There are five provocation tests commonly used to assess for Sacroiliac (SI) joint dysfunction: Gaenslen's test, thigh thrust, distraction, compression, and sacral thrust.
Understanding SI Joint Dysfunction and Provocation Tests
Sacroiliac (SI) joint dysfunction refers to pain in the lower back or buttocks caused by problems in the SI joint, which connects the sacrum and the pelvis. These joints are crucial for supporting the body and transferring weight between the upper and lower body. Provocation tests are physical maneuvers designed to stress the SI joint and reproduce pain if dysfunction exists.
The 5 Provocation Tests for SI Dysfunction
These tests are part of a clinical decision rule that requires at least three positive tests out of five to suggest SI joint dysfunction.
| Test | Description | Positive Result |
|---|---|---|
| Gaenslen's Test | The patient lies supine with one leg hanging off the table while the other leg is flexed towards the chest, stressing the SI joint. | Pain localized at the SI joint. |
| Thigh Thrust | The patient lies supine with one hip flexed to 90 degrees. The examiner applies an axial force through the femur, stressing the SI joint. | Reproduction of SI pain. |
| Distraction Test | The patient lies supine. The examiner applies a lateral force to both ASIS (Anterior Superior Iliac Spine) bones, gapping the SI joints. | Pain in the SI joint. |
| Compression Test | The patient lies on their side. The examiner applies a downward pressure on the iliac crest, compressing the SI joint. | Pain at the SI joint. |
| Sacral Thrust | The patient lies prone. The examiner applies a downward force to the sacrum, stressing the SI joint. | Pain that is localized at the SI joint. |
Clinical Relevance of the 5 Tests
These tests are commonly used by physical therapists, chiropractors, and other healthcare professionals in the diagnosis of SI joint dysfunction. A positive result on at least three of the five tests will increase the probability of SI joint pain.
Confirmation of SI Joint Pain
Although these provocation tests are helpful, the confirmation of SI joint pain is ideally done with an image-guided anesthetic block of the SI joint. This technique will help to ensure the pain is specifically originating from the SI joint itself.
When to Suspect SI Joint Dysfunction
- Lower back pain that worsens with prolonged sitting or standing.
- Pain that radiates into the buttocks, groin, or thigh.
- Pain that feels like a deep ache.
- Pain that may be associated with clicking or popping in the SI joint.
Example
If a patient reports lower back and buttock pain, and during examination, they experience pain during the Gaenslen's test, the thigh thrust, and the compression test, this clinical decision rule would indicate a higher likelihood of SI joint dysfunction.
