelvic Sulci Examination The subject is prone. The
9. Mitchell FL Jr: Structural pelvic function. Academy of Applied examiner palpates the posterior surface of the PSIS with
Osteopathy: 1965 Year Book, Vol 11:178-199 his thumbs. From the posterior surface of the PSIS, the
10. MitchellFL Jr, Moran PS. Pruzzo NA: An Evaluation and Treatment examiner's thumbs are curled medially into the sacral
Manual of Osteopathic Muscle Energy Procedures. Valley Park, sulci. The sulcus depth is that distance from the peak of
344 BEMlS AND DANIEL JOSPT Vol. 8, No. 7
the PSlS to the bottom of the adjacent sulcus. The depths crest, then ask the subject to raise his thigh from the
of the sulcus are compared bilaterally, using both obser- table. The examiner will place his free hand over the distal
vations and palpati~n.'~ end of the thigh and ask the subject to raise his thigh
2. Prone Knee Flexion Test to 90' The subject lies prone further, while the examiner offers resistance.'
with the cervical spine in the neutral rotation position and b. Extensors. To test the gluteus maximus muscle, the
arms resting at the sides. The test is best performed with subject will lie prone and flex his knee. The examiner will
the shoes on. The examiner stands at the foot of the place his forearm over the iliac crests to stabilize the
plinth, and grasps the subject's feet with the thumbs pelvis, and then ask the subject to raise his thigh from the
passing transversely just anterior to the heel of the shoe table. The examiner will use his other hand to offer resist-
and the index fingers just posterior to the lateral malleoli ance to the motion leg pushing down on the posterior
distal fibular shafts. The feet are held in the same degree aspect of the thigh just above the knee joint. The gluteus
of pronation/supinationand slightly externally rotated. At maximus muscle should be palpated for tone during the
this point, the relative apparent lengths of the lower ex- test. To test the hamstrings as a group, the patient will lie
tremities are noted. The shorter of the two will be consid- prone on the plinth. His thigh will be stabilized just above
ered to be the side of the lesion. The knees are now the knee. Then he will flex his knee while the examiner
flexed to 90' and any change in apparent length is noted. resists his motion at the back of his ankle joint.
If the short leg appears to increase in length and becomes c. Abductors. With subject supine and his legs abducted
the longer of the two as the test is performed, this about 20°, the examiner will place his hands on the lateral
represents a posterior innominate on that side. If the short sides of the subject's knees and offer resistanceto further
side stays or becomes even shorter, an anterior innomi- abduction.
nate is present3 d. Adductors. With subject supine, have him adduct his
3. Sacroiliac Fixation Test To test the upper part of the legs while the examiner exerts resisting pressure on the
joint while the subject is standing, the examiner places medial aspects of both knees.
one thumb over the second sacral spinous process and e. lntdrnal Rotation. With the subject sitting on the plinth
the thumb of the other hand over the PSlS of the side to with his legs flexed over the side, the examiner exerts
be tested. The subject then flexes both the hip and knee resistance pressure on the lateral surface of the ankle.
on the side to be tested and lifts the leg as high as Stabilize and apply counterpressureto the medial side of
possible (at least past 90' hip flexion.) In a normal joint, the distal aspect of the thigh.
the thumb placed on the PSlS moves caudally 1-2 cm. In f. External Rotation. Same position as above. Resist-
a fixed joint, with reduction of movement, the thumb over ance applied to the medial surface of the ankle. Stabilize
the PSlS does not move downward or moves slightly and apply counterpressureto the anterolateral surface of
upward. For examination of the lower part of the joint the the distal femur.6
examiner's thumbs are placed over the apex of the sac- 6. Leg Length Measurement The most accurate, quick
rum, the other over the ischial tuberosity on the side to clinical measurement of leg length hgs been determined
be tested. The subject then flexes the hip and knee as to be from ASlS to lateral malleolus."
described above. In a normal joint, the ischial tuberosity 7. Thomas Test The subject will be supine on the exam-
moves laterally 1-2 cm. In a fixed joint, the tuberosity will ining plinth, with his pelvis level and square to his trunk.
remain stationary or move cephalad.8 The subject will flex his hip, bringing his thigh up onto his
