Sacroiliac Joint Provocation Tests:
To help identify the source as SI joint, stress testing of this joint should provoke pain or the patient’s symptoms. This alone is not enough however as it can be difficult to differentiate the source of pain with this test. So, other combinations of tests can be used in order to isolate SI joint as the source of symptoms. Some of these SI joint provocation tests include:
1. Distraction: With the patient lying supine on the table, the therapist applies a posterior force bilaterally at the anterior superior iliac spines (ASIS) to distract the anterior portion of the SI joint.
2. Thigh thrust (P4): For this test, the patient is lying supine with the hip and knee flexed, with the thigh at a right angle and slightly abducted in reference to the table. The therapist places one hand underneath the sacrum and the other arm wraps around the flexed knee. A force along the line of the femur is directed down towards the table to give a shearing force to the SI joint. This test should be performed bilaterally.
3. Compression: The patient is in sidelying with both the hips and knees flexed to approximately right angles. The therapist is behind the patient, and provides a downward vertical force at the uppermost iliac crest to compress both SI joints.
4. Sacral thrust: The patient should lie prone with their face down. The therapist provides a vertical downward force to the center of the sacrum. This test gives an anterior shearing force of the sacrum on both ilia.
Statistical validity of these 4 provocation tests: Using the above mentioned 4 tests to determine that the SI joint is the pain source, having 3 or more “positive tests” gives a sensitivity of 93.8% and a specificity of 78.1%. As determined by the research, perform the distraction, thigh thrust, compression, and sacral thrust tests and stop when two positive tests have been achieved. This “rule” leads to a sensitivity of 0.88 and a specificity of 0.78. See the videos below for a demonstration on how to perform these 4 tests.
To help identify the source as SI joint, stress testing of this joint should provoke pain or the patient’s symptoms. This alone is not enough however as it can be difficult to differentiate the source of pain with this test. So, other combinations of tests can be used in order to isolate SI joint as the source of symptoms. Some of these SI joint provocation tests include:
1. Distraction: With the patient lying supine on the table, the therapist applies a posterior force bilaterally at the anterior superior iliac spines (ASIS) to distract the anterior portion of the SI joint.
2. Thigh thrust (P4): For this test, the patient is lying supine with the hip and knee flexed, with the thigh at a right angle and slightly abducted in reference to the table. The therapist places one hand underneath the sacrum and the other arm wraps around the flexed knee. A force along the line of the femur is directed down towards the table to give a shearing force to the SI joint. This test should be performed bilaterally.
3. Compression: The patient is in sidelying with both the hips and knees flexed to approximately right angles. The therapist is behind the patient, and provides a downward vertical force at the uppermost iliac crest to compress both SI joints.
4. Sacral thrust: The patient should lie prone with their face down. The therapist provides a vertical downward force to the center of the sacrum. This test gives an anterior shearing force of the sacrum on both ilia.
Statistical validity of these 4 provocation tests: Using the above mentioned 4 tests to determine that the SI joint is the pain source, having 3 or more “positive tests” gives a sensitivity of 93.8% and a specificity of 78.1%. As determined by the research, perform the distraction, thigh thrust, compression, and sacral thrust tests and stop when two positive tests have been achieved. This “rule” leads to a sensitivity of 0.88 and a specificity of 0.78. See the videos below for a demonstration on how to perform these 4 tests.
References:
1. Dutton, M. (2008). Orthopaedic Examination Evaluation and Intervention. New York: McGraw-Hill Companies, Inc.
2. 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. Dutton, M. (2008). Orthopaedic Examination Evaluation and Intervention. New York: McGraw-Hill Companies, Inc.
2. 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.