PT Classroom - A Review of Sacroiliac Joint Provocative Tests ׀ by Chai Rasavong, MPT, COMT, CMTPT, MBA

The sacroiliac joint (SIJ) is a synovial joint that garners a lot of controversy as it can share common pain patterns with multiple conditions at the spine (stenosis, DDD, herniated disc, etc.), hip (FAI, OA, AVN, etc) and pelvis (glut tear, piriformis, pelvic floor) (1). Given the shared pain patterns involving the SIJ and the structures mentioned previously, obtaining a SIJ pain diagnosis can prove to be challenging. Diagnosing SIJ pain involves obtaining a detailed subjective history which is positive, conducting a thorough lumbar spine & hip exam to help rule out issues at these structures, obtaining positive provocative test results for the SIJ and achieving a positive response to an intra-articular injection (1). Often times SIJ ROM and position testing are performed in the physical exam as well but have been found to be unreliable (1, 2, 3). The chart provided below details common pain referral patterns for the lumbar spine, hip and SIJ (1, 4, 5).

With the patient in supine a vertically oriented pressure is applied to the anterior superior iliac spinous (ASIS) processes directed posteriorly, distracting the SIJ.

Thigh Thrust (1, 2)

With the patient in supine, holding the hip flexed to 90 degrees and stabilizing the opposite ASIS with the other hand, a vertically oriented force is applied through the line of the femur directed posteriorly, producing a posterior shearing force at the SIJ.

Compression (1, 2)

With the patient in sidelying a vertically directed force is applied to the iliac crest directed towards the floor compressing the SIJs.

FABER (Flexion, Abduction/External Rotation) (1, 2)

With the patient in supine cross the same side foot over the opposite side thigh while stabilizing the opposite ASIS and apply a force on the same side knee of the patient exaggerating the motion of hip flexion, abduction and external rotation resulting in a tensile force on the anterior aspect of the SIJs.

Gaenslen (1, 2)

Wfont>ith the patient in supine near the edge of the table, the patient is asked to flex the opposite hip grasping their knee which locks the SIJ in position. The near leg is then slid of the table and an extension force is applied while a flexion force is applied simultaneously through the opposite leg resulting in a torsional stress on the SIJs.

REFERENCES

1. LeClair, L., Frank, C (November 10, 2016). The Symptomatic SI Joint: Clinical Examination, Diagnosis and Treatment. SI-BONE - Integrated Spine Care, Milwaukee, WI.
2. Laslett M. Evidence Based Diagnosis and treatement of the painful Sacroiliac Joint. J. Manip THer. 2008;16(3):142-52.
3. Robinson HS, et al. The reliability of slected motion and pain provocation tests for the sacroiliac joint, Man Ther. 2007;12:72-9.
4. Devin CJ, et al. Hip-Spine Syndrome. J Am Acad Orthop Surg. 2012;20:434-42
5. Vanelderen P, et al. Sacroiliac Joint Pain. Pain Pract. 2010 Sept-Oct; 10(5):470-8.