4. Quick Active Range of Motion Tests6 trunk. The hip will be flexed as far as possible. The other
a. Abduction. Ask subject to stand and to spread his hip will be flexed in the same way. The subject will hold
legs apart as far as he can. He should be able to abduct one leg on his chest and let his other leg down until it is
each leg at least 45' from the midline. flat on the table. If the hip does not extend fully, a flexion
b. Adduction. lnstruct the subject to bring his legs to- contracture of that hip may exist. Repeat the procedure
gether from the abducted position, and alternately cross for the opposite leg. Next, the subject is positioned in a
them, first with right leg in front, then with the left. He supine position so that his knees are able to flex over the
should be able to achieve at least 20' of adduction. plinth. Rectus femoris tightness is indicated if the subject
c. Flexion. lnstruct the subject to draw each knee toward is not able to flex his knee to 90' with the hip maintained
his chest as far as he can without bending his back. He in a neutral position.8
should be able to bring his knees almost to his chest 8. Ober Test The subject will lie on his side with the leg to
(approximately 135' of flexion.) be tested uppermost. The leg will be adducted as far as
d. Extension. Have the subject sit in a chair. Ask him to possible and the knee flexed to 90' while keeping the hip
fold his arms across his chest, and, keeping his back joint in the neutral or slight extension position to relax the
straight, to get up from the chair. iliotibial tract. The abducted leg will then be released. If
e. Internal Rotation. Have the subject sit on the plinth the iliotibial tract is normal, the thigh should drop to the
with knees bent over the side of the plinth. Rotate the adducted position. If there is a contracture of the fascia
thigh of the leg to be tested inward by having the subject lata or iliotibial band, the thigh will remain abducted when
swing his foot laterally to 45'. the leg is released or compensation will occur in the
f. External Rotation. Same positon as above. Rotate the lumbar spine to allow the leg to a d d ~ c t . ~
thigh of the leg to be tested outward by having the subject 9. SI Compression/Distraction Tests The anterior portion
swing his foot medially to 45'. of the SI joint is tested with the patient supine. The
5. Hip Muscle Testing6 examiner contacts the ASlS with the heels of both hands.
a. Flexors. lnstruct the subject to sit upon the edge of The forearms are crossed, and a posterior-lateral spring
the examining table with his legs dangling. The examiner is g i ~ e n . ~ . ~The
, ' ' posterior portion is tested with the
will stabilize the pelvis by placing his hand over the iliac subject side lying with hand contact on the anterior-lateral
JOSPT January 1987 LONG SITTING TEST 345
rim of the ilium. A downward thrust is given. The joint extended by the examiner placing one hand on the flexed
being tested is on the top If either of these tests knee joint and the other hand on the ASlS of the opposite
elicit pain, it is an indication there is pathology in the side and pressing down on each of these points. If the
joint." subject complains of increased pain in the SI joint region,
10. FABERE Test The subject lies supine on the plinth and there may be pathology in the SI joint or hip joint.6
places the ankle of his side to be tested on his opposite 11. Degree of SLR Hamstring length will permit approxi-
knee. The hip joint is thus flexed, abducted, and externally mately 70° of hip joint flexion?
rotated. To stress the SI joint, the range of motion is

APPENDIX 2-DATA SHEET

subject Number Date


Age Sex Service
Occupation Leisure Activities
Previous back pain or injuries
Screening Tests
1. Static Pelvic Exam High Low Level
(R) lliac crest
(L) lliac crest

(L) PSIS
(R) ASlS
(L) ASlS
2. Special Tests Positive on:
Standing Flexion Test R L Symmetrical
Sitting Flexion Test R L Symmetrical
Test Data DX Date
Long Sitting Test R L Malleolus
Supine R L mm longer short to long
Sitting R L mm longer long to short
Confirmational Data
Results
Sulci (deep or shallow) R L-
Prone Knee Flexion Test to 90°
short leg in extension R L
short leg in flexion R L
Sacroiliac Fixation Test
PSIS moves superiorly inferiorly no change
Supplemental Data
Hip AROM Flexion Extension -
IR -
ER & ADD
Muscle Testing Hip Flexors ~xtensors -
IR -
ER ABD -
ADD
Leg
. Lengths
. (ASIS to lateral malleolus) R cm L cm
R L R L
Thomas Test Sl Comp/Dis Test
Ober Test FABERE Test
Degree of SLR (Hamstring Length) R -L
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