A seated flexion test is negative; the sacral bases are both shallow; the ILAs are both shallow. What is the diagnosis?

• A. Bilateral flexion
• B. No dysfunction
• C. Anterior torsion
• D. Bilateral extension

Answer: (B)

In sacral diagnosis, you’re looking for symmetry and how the sacral landmarks respond to motion tests to distinguish torsions, flexions, or extensions from a neutral state. A negative seated flexion test means there’s no unilateral sacroiliac dysfunction on either side. When both sacral bases (sulci) are shallow and both inferior lateral angles are shallow, that pattern is symmetric and does not indicate a rotational or tilt abnormality of the sacrum. Put together, these findings point to a neutral sacrum with no somatic dysfunction.

If there were a dysfunction, you’d expect asymmetry or a pattern that matches a specific torsion, flexion, or extension, such as a deep sulcus on one side with a corresponding shallow ILA, or other asymmetrical palpatory cues that accompany a positive seated flexion test.