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LECOM-SH OPP 1001 Exam 3: Advanced Somatic Dysfunctions, Sacral/Pelvic Mechanics,
and Targeted OMT Practice Questions with Detailed Rationales
SECTION 1: SACRAL MECHANICS & DYSFUNCTIONS
Sacral Anatomy & Axes
Q1. What are the four physiologic axes of the sacrum and
innominates?
A. The superior transverse axis, the inferior transverse axis, the
left oblique axis, and the right oblique axis.
Rationale: These four axes govern all sacral motion. The
transverse axes allow flexion and extension (nutation and
counternutation), while the oblique axes allow torsion.
Understanding these axes is essential for diagnosing and
treating sacral somatic dysfunction.
Q2. What motion occurs around the superior transverse axis of
the sacrum?
A. Flexion and extension (nutation and counternutation) of the
sacral base.
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Rationale: The superior transverse axis runs through the region
of the S1–S2 sacral segments. Motion around this axis produces
anterior/posterior rotation of the sacral base.
Q3. What motion occurs around the oblique axes of the
sacrum?
A. Torsion — rotation of the sacrum about a diagonal axis.
Rationale: The oblique axes run diagonally from the superior
aspect of one side of the sacrum to the inferior aspect of the
opposite side. Torsions are named for the side of the oblique
axis and the direction of rotation.
Q4. What is nutation of the sacrum?
A. Anterior rotation of the sacral base (forward rotation). Also
called sacral flexion or craniosacral extension.
Rationale: During nutation, the sacral base moves anteriorly
and inferiorly, while the sacral apex (coccyx) moves posteriorly.
This is the normal motion during weight-bearing and gait.
Q5. What is counternutation of the sacrum?
A. Posterior rotation of the sacral base (backward rotation).
Also called sacral extension or craniosacral flexion.
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Rationale: During counternutation, the sacral base moves
posteriorly and superiorly. This motion occurs during relaxation
and in certain somatic dysfunctions.
Q6. What is the seated flexion test, and what does it assess?
A. A test where the patient sits and the physician observes the
relative superior movement of the PSISs during forward flexion.
Greater than 2 cm of superior movement on one side indicates
sacral dysfunction on that side.
Rationale: The seated flexion test is the first test to assess for
sacral dysfunction. A positive test localizes the side of the
dysfunction to the side of greater PSIS excursion.
Q7. What is the standing flexion test, and what does it assess?
A. A test where the patient stands and the physician observes
the relative superior movement of the PSISs during forward
flexion. Greater movement on one side suggests iliosacral
dysfunction on that side.
Rationale: The standing flexion test assesses iliosacral motion
and is used to diagnose innominate dysfunction. A positive test
indicates the side of the dysfunctional innominate.
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Q8. What does a deep sacral sulcus indicate?
A. The sacral base on that side is positioned anteriorly
(forward).
Rationale: The sacral sulcus is the depression between the
sacrum and the ilium. A deep sulcus indicates the sacral base is
rotated forward on that side.
Q9. What does a shallow sacral sulcus indicate?
A. The sacral base on that side is positioned posteriorly
(backward).
Rationale: A shallow sulcus indicates the sacral base is rotated
posteriorly on that side.
Q10. What does a posterior inferior ILA (inferior lateral angle)
indicate?
A. The sacral base on that side is positioned anteriorly (forward
rotation).
Rationale: When the sacral base rotates forward, the ILA on the
same side moves posteriorly and inferiorly. This is a key
diagnostic finding in sacral torsion.
LECOM-SH OPP 1001 Exam 3: Advanced Somatic Dysfunctions, Sacral/Pelvic Mechanics,
and Targeted OMT Practice Questions with Detailed Rationales
SECTION 1: SACRAL MECHANICS & DYSFUNCTIONS
Sacral Anatomy & Axes
Q1. What are the four physiologic axes of the sacrum and
innominates?
A. The superior transverse axis, the inferior transverse axis, the
left oblique axis, and the right oblique axis.
Rationale: These four axes govern all sacral motion. The
transverse axes allow flexion and extension (nutation and
counternutation), while the oblique axes allow torsion.
Understanding these axes is essential for diagnosing and
treating sacral somatic dysfunction.
Q2. What motion occurs around the superior transverse axis of
the sacrum?
A. Flexion and extension (nutation and counternutation) of the
sacral base.
, Page |2
Rationale: The superior transverse axis runs through the region
of the S1–S2 sacral segments. Motion around this axis produces
anterior/posterior rotation of the sacral base.
Q3. What motion occurs around the oblique axes of the
sacrum?
A. Torsion — rotation of the sacrum about a diagonal axis.
Rationale: The oblique axes run diagonally from the superior
aspect of one side of the sacrum to the inferior aspect of the
opposite side. Torsions are named for the side of the oblique
axis and the direction of rotation.
Q4. What is nutation of the sacrum?
A. Anterior rotation of the sacral base (forward rotation). Also
called sacral flexion or craniosacral extension.
Rationale: During nutation, the sacral base moves anteriorly
and inferiorly, while the sacral apex (coccyx) moves posteriorly.
This is the normal motion during weight-bearing and gait.
Q5. What is counternutation of the sacrum?
A. Posterior rotation of the sacral base (backward rotation).
Also called sacral extension or craniosacral flexion.
, Page |3
Rationale: During counternutation, the sacral base moves
posteriorly and superiorly. This motion occurs during relaxation
and in certain somatic dysfunctions.
Q6. What is the seated flexion test, and what does it assess?
A. A test where the patient sits and the physician observes the
relative superior movement of the PSISs during forward flexion.
Greater than 2 cm of superior movement on one side indicates
sacral dysfunction on that side.
Rationale: The seated flexion test is the first test to assess for
sacral dysfunction. A positive test localizes the side of the
dysfunction to the side of greater PSIS excursion.
Q7. What is the standing flexion test, and what does it assess?
A. A test where the patient stands and the physician observes
the relative superior movement of the PSISs during forward
flexion. Greater movement on one side suggests iliosacral
dysfunction on that side.
Rationale: The standing flexion test assesses iliosacral motion
and is used to diagnose innominate dysfunction. A positive test
indicates the side of the dysfunctional innominate.
, Page |4
Q8. What does a deep sacral sulcus indicate?
A. The sacral base on that side is positioned anteriorly
(forward).
Rationale: The sacral sulcus is the depression between the
sacrum and the ilium. A deep sulcus indicates the sacral base is
rotated forward on that side.
Q9. What does a shallow sacral sulcus indicate?
A. The sacral base on that side is positioned posteriorly
(backward).
Rationale: A shallow sulcus indicates the sacral base is rotated
posteriorly on that side.
Q10. What does a posterior inferior ILA (inferior lateral angle)
indicate?
A. The sacral base on that side is positioned anteriorly (forward
rotation).
Rationale: When the sacral base rotates forward, the ILA on the
same side moves posteriorly and inferiorly. This is a key
diagnostic finding in sacral torsion.
