SIJ Functional/Special Tests Flashcards
SIJ Provocation/Stress Tests
-statistically the best
-reproduce pain
-FABER
-Distraction
-Compression
-Thigh Thrust
-Sacral Thrust
-Gaenslen’s Test
SIJ Alignment/Positional Tests
-Questionable reliabiliy/validity
-Iliac Crest Height
-ASIS Height
-PSIS Height
-Isch Tub Height
Mobility/Functional Tests
-questionable reliability/validity
-More movement=Hypomobile segment
-Standing Flexion Test
-Seated Flexion Test
-Stork Gilet Marching
-Supine to Long Sit Test
Form/Force Closure Tests
Active SLR Test
Evaluation Order of SIJ Dysfunction
- Do Hip and/or Lumbar Exam
- Confirm Presence of SIJ dysfunction with Provocation
- Determine side of Hypomobiltiy (mobility/functional tests)
- Determine Pathology
- Determine if Form or Force are a component
- Select Intervention (treat lumbar or hip dysfunction first, then SIJ hypomobility first)
Fortin’s Sign
-pain localized with one finger over PSIS
->2 times
Primary SI Gapping (Distraction) Test
-provocation tests
-anterior SI joint stress test
-push on ASISs
(+) Reproduction of s/s
Primary SI Compression Test
-provocation tests
-in sidelying press down on hip
-painful side up
(+) Reproduction of s/s
Sacral Thrust Test (PA Glide)
-provocation tests
-Palapate sacrum
-apply force downward over S3
-repeat multiple times (<6)
(+) Reproduction of pt pain over SIJ or posterior ligs
Gaenslen’s Test
-provocation tests
-Thomas Test position, testing leg down
-flex non-testing leg and assess s/s
-PT presses top leg into flx and bottom into ext
(+) reproduction of pt pain at SIJ or pubic symphysis
FABER Test
-provocation tests
-pt supine, PT on ipsi side of leg
-hip in flx, ER, abduction
-press into contra ASIS and knee
(+) reproduction of pt pain at posterior pelvis or butt
Thigh Thrust Test
-provocation tests
-PT on contra side of testing leg
-PT hand under sacrum
-Pt hip flx and adducted
-PT pushes hip past sacrum
(+) reproduction of pt pain at SIJ
(+) SIJ Dysfunction CPR
- Compression
- Distraction
- Sacral Thrust*
- Gaeslen Test
- Thigh Thrust
3 or more/5 (+) = dysfunction
(-) SIJ Dysfunction CPR
- Compression
- Distraction
- FABER*
- Gaeslen Test
- Thigh Thrust
3 or less /5 (+) = no dysfunction
Pubic Stress Test for Anterior Pain
-provocation tests
-PT uses heel of hand 1 superior aspect of pubic ramiu and 1 hand at inferior
-slow downward opposite pressure
-switch sides
(+) reproduction of pain over pubic symphysis or anterior pelvis
Sign of Buttock Test
-provocation tests
-sign of serious pathology (hip absess, fracture, infection, cancer)
-nerve on slack and pain still there
- Passive SLR (+)
- Return to neurtral and bend hip and knee
- Passive bent leg raise (+) and same ROM
Alignment Palpation Sites
-ASIS
-PSIS
-Pubic Tubercle
-Sacral Base Depth
-Inferior Lateral Angle
-Isch tubs
Seated Flexion Test
-Mobility/functional test
-Pt seated
-PSIS found then Pt bends over
-PSISs should move superiorly equally
-rules out Leg length diff or hamstring tightness**
(+) Don’t move equally, affected (hypomobile) side moves more than unaffected
Long Sitting (Suine to sit) Test
-Mobility/functional test
-Pt supine
-palpate medial malleoli on both ankles
-Pt sits up, Med mals should come down equally
(+) malleoli don’t move equally
longer limb= posterior innominate
Shorter limb= anterior innominate
Standing Flexion Test
-Mobility/functional test
-Pt standing
-PSIS found then Pt bends over with knees extended
-PSISs should move superiorly equally
(+) Don’t move equally, affected (hypomobile) side moves more than unaffected
Gillet’s (Stork) Test
-mobility/functional test
-Pt in standing with testing leg down and opp hip flexed
-P palpates PSIS and contra sacrum
-Pt flexes opp hip
-PSIS should move inferiorly to sacrum
(+) PSIS doesn’t move inferiorly to sacrum (hypomobile) OR causes SI joint pain
Active SLR Test
Form Closure Test
Step 1. Pt actively lifts leg
(+) reproduces SIJ pain OR abberant movements during
1 must be positive to move on to 2 and 3
Step 2: PT compresses pelvis laterally and Pt lifts leg
(+) Pt has less pain OR fewer abberant movements
-Tx: SI compression belt
Step 3: Pt contracts core then lifts leg
-PT can reisist contra shoulder to help
(+) Pt can perform ASLR with less pain OR few abberant movements
Tx: stabilization exercises
Sidelying SI Gapping Manipulation
- Pt sidelying with hips flexed 90 deg, shoulders stacked ( PT behind pt)
- Pt rotated by pulling “table arm” across Pt
- Pelvis remains stable with PT hand
- Pt then rotated more to take up slack while pushing hip medially
- Quick thrust to manip,
Million Dollar Roll Manipulation
1.Pt Supine
2.Banana shape with Pt on outside of curve
3.Roll trunk toward PT
4.Place resistance on opp ASIS
5. Rote in opposite directions
add HVLAT for manipulation
Long Axis Traction Manipulation
-2 person technique
-Pt prone with legs off table in closed packed (ext, abd, IR)
-PT grabs affected LE and lifts up and out
-other PT stabilizes sacrum
-PT takes of slack on leg then quickly pulls
Prone Sacral PA Mobilization
-Palapate sacrum
-assess glide of sacrum
-apply force downward over base (counternutated) or apex (nutated)
Prone Joint Mobilization to Restore Anterior Innominate Rotation
-Pt prone with unaffect LE relaxed or off table
-PT extends affected legwhile stabilizing ipsi PSIS
-Mobilize joint into anterior rotation if stuck in posterior
-maintain extension
Supine w/ Hip Flexed and Extended Isometric Hold MET
-Pt supine with hips and knees flexed
-PT puts hand on ipsi knee and contra posterior thigh
-Simultaneously push into flexion and extention
-Pt reissts for 6 sec
-Resist flexion: brings pelvis ant
-Resist extension: brings pelvis post
brings both sides closer together
Adduction Isometric for Anterior pelvic/SIJ Pain MET
-Pt in hooklying
-PT pushes against medial knees to resist add the switch to resisit abduction (can use chest)
-Pt pushes against for 3 seconds 3x
