SI Joint Provocation Tests

Provocation SIJ Tests

SIJ testing should be done on patients with buttock pain, with or without lumbar or LE symptoms. Most SIJ is unilateral and around the PSIS. For all provocation tests, a + test is reproduction of symptoms and – test is no reproduction of symptoms.

Distraction Test

1. Distraction Test: The patient is supine the examiner applies pressure to “spread” the ASISs.

Compression Test

2. Compression Test: The patient is in a side-lying position. The tester is behind the patient with both hands applying a downward pressure through the anterior portion of the ilum, spreading the SIJ.

Thigh Thrust

3. Thigh Thrust Test:The patient is supine and the hip is flexed to 90 degrees and the knee is bent. The tester then applies a posterior shearing force to the SIJ through the femur. Avoid excessively adducting during this exam.

Gaenslens Test

4. Gaenslen’s Test (Right): The patient is supine lying near the side of table. The examiner stands on side of patients and places leg closest to them off edge of table. The examiner then instructs the patients to actively flex the opposite leg to their chest and hold.  The examiner then applies pressure to the leg handing off edge of table forcing the hip into extension.

5. Ganenslen’s Test (Left): same as #4 on opposite side.

Sacral Thrust

6. Sacral Thrust Test: The patient is prone and the examiner applies an anterior pressure through the sacrum.

• 2 out of 4 provocation tests (distraction, compression, thigh thrust or sacral thrust) have sensitivity of .88 and specificity of .78. + Likelihood ratio (LR) of 4.00 and – LR of .16 for SIJ pathology.
• 3 out of all 6 provocation have sensitivity of .94 and specificity of .78. + LR of 4.29 and – LR of .80 for SIJ pathology.

Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of Sacroiliac Joint Pain: Validity of Individual Tests and Composites of Tests. Manual Therapy. 2005: 10; 207-18.