SIJ Special Tests

Question 1

Thigh Thrust: response

Answer 1

Positive if reproduction of pain (symptoms) over SI region of tested side

Question 1

Supine to sit test: indications for performing test

Answer 1

To distinguish between true leg length discrepancy and innominate rotation

Question 1

Distraction: how to perform

Answer 1

Pt supine Press both iliums into table by pushing just medial to ASIS. Can cross arms to do this. Think of it as intending to stretch the anterior SI tendon.

Question 1

Gillet’s test: response and implications

Answer 1

Normal if PSIS rotates posterioraly in relation to S2 spinous process during flexion. Abnormal response is when PSIS doesn’t rotate posterioraly in relationship to S2 (hypomobile) Indicative of asymmetrical SIJ mobility

Question 2

SIJ provocation test algorithm two

Answer 2

+ for SIJ pathology (likely hypomobility) if 3/6 of the following tests are +. Sens 0.94, spec 0.78 Thigh Thrust Distraction Compression Sacral Thrust Gaenslen’s Right Gaenslen’s Left

Question 3

Gaenslen’s test (Left): how to perform

Answer 3

pt supine Hang left (?) leg off table and flex the right hip passively to end range. Apply overpressure to left hip extension and right hip flexion. Example shows therapist standing on side of leg hanging off table.

Question 4

Gillet’s test: indications for performing test

Answer 4

To assess for asymmetrical mobility

Question 5

Thigh Thrust: how to perform the test

Answer 5

Pt supine Passively flex hip on side of pain. Slide one hand under sacrum (inferior approach important but awkward!). Be careful not to cause axial rotation in flexed hip. Use other arm to encircle knee and apply axial compression through femur. This causes shear force on the SIJ.

Question 6

SIJ Compression test: how to perform

Answer 6

Pt side-lying with knees/hips a little flexed (~45 degrees in picture). Stand behind pt (I found it easier to stand anterior to pt) and apply pressure on exposed ilium. Apply the pressure medial and slightly posteriorly. Think of it as trying to compress the anterior SI ligament. Symptomatic side should be up

Question 7

Are the SIJ motion tests good tests?

Answer 7

Not really, but they are still commonly done in the clinic

Question 8

SIJ Motion Tests (3)

Answer 8

1. Supine to sit 2. Standing flexion test 3. Gillet’s test

Question 10

Which SIJ Provocation tests are unnecessary except when using second algorithm approach?

Answer 10

Right and Left Gaenslen’s tests

Question 10

Gillet’s test: how to perform

Answer 10

Sit or stand behind standing pt and palpate S2 spinous process and PSIS with thumbs while pt flexes hip on side of palpated PSIS. Normal if PSIS rotates posterioraly in relation to S2 spinous process during flexion. Abnormal response is when PSIS doesn’t rotate posterioraly in relationship to S2 (hypomobile)

Question 10

Standing flexion test: response and implications

Answer 10

Normal response/negative test: both PSIS move anterioraly and superioraly equally with flexion Abnormal response/positive test: asymmetrical movement of SIJ Indicative of asymmetrical SIJ mobility during flexion

Question 11

Gaenslen’s test (Right): how to perform

Answer 11

pt supine Hang right (?) leg off table and flex the left hip passively to end range. Apply over pressure to right hip extension and left hip flexion. Example shows therapist standing on side of leg hanging off table.

Question 13

Standing flexion test: how to perform

Answer 13

Sit behind standing patient. Palpate PSIS (by hooking thumb under it). Have patient bend forward and return to standing and assess difference in movement between the two PSISs. If painful side moves up more than other side, joint might be hypomobile. If it moves up less than the other side, or doesn’t move, the joint could be hypermobile. Normal is when both move the same

Question 15

Can the standing flexion test only be done in standing?

Answer 15

No it can also be done in sitting (but maybe it would be called the sitting flexion test?)

Question 17

Are the SIJ provocation tests good tests?

Answer 17

Yes, they are the best that we have. They are even better in the absence of centralization (clear lumbar spine). Depending on the approach, estimated sensitivity is at least 0.88 & specificity is 0.78

Question 18

Sacral Thrust: how to perform

Answer 18

Pt prone Place one hand on sacrum as a tool hand (like when doing thoracolumbar mobs).use the other hand on top of tool hand to thrust into body of sacrum

Question 19

5 SI Joint provocation tests

Answer 19

1. Thigh thrust 2. Distraction 3. Compression 4. Sacral thrust 5. Gaenslen’s (right & left)

Question 20

Standing flexion test: indications for performing

Answer 20

To asses for asymmetrical SIJ mobility

Question 22

Supine to sit test: response and implications

Answer 22

Painful side: long to short–> anterior rotation Short to long–> posterior rotation Assume symptomatic side is one at fault If this test is positive, it can suggest innominate rotation

Question 22

SIJ Compression Test: response

Answer 22

Positive if reproduction of pain (symptoms) over SI region (either side).

Question 23

5 SIJ Provocation Tests

Answer 23

1. Thigh thrust 2. Distraction 3. Compression 4. Sacral Thrust 5. Gaenslen’s (right & left)

Question 24

SIJ provocation test algorithm one

Answer 24

+ if 2/4 of the following reproduce pain in this order (I think) SIJ path likely (hypomobile prob). Sens 0.88, spec 0.78 Thigh Thrust and Distraction If both are positive, stop testing bc SIJ pathology likely. If both -, stop testing bc SIJ pathology unlikely. If one is + do Compression. If + stop, if - do Sacral Thrust.

Question 25

Supine to sit test: how to perform

Answer 25

Pt starts in supine (after preparing by doing Weber-Barstow maneuver). Assess leg length on both sides by palpating just under medial malleoli with thumbs to compare length. Then ask patient to sit up and re-compare legs the same way. Painful side: long to short–> anterior rotation Short to long–> posterior rotation

Question 27

SIJ Distraction test: response

Answer 27

Positive if reproduction of pain (symptoms) over SI region of either side

Question 28

Sacral Thrust: Response

Answer 28

Positive if reproduction of pain (symptoms) over SI region (either side).

Question 29

Gaenslen’s test (right and left often counted at 2 tests): response

Answer 29

Positive if reproduction of pain (symptoms) over SI region (either side).