0196-6011/87/0807-0336$02.

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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
therapy procedure depends upon the correct di-
agnosis of the dysfunction. Multiple clinical tests
assist the physical therapist in formulating a par-
ticular diagnosis. A clinical test frequently per-
formed by orthopaedic physical therapists in the
evaluation of iliosacral dysfunctions is the long
sitting 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 the
innominates or the innominates moving on the
sacrum. Although the sacral movements can be
complex, as they can occur around five axes of
motion, the prirlciple movement of the innomi-
nates is r ~ t a t i o n . ~The manner in which the
sacrum and innominates move on each other
forms the basis upon which sacroiliac or iliosacral
dysfunction is diagnosed.
Sacroiliac dysfunction suggests an abnormal
motion of the sacrum within the ilia, and specific
clinical findings include forward and backward
sacral torsions and unilateral f l e ~ i o n . ' ~Mitchellg
.'~
' 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
vlews 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, TX
78240.
states that muscles, fascia, ligaments and other
structures of the spinal mechanism produce and
maintain these dysfunctions. A positive sitting
flexion test indicates that a sacroiliac dysfunction
is present.
lliosacral dysfunctions consist of abnormal mo-
tions of the ilia moving on the sacrum, and are
often produced and maintained by tissues of the
lower extremities and a b d ~ m e n .Minimal
~ diag-
nostic criteria for establishing the presence of an
iliosacral dysfunction includes the presence of
uneven posterior superior iliac spine (PSIS)
heights, a positive standing flexion test, and a
negative sitting flexion test.l5 The diagnostic se-
quence follows this order: the presence of uneven
PSIS would suggest that a lesion is present; the
standing flexion test would reveal which side the
lesion is on; and the sitting flexion test would rule
out sacroiliac dysfunction. The most common il-
iosacral dysfunctions are classified as either an-
terior or posterior inn om in ate^.^^^^'^-^^ An anteriar
innominate indicates that the innominate is fixed
in a position of forward rotation (high PSIS), and
a posterior innominate suggests a fixed backward
rotation of the innominate (low PSIS).
The long sitting test is also commonly used as
an indicator of iliosacral dysf~nction.'.~*'~.'~ To
perform the test, the subject lies supine on a
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-
apist again compares the positions of the malleoli
to each other. The overall movement of the medial
malleolus on the side of the positive standing
flexion test is then determined. If an anterior in-
nominate is present, an apparent leg shortening
occurs as the malleolus moves from a longer to a
shorter position in comparison to the contralateral
medial malleolus. A posterior innominate would
produce an apparent leg lengthening as the mal-
leolus moves from a shorter to a longer position.
The mechanism for the apparent changes in leg
length depends on the position of the acetabulum
on the side of the iliosacral dysfun~tion.~,"In a
supine subject with a posterior innominate, the
acetabulum is positioned anterior-superior to the
"normal" position resulting in a shortened leg. As
the subject assumes a sitting position, the ace-
tabulum moves around an arc of motion ending in
a position which is inferior to the normal and
results in an apparent long leg. The opposite is
true for an anterior innominate (Fig. 1).
In addition to the clinical findings cited above,
other physical signs of an iliosacral dysfunction
have been r e p ~ r t e d . ' ~ ~ ~In~ an
. ~ ~anterior
' ~ . ' ~ in-
nominate the anterior-superior iliac spine (ASIS) is
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.
Subjects
The subjects were 28 men and 23 women,
ranging in age from 18-37 years (X = 26.9). They
were selected from a larger sample of active duty
military personnel assigned to the Academy of
Health Sciences, Fort Sam Houston, TX. Based
upon screening results, volunteers were divided
into a control group consisting of 30 normals and
an experimental group of 21 iliosacral dysfunc-
tions.
Screening Procedure
While standing, the volunteer's bare feet were
neutrally positioned 15 cm apart on a gridded
base to ensure standardization of lower extremity
alignment, and to prevent leg lengthening or short-
ening influences from either internal or external
rotation of the hips. The researchers then pal-
pated and documented the heights of the iliac
crests, PSIS, and ASlS as either high or low.
While the subject remained in the standardized
position, the standing flexion test was performed.
After palpating the inferior aspect of each PSlS
(Fig. 2), the researcher observed the excursion of
his fingers on the PSlS as the subject bent for-

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

Fig. 3. The standing flexion test, flexed pos~t~on.
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
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
Fig. 13. Prone knee flexion test, knees extended.
Fig. 14. Prone knee flexion test, knees flexed.
placed 25 subjects in group 1, 5 in group 2, 13 in
group 3, and 8 in group 4. A chi-square distribu-
tion was used to test the null hypothesis that the
LST results and the presence or absence of ilio-
sacral dysfunction are independent. A .2x 2 con-
tingency table, shown as Table 1, was established
to show the frequency of each occurrence.
