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Question 1

• Sacral Thrust Test:

1. The patient lies face down
2. The examiner applies a force vertically downward to the center of the sacrum.
3. The presumed action is an anterior shearing force of the sacrum on both ilia.
4. This test is part of the [Sacroiliac Provocation Test Cluster].

Answer 1

• Sn: .63
• Sp: .65

Question 2

• Gaenslen’s Test
  
  1. The patient lies supine near the edge of the table with the leg hanging over the edge of the table and the other hip and knee flexed towards the patient’s chest.
  2. The examiner applies firm pressure to the knee being flexed to the patient’s chest and a counter pressure is applied to the knee of the hanging leg, towards the floor.
  3. The procedure is carried out on both sides.
  4. The presumed action is a posterior rotation force to the sacroiliac joint on the side of the flexed hip and knee, and an anterior rotation force of the SIJ on the side of the hanging leg.
  5. A positive test = reproduction of their symptoms.

Answer 2

• On the right:
  
  • Sn: .53
  • Sp: .51
• On the left:
  
  • Sn: .50
  • Sp: .77

Question 3

• Thigh Thrust/Femoral Shear
  
  1. The patient lies supine with the hip and knee flexed where the thigh is at right angles to the table and slightly adducted.
  2. One of the examiner’s hands cups under the sacrum and the other arm and hand wraps around the flexed knee in a cradling position (the pressure applied is directed dorsally along the line of the vertically oriented femur).
  3. The procedure is carried out on both sides (the presumed action is a posterior shearing force to the SIJ of that side).
  4. A positive test is confirmed if it reproduces the patient’s symptoms

Answer 3

• Sn: 0.88
• Sp: 0.69

Question 4

• ASIS Distraction
  
  1. The patient lies supine and the examiner applies a posteriorly directed force to both anterior superior iliac spines (lean over patient, lock out elbows, and provide posteriorly directed force).
  2. The presumed effect is a distraction of the anterior aspects of the SIJ.
  3. A test is positive if it reproduces the patient’s symptoms.

Answer 4

• Sn: 0.60
• Sp: 0.81

Question 5

• Sacroiliac Compression Test
  
  1. The patient lies on the side with hips and knees flexed to about a right angle.
  2. The examiner kneels on the table and applies a force vertically downward on the uppermost iliac crest.
  3. The presumed action is a compression force to both sacroiliac joints.
  4. A positive test is confirmed if it reproduces the patient’s symptoms.

Answer 5

• Sn: 0.69
• Sp: 0.69

Question 6

• Prone Instability Test
  
  1. The patient lies prone on an examination table with the legs over the edge and the feet resting comfortably on the floor, with the knees slightly flexed to relax the torso muscles.
  2. In this position, the clinician applies manual PA (Posterior to Anterior) pressure on each lumbar spinous process while asking the patient to report any provocation of pain at each segment.
  3. The painful segments are noted, and then the patient is asked to slightly raise the feet off the floor to contract the lumbar extensor muscles.
  4. While the patient maintains isometric contraction of these muscles, the clinician again applies PA pressure on each lumbar spinous process and records which previously painful segments are now nonpainful.
  5. A positive test is indicated by painful segments in the first position becoming nonpainful with contraction of the back extensors, presumably from the muscular stabilization role of these muscles on lumbar facet joint mobility.

Question 7

• Active Straight Leg Raise
  
  1. The test is performed with the patient in a supine position with legs straight and feet 20cm apart.
  2. The test is performed after the verbal instruction:
     “Try to raise your legs, one after the other, above the table for 20cm without bending the knee.”
  3. The patient asked to score impairment on a sixpoint scale:
     
     • 0 = not difficult at all
     • 1 = minimally difficult
     • 2 = somewhat difficult
     • 3 = fairly difficult
     • 4 = very difficult
     • 5 = unable to do
  4. The scores of both sides are added, so that the summed score ranges from 0 to 10.