A seated flexion test is positive on the right. The sacral base is deep, and the ILA on the dysfunctional side is deep. What is the most likely sacral diagnosis?

• A. Right unilateral shear flexed
• B. Anterior torsion
• C. Bilateral extension
• D. Left axis rotation

Answer: (B)

Main concept: Distinguishing sacral torsions from other sacral dysfunctions relies on the seated flexion test and the pattern of sacral landmarks (sacral base and ILA) you palpate.

A positive seated flexion test on the right localizes the dysfunction to the right sacrum. The described pattern—sacral base deep on the right and the ILA on the dysfunctional side also deep—fits a forward torsion pattern, where the sacrum has rotated anteriorly about the right oblique axis. This combination is most consistent with anterior torsion on the right (often called right-on-right anterior torsion).

Other patterns (unilateral flexion/extension or different axis rotations) would produce different correlations between seated flexion side and the sulcus/ILA depths, so the described findings best align with anterior torsion on the right.