The total malleolar movement in millimeters, leg
length differences in centimeters, and hamstring
length difference (HLD) in degrees were also re-
corded. Table 2 shows the mean, standard devia-
tion, and variance of each variable for each group.
A two-tailed t-test was performed to test for dif-
ferences between variable means.
Supplemental data was analyzed for frequence
of occurrence and for possible effects on the
experimental tests. Specific frequencies of occur-
rence for high iliac crest (HIC), high ASlS (HASIS),
deep sacral sulcus (DSS), short hamstring (SHS),
and long leg (LL) each on the side of the iliosacral
dysfunction were tested for significant differences
using a chi-square distribution.
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
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
this sample. T-test results of mean differences are
presented in Table 4.
All subjects in this sample were noted as having
symmetrical AROM, muscle strength, Thomas
test, Ober test, and sacroiliac fixation test results.
Only two subjects, each in group 1, demonstrated
sacroiliac joint pain secondary to the SI compres-
sion/distraction and FABERE tests. Observations
concerning the presence of a HIC, HASIS, LL,
SHS, and DSS as they occurred in relationship to
the side of the iliosacral dysfunction for those
subjects classified as anterior and posterior in-
nominates are listed in Table 5. A chi-square
distribution at CY = 0.01 did not reveal statistically
significant differences regarding the frequency of
occurrence of any variable between groups.
DISCUSSION
The LST was performed on 30 subjects deter-
mined to have symmetrical pelvic alignment and
on 21 subjects with iliosacral dysfunction in the
form of an anterior or posterior innominate. The
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
Diagnosis
LST results
Normal lliosacral dysfunction
Switch 10.59 7.41
NO switch 19.41 13.59
Chi-square = 6.635; d.f. = 1; CY = 0.01.
if the LST is a valid test for confirming the pres-
ence of iliosacral dysfunction, and 2 ) to explore
other factors which might influence test results.
Study findings revealed that the results of the
LST confirmed the diagnosis of iliosacral dysfunc-
tion more times than it did not, and that the
differences evident between the control and ex-
perimental groups were statistically significant. It
did not, however, confirm the diagnosis in all
cases. Possible reasons may include 1 )influences
from other structures or 2) examiner error.
No statistically significant differences were seen
in the mean leg lengths of all groups. In addition,
there was no obvious recurrence of a long or
short leg on the side of the iliosacral dysfunction.
Although a clinically accepted method of meas-
uring leg lengths was utilized, the question of
accuracy became rapidly apparent in the cases of
innominate rotation. Measuring from either an in-
feriorly or superiorly positioned ASlS leads to
inaccurate leg length measurements.
It has been proposed that a short hamstring
muscle may produce a posterior innominate. This
study did not show a statistically significant differ-
ence between the mean hamstring lengths of
groups. Although the LST produced a short to
long switch in three normals and in two anterior
innominates, each on the side of the short ham-
string, the frequency of occurrence of a short
hamstring muscle on the side of the iliosacral
dysfunction was not statistically notable.
Comparisons of iliac crest and ASlS heights
innominate groups did not produce statistical dif-
ferences. In addition, study results did not appear
to be affected by AROM, muscle strength, hip
flexor length, iliotibial band length, or SI joint pain.
Unfortunately, a comparison of prone knee flexion
test results-with the LST could not be made
because of testing techniques used.
The possibility of examiner error in this study
exists. Classification of subjects as normal or as
having an iliosacral dysfunction is based upon the
palpatory skills of the examiner. Thus, the tests
used to arrive at a diagnosis are quite subjective.
The authors feel that palpationof the medial sacral
sulci was the most subjective of the supplemental
tests. Obese subjects and subpcts with the pres-
ence of nodules in the area of the PSIS made the
palpation process more complicated.
Recommendations for further study include: 1 )
employment of a standardized x-ray technique for
measuring leg length differences and bony land-
marks; 2 ) further assessment of lower extremities
to include the presence or absence of genu varus/
valgus or pronated feet as they may affect leg
length; 3) examination by experienced ortho-
paedic physical therapists to compare palpation
results; 4 ) inclusion of additional areas of palpa-
tion such as lumbar transverse processes for the
presence of lumbar malrotation, inferior lateral
angles of sacrum to further rule out a sacral lesion,
and pubic tubercle heights for pelvic shifts; and
5) comparison of LST results with prone knee
flexion test results.
CONCLUSION
There are few well established and researched
tests for iliosacral dysfunction. This study sug-
gests that the long sitting test is an accurate
method of predicting such lesions. However, the
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
diagnosis.
The authors would like to thank MAJ Woerman and CPT Stratton
for their assistance as advisors for this project; Kathleen Daniel for her
many hours of typing; and Emily Bemis for her patience and understand-
ing.
