For Providers
SI Joint Exam: Provocative Tests
Provocative tests are a commonly used method for healthcare professionals to determine whether pain is originating from the SI joint. The maneuvers are used to isolate the SI joint as the source of pain.
Provocative Tests: General Testing Comments
- For a test to be positive, it must reproduce the patient’s typical pain in their SI joint region.
- While 1 positive test raises suspicion, 3 or more positive tests would indicate the SI joint as a pain generator.
- The Laslett study indicates that 3 or more positive provocative tests give 91% sensitivity and 78% specificity.1 The Szadek study indicated the thigh thrust and the compression tests both have good singular diagnostic validity.2
Distraction
Applies tensile forces on the anterior aspect of the SI joints
- The patient lies supine and is asked to place their forearm under their lower back to maintain lordosis and to support the lumbar spine. A pillow is placed under the patient’s knees. The examiner places their hands on the anterior and medial aspects of the patient’s left and right ASIS with arms crossed and elbows straight.
- A slow and steady posterior force is applied by leaning down toward the patient.
Thigh Thrust
Applies anteroposterior shear stress on the SI joint
- The patient lies supine with affected side hip flexed to 90 degrees. The pelvis is stabilized at the opposite ASIS with the hand of the examiner.
- The examiner stands on the same side as the flexed leg. The examiner provides steady increasing pressure through the axis of the femur.
FABER: Flexion, Abduction, External Rotation
Applies tensile force on the anterior aspect of the SI joint on the side tested
- The patient lies supine as the examiner crosses the affected-side foot over the opposite-side thigh. The pelvis is stabilized at the opposite ASIS with the hand of the examiner.
- A gentle downward force is applied to the affected-side knee of the patient and is steadily increased, exaggerating the motion of hip flexion, abduction, and external rotation.
Compression
Applies compression force across the SI joints
- The patient is placed in a side-lying position, with the affected side up, facing away from the examiner, with a pillow between the knees.
- The examiner places a steady downward pressure through the anterior aspect of the lateral ilium, between the greater trochanter and iliac crest.
Gaenslen's
Applies torsional stress on the SI joints
- The patient lies supine with the affected side leg near the edge of the table. For safety, the patient’s shoulders are positioned toward the middle of the table.
- The patient then draws the non-affected side leg into full flexion and holds the flexed knee. The examiner stabilizes the leg with their hand placed over the patient’s hand. This action keeps the ilium on the non-tested side in a slightly posterior and stable position during the maneuver.
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