SI Joint assessments

Question 1

Cephalad movement of sacrum with caudal movement of ilium.

Answer 1

The examiner places the heel of one hand over the iliac crest and the heel of the other hand over the apex of the sacrum. The ilium is pushed down or caudally with one hand while the sacrum is pushed up or cephalad with the other hand. The test is repeated for the other ilium. The examiner should feel only minimal movement, and there should be no pain in the joint if the joint is normal.

Question 2

Cephalad movement of ilium with caudal movement of sacrum.

Answer 2

To test caudal movement of the sacrum and cephalad movement of the ilium, the examiner places the heel of one hand over the base of the sacrum and the heel of the other hand over the ischial tuberosity. The examiner then pushes the pelvis cephalad and the sacrum caudally. The test is repeated with the other half of the pelvis being moved. The movement and amount of pain are compared.

Question 3

Anterior movement of sacrum on ilium

Answer 3

The anterior movement of the sacrum on the ilium is tested with the patient lying prone. The examiner places the heel of one hand over the sacrum and places the other hand under the iliac crest in the area of the ASIS on one side. The hand is then pushed down on the sacrum while the other hand lifts up. The process is repeated on the other side, and the results are compared. Similarly, with the patient supine, a wedge may be used against the sacrum with the patient’s body weight acting to push the sacrum forward.

Question 4

Anteroposterior translation of ilium on sacrum

Answer 4

To test anteroposterior translation of the ilium on the sacrum, the examiner, using the other hand, applies pressure through the iliac crest and ASIS. Posterior movement of the ilium should be noted and end range is achieved at the sacroiliac joint when the pelvis is felt to rotate or move at L5–S1. The motion is compared with the other side.

Question 5

Superoinferior translation of ilium on sacrum

Answer 5

To test superoinferior translation of the innominate (ilium) bone on the sacrum, the examiner applies a superior force through the ischial tuberosity. The end of motion is reached when the pelvic girdle is felt to laterally bend beneath L5–S1. The motion is compared with the opposite side.

Question 6

Inferiorposterior translation of ilium on sacrum

Answer 6

To test inferoposterior translation of the innominate on the sacrum, the examiner, using the heel of the other hand, applies an anterior rotation force to the ipsilateral ASIS and iliac crest. This produces an inferoposterior glide at the sacroiliac joint and is associated with nutation of the sacrum.

Question 7

Superoanterior translation of ilium on sacrum

Answer 7

To test superoanterior translation of the innominate on the sacrum, the examiner, using the heel of the other hand, applies a posteriorly rotating force to the ipsilateral
ASISs and iliac crest. This produces a
superoanterior glide at the sacroiliac joint and is associated with counternutation of the sacrum.