REFERENCES
1. Beal MC: The sacroiliac problem: review of anatomy, mechanics.
and diagnosis. JAOA 81(10):667-679, 1982
2. Colachis SC, Worden RE. Bechtol CO, Strohm BR: Movement of
the sacroiliac joints in the adult male: a preliminary report. Arch
Phys Med Rehabil44:490-498,1963
3. Erhard R, Bowling R: The recognition and management of the
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
5. Grieve GP: The sacro-iliac joint. Physiotherapy 62(12):384-400,
1976
6. Hoppenfeld S: Physical Examination of the Spine and Extremities.
New York: Appleton-Century-Crofts,1976
7. Kendall FP. McCreary EK: Muscles: Testing and Function. Balti-
more: Williams & Wilkins, 1983
8. Kirkaldy-Willis WH: A more precise diagnosis for low-back pain.
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9. Mitchell FL Jr: Structural pelvic function. Academy of Applied
Osteopathy: 1965 Year Book, Vol 11:178-199
10. MitchellFL Jr, Moran PS. Pruzzo NA: An Evaluation and Treatment
Manual of Osteopathic Muscle Energy Procedures. Valley Park,
Mo.: Mitchell, Moran and Pruzzo Associates, 1979
11. Pitkin HC, Pheasant HC: Sacroarthrogenetictelalgia: II. A study of
sacral mobility. J Bone Joint Surg (Am) 18(2):365-374, 1936
12. Saunders HD: Orthopaedic Physical Therapy: Evaluation and
Treatment of Musculoskeletal Disorders, pp 69-69. Minneapolis:
H. Duane Saunders, Publisher, 1982
13. Solonen KA: The sacroiliac joint in the light of anatomical, roent-
genological, and clinical studies. Acta Orthop Scand (Suppl) 27:l-
115,1957
14. Stoddard A: Conditions of the sacro-iliac joint and their treatment.
~ h ~ & o t h e44:97-101,1958
ra~~
15. Sutton SE: Postural imbalance: examination and treatment utilizing
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sessment: accuracy and precision in five clinical methods of eval-
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APPENDIX 1
Explanation of Confirmational and Supplemental Tests
1. Pelvic Sulci Examination The subject is prone. The
examiner palpates the posterior surface of the PSIS with
his thumbs. From the posterior surface of the PSIS, the
examiner's thumbs are curled medially into the sacral
sulci. The sulcus depth is that distance from the peak of
344 BEMlS AND DANIEL
the PSlS to the bottom of the adjacent sulcus. The depths
of the sulcus are compared bilaterally, using both obser-
vations and palpati~n.'~
2. Prone Knee Flexion Test to 90' The subject lies prone
with the cervical spine in the neutral rotation position and
arms resting at the sides. The test is best performed with
the shoes on. The examiner stands at the foot of the
plinth, and grasps the subject's feet with the thumbs
passing transversely just anterior to the heel of the shoe
and the index fingers just posterior to the lateral malleoli
distal fibular shafts. The feet are held in the same degree
of pronation/supinationand slightly externally rotated. At
this point, the relative apparent lengths of the lower ex-
tremities are noted. The shorter of the two will be consid-
ered to be the side of the lesion. The knees are now
flexed to 90' and any change in apparent length is noted.
If the short leg appears to increase in length and becomes
the longer of the two as the test is performed, this
represents a posterior innominate on that side. If the short
side stays or becomes even shorter, an anterior innomi-
nate is present3
3. Sacroiliac Fixation Test To test the upper part of the
joint while the subject is standing, the examiner places
one thumb over the second sacral spinous process and
the thumb of the other hand over the PSlS of the side to
be tested. The subject then flexes both the hip and knee
on the side to be tested and lifts the leg as high as
possible (at least past 90' hip flexion.) In a normal joint,
the thumb placed on the PSlS moves caudally 1-2 cm. In
a fixed joint, with reduction of movement, the thumb over
the PSlS does not move downward or moves slightly
upward. For examination of the lower part of the joint the
examiner's thumbs are placed over the apex of the sac- 6.
rum, the other over the ischial tuberosity on the side to
be tested. The subject then flexes the hip and knee as
described above. In a normal joint, the ischial tuberosity 7.
moves laterally 1-2 cm. In a fixed joint, the tuberosity will
remain stationary or move cephalad.8
4. Quick Active Range of Motion Tests6
a. Abduction. Ask subject to stand and to spread his
legs apart as far as he can. He should be able to abduct
each leg at least 45' from the midline.
b. Adduction. lnstruct the subject to bring his legs to-
gether from the abducted position, and alternately cross
them, first with right leg in front, then with the left. He
should be able to achieve at least 20' of adduction.
c. Flexion. lnstruct the subject to draw each knee toward
his chest as far as he can without bending his back. He
should be able to bring his knees almost to his chest 8.
