Standing Flexion Test

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 Standing Flexion Test

What is Standing Flexion Test?

Standing flexion test (also called Piedallu test) is used to assess sacroiliac joint function.

See Also: Three-Phase Hyperextension Test

How do you do the Standing Flexion Test?

Standing Flexion Test procedure

What does a positive Standing Flexion Test mean?

Standing Flexion Test Accuracy

The sensitivity and specificity of the standing flexion were poor. 1

Seated Flexion Test

Seated Flexion Test is purported by osteopaths to help distinguish between a SI lesion and an iliosacral lesion when compared with the results of the standing flexion test.

The patient sits on a hard surface with the legs over the end of the table and feet supported. In this position, innominate motion is severely abbreviated, because sitting places the innominates near the end of their extension range. The test is performed as follows. Each PSIS (posterior superior iliac spine) is palpated with the thumb placed under it inferiorly (caudally). The patient then bends forward at the waist.

Provided there is no impairment in the SIJ or the lower lumbar spine, as the patient bends forward, both thumbs should move superiorly (cranially). If the joint is blocked, it moves superiorly further in relation to the other side.

A similar test, referred to as the sitting bend over test or sitting forward flexion test, is performed in the same manner except the patient is seated on a soft surface

This examination has been shown to lack reliability, have poor sensitivity, and have low specificity as a result a low false positive rate.

A study by Levangie determined the sensitivity to be 9%, the specificity to be 93%.

Seated Flexion Test
Seated Flexion Test



  1. Nejati P, Sartaj E, Imani F, Moeineddin R, Nejati L, Safavi M. Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction. J Chiropr Med. 2020 Mar;19(1):28-37. doi: 10.1016/j.jcm.2019.12.002. Epub 2020 Sep 12. PMID: 33192189; PMCID: PMC7646135.
  2. Levangie PK. Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Phys Ther. 1999 Nov;79(11):1043-57. PMID: 10534797.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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