Sacroiliac joint Test (SI Joint Tests)
1. SI Compression test
2. SI Distraction Test
3. Gaenslen`s Test
4. Posterior Pelvic Pain Provocation ( P4) Test
5. Sacral Spring Test
6. 3(+) out of 5 indicates SIJ as the source of the pain
SI Joint Provocation Test:-
1. SI Compression Test:-
-Patient assumes a side lying position with his or her painful side up superior to the plinth.Resting symptoms are assessed.
-Examiner cups the iliac crest of the painful side and applies a downward force through the ilium.This position is held for 30 seconds.As with the other sacroiliac,considerable vigor is required to reproduce the symptoms;in some cases,repeated force is necessary.
-(+) test is reproduction of the concordant sign of the patient.
2. SI Distraction Test:-
-Patient assumes a supine position.Resting symptoms are assessed.
-The medial aspect of both anterior superior iliac spines are palpated by the examiner .The examiner crosses his or her arms,creating an X at the forearms,and a force is applied in a lateral-posterior direction.For comfort,it is often required that the examiner relocate his or her hand on the anterior superior iliac spine ( ASIS) several times.
-Examiner holds the position for 30 seconds,then applies a vigorous force repeatedly in an attempt to reproduce the concordant sign of the patient.
- (+) test is reproduction of concordant symptoms.
3. 4P Test or Thigh thrust Test.
-Patient is positioned in a supine position.Resting symptoms are assessed.
-Examiner stands opposite the painful side of the patient.
-The hip on the painful side is flexed to 90degree.
- Examiner places his or her hand under the sacrum to form a stable “bridge” for the sacrum.
-A downward pressure is applied through the femur to force a posterior translation of the innominate.The patient`s symptoms are assessed to determine if they are concordant.
- (+) test is concordant pain that is posterior to the hip or near the sacroiliac joint.A (+) test requires reproduction of pain on the thrust side ( the side of the loaded femur).
4. Sacral Thrust test:-
-Patient lies in a prone position.Resting symptoms are assessed.
-Examiner palpates the second or third spinous process of the sacrum.Using the pisiform,the examiner places a downward pressure on the sacrum at S3.By targeting the midpoint of the sacrum,the examiner is less likely to force the lumber spine into hyperextension.
-Vigorously and repeatedly ( up to six thrust),examiner applies a strong downward force to the sacrum in an attempt to reproduce the concordant sign of the patient.
- (+) test is a reproduction of the concordant sign during downward pressure.
5. Gaenslen`s Test:-
-Patient is positioned in a supine position with the painful leg resting very near the end of the treatment table.Resting symptoms are assessed.
- Examiner sagittal raises the no painful side of the hip ( with the knee bent ) up to 90 degree .Examiner tests both sides if the patient complains of pain bilaterally.
- A downward force ( up to six bouts ) is applied to the lower leg ( painful side ) while a flexion-based counterforce is applied to the flexed leg ( pushing the leg in the opposite direction ). The effect causes a torque to the pelvis.Concordant symptoms are assessed.
- (+) test if the torque reproduces pain of the concordant sign.