Additional tests to identify SI Joint Pain or Dysfunction:
1. Gaenslen’s test: With the patient in supine close to the edge of the table, the leg closest to the edge hangs off of the table and the other leg is flexed and brought to the patient’s chest. The therapist provides pressure at the flexed knee pushing the leg towards the patient’s chest, and pressure at the other leg pushing down towards the floor. This counter pressure creates a posterior rotation at the SI on the side being flexed, and an anterior rotation at the SI on the side with the leg hanging off of the table. This test should be performed bilaterally.
2. Active SLR: With the patient lying supine, have them lift one leg at least 6 inches off of the table. Ask them about the perceived effort of this task on a scale from 0-5 with 0 being no effort and 5 being they are unable to complete the task. The therapist then applies a compressive force bilaterally to the pelvis to provide stabilization and the patient performs the leg raise again. The patient is then asked to rate the perceived effort again. A decrease in perceived effort is considered a positive test and indicates poor muscular control. See the associated video below for how to perform this test.
3. Patrick’s or FABER Test: With the patient lying supine, one leg is placed into flexion, abduction, and external rotation with the foot resting on top of the knee of the opposite leg, in a figure 4 position. The therapist lowers the knee of the test leg towards the bed, stabilizes the pelvis, and then applies an overpressure towards the test leg. This is performed bilaterally and pain with this indicates hip, pubic symphysis, or SI joint involvement.
4. Forward flexion test: With the patient standing, the therapist palpates both PSIS while the patient bends forward at the waist. If one PSIS moves more cranially than the other (as indicated with the therapist's thumbs that are palpating the PSIS finishing unlevel with the forward bend), it is considered a positive test and indicates dysfunction in the lumbosacral region.
5. Seated flexion test: The patient sits with legs over the end of the table and the feet supported. The therapist palpates both PSIS while the patient bends forward at the waist. Both thumbs on the PSIS should move equally in the cranially direction.
1. Gaenslen’s test: With the patient in supine close to the edge of the table, the leg closest to the edge hangs off of the table and the other leg is flexed and brought to the patient’s chest. The therapist provides pressure at the flexed knee pushing the leg towards the patient’s chest, and pressure at the other leg pushing down towards the floor. This counter pressure creates a posterior rotation at the SI on the side being flexed, and an anterior rotation at the SI on the side with the leg hanging off of the table. This test should be performed bilaterally.
2. Active SLR: With the patient lying supine, have them lift one leg at least 6 inches off of the table. Ask them about the perceived effort of this task on a scale from 0-5 with 0 being no effort and 5 being they are unable to complete the task. The therapist then applies a compressive force bilaterally to the pelvis to provide stabilization and the patient performs the leg raise again. The patient is then asked to rate the perceived effort again. A decrease in perceived effort is considered a positive test and indicates poor muscular control. See the associated video below for how to perform this test.
3. Patrick’s or FABER Test: With the patient lying supine, one leg is placed into flexion, abduction, and external rotation with the foot resting on top of the knee of the opposite leg, in a figure 4 position. The therapist lowers the knee of the test leg towards the bed, stabilizes the pelvis, and then applies an overpressure towards the test leg. This is performed bilaterally and pain with this indicates hip, pubic symphysis, or SI joint involvement.
4. Forward flexion test: With the patient standing, the therapist palpates both PSIS while the patient bends forward at the waist. If one PSIS moves more cranially than the other (as indicated with the therapist's thumbs that are palpating the PSIS finishing unlevel with the forward bend), it is considered a positive test and indicates dysfunction in the lumbosacral region.
5. Seated flexion test: The patient sits with legs over the end of the table and the feet supported. The therapist palpates both PSIS while the patient bends forward at the waist. Both thumbs on the PSIS should move equally in the cranially direction.
References:
1. Cusi, M.F. (2010). Paradigm for assessment and treatment of SIJ mechanical dysfunction. Journal of Bodywork & Movement Therapies, 14: 152-161.
2. Dutton, M. (2008). Orthopaedic Examination Evaluation and Intervention. New York: McGraw-Hill Companies, Inc.
3. Laslett, M., Young, S., Aprill, C., McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac
provocation tests. Australian Journal of Physiotherapy, 49: 89-97.
1. Cusi, M.F. (2010). Paradigm for assessment and treatment of SIJ mechanical dysfunction. Journal of Bodywork & Movement Therapies, 14: 152-161.
2. Dutton, M. (2008). Orthopaedic Examination Evaluation and Intervention. New York: McGraw-Hill Companies, Inc.
3. Laslett, M., Young, S., Aprill, C., McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac
provocation tests. Australian Journal of Physiotherapy, 49: 89-97.