(approximately 135' of flexion.)
d. Extension. Have the subject sit in a chair. Ask him to
fold his arms across his chest, and, keeping his back
straight, to get up from the chair.
e. Internal Rotation. Have the subject sit on the plinth
with knees bent over the side of the plinth. Rotate the
thigh of the leg to be tested inward by having the subject
swing his foot laterally to 45'.
f. External Rotation. Same positon as above. Rotate the
thigh of the leg to be tested outward by having the subject 9.
swing his foot medially to 45'.
5. Hip Muscle Testing6
a. Flexors. lnstruct the subject to sit upon the edge of
the examining table with his legs dangling. The examiner
will stabilize the pelvis by placing his hand over the iliac
JOSPT Vol. 8, No. 7
crest, then ask the subject to raise his thigh from the
table. The examiner will place his free hand over the distal
end of the thigh and ask the subject to raise his thigh
further, while the examiner offers resistance.'
b. Extensors. To test the gluteus maximus muscle, the
subject will lie prone and flex his knee. The examiner will
place his forearm over the iliac crests to stabilize the
pelvis, and then ask the subject to raise his thigh from the
table. The examiner will use his other hand to offer resist-
ance to the motion leg pushing down on the posterior
aspect of the thigh just above the knee joint. The gluteus
maximus muscle should be palpated for tone during the
test. To test the hamstrings as a group, the patient will lie
prone on the plinth. His thigh will be stabilized just above
the knee. Then he will flex his knee while the examiner
resists his motion at the back of his ankle joint.
c. Abductors. With subject supine and his legs abducted
about 20°, the examiner will place his hands on the lateral
sides of the subject's knees and offer resistanceto further
abduction.
d. Adductors. With subject supine, have him adduct his
legs while the examiner exerts resisting pressure on the
medial aspects of both knees.
e. lntdrnal Rotation. With the subject sitting on the plinth
with his legs flexed over the side, the examiner exerts
resistance pressure on the lateral surface of the ankle.
Stabilize and apply counterpressureto the medial side of
the distal aspect of the thigh.
f. External Rotation. Same position as above. Resist-
ance applied to the medial surface of the ankle. Stabilize
and apply counterpressureto the anterolateral surface of
the distal femur.6
Leg Length Measurement The most accurate, quick
clinical measurement of leg length hgs been determined
to be from ASlS to lateral malleolus."
Thomas Test The subject will be supine on the exam-
ining plinth, with his pelvis level and square to his trunk.
The subject will flex his hip, bringing his thigh up onto his
trunk. The hip will be flexed as far as possible. The other
hip will be flexed in the same way. The subject will hold
one leg on his chest and let his other leg down until it is
flat on the table. If the hip does not extend fully, a flexion
contracture of that hip may exist. Repeat the procedure
for the opposite leg. Next, the subject is positioned in a
supine position so that his knees are able to flex over the
plinth. Rectus femoris tightness is indicated if the subject
is not able to flex his knee to 90' with the hip maintained
in a neutral position.8
Ober Test The subject will lie on his side with the leg to
be tested uppermost. The leg will be adducted as far as
possible and the knee flexed to 90' while keeping the hip
joint in the neutral or slight extension position to relax the
iliotibial tract. The abducted leg will then be released. If
the iliotibial tract is normal, the thigh should drop to the
adducted position. If there is a contracture of the fascia
lata or iliotibial band, the thigh will remain abducted when
the leg is released or compensation will occur in the
lumbar spine to allow the leg to a d d ~ c t . ~
SI Compression/Distraction Tests The anterior portion
of the SI joint is tested with the patient supine. The
examiner contacts the ASlS with the heels of both hands.
The forearms are crossed, and a posterior-lateral spring
is g i ~ e n . ~ . ~The
, ' ' posterior portion is tested with the
subject side lying with hand contact on the anterior-lateral
JOSPT January 1987 LONG SITTING TEST
rim of the ilium. A downward thrust is given. The joint
being tested is on the top If either of these tests
elicit pain, it is an indication there is pathology in the
joint."
10. FABERE Test The subject lies supine on the plinth and
places the ankle of his side to be tested on his opposite
knee. The hip joint is thus flexed, abducted, and externally
rotated. To stress the SI joint, the range of motion is
345
extended by the examiner placing one hand on the flexed
knee joint and the other hand on the ASlS of the opposite
side and pressing down on each of these points. If the
subject complains of increased pain in the SI joint region,
there may be pathology in the SI joint or hip joint.6
11. Degree of SLR Hamstring length will permit approxi-
mately 70° of hip joint flexion?

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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