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.

4 replies »

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  2. The study by Laslett et al 2005 does indeed show statistical significance but what about the clinical significance. Provoking pain in the SIJ or any other joint structure tells us nothing about the structures involved or the cause; if we adopt this type of model to our practice then all we would do is inject painful structures with the false perception that we have actually identified the correct source of the problem.
    And what happens when the pain block or cortisone has worn off, do we just inject it again?

    The following are some issues to consider with the pain provocation tests:
    1. How can you be certain that when you apply the compressive force that it is the joint that your are provoking pain from and not other extra-articular structures?
    2. Elimination of pain by guided injection is not a defence. Guided injections are not the ‘gold standard’ they are made out to be. Even the original authors make mention of this as have others.
    3. The provocative tests do not achieve what they are supposed to achieve which is to identify pain originating from the SIJ with the exclusion of pain from any other sites in the region.
    4. The posterior aspect of the SIJ may be vulnerable from compressive forces due to the presence of clear anatomical structures such as the dorsal rami of the sacral plexus, could this possibly be the cause of positive test findings?

    For a more clear. concise argument have a look at: McGrath C, International Journal of Osteopathic Medicine (2010): Composite sacroiliac joint pain provocation tests: A question of clinical significance.

    A more balanced debate would acknowledge that this approach does have some issues that need to be addressed. Much work has gone on since the original article/study by Laslett & his group on developing an understanding of pelvic stability based on the anatomy and biomechanics. The form-force closure conceptual model (as proposed by Andre Vleeming and many others) does face up pretty well to scientific scrutiny. I’m interested to see what comes out of the forthcoming World Congress on Low Back & Pelvic pain in Dubai, no doubt there will be some strong arguments been put forward on this topic.

    Regards
    Taso Lambridis

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