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Continuing Education1 Credit

Special Tests: Sacroiliac Joint (SIJ)

Special tests for the sacroiliac joint (SIJ). The Sacral Thrust Test, Compression Test, Distraction Test, Thigh Thrust Test, Gaenslen's Test, the Stork/Gillet Test (Laslett's Cluster II: Sacroiliac joint pain test-item Cluster), and the FABERs (Patrick) Test. The reliability, specificity, sensitivity, validity, safety, and screening for sacroiliac joint (SIJ) pathology, sacroiliac joint pain, pelvic fracture, and SI joint stiffness.

Course Description: Special Tests: Sacroiliac Joint

Special Tests Covered in this Course

Sacroiliac joint dysfunction (a.k.a. SIJD, SI joint dysfunction, SI joint syndrome, SI joint pain) may result from movement impairment, acute injury, or trauma, and is often mistaken for lower back pain or develops concurrently with lower back pain. Due to controversy regarding the amount of motion that occurs at the SI joint, and the relative strength of the ligaments and connective tissue that support these joints, conservative treatment options are often dismissed. It is common that patients and clients will not receive treatment for symptoms until they are complaining of chronic pain; for example, nerve (e.g. "patient complains of pinched nerve"), ligament (e.g. pain with forward bending), or connective tissue (e.g. continuous dull ache) inflammation. Most often, clinical movement professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are the safest and most effective option for pain relief (e.g. manual therapy, certain modalities, and corrective exercise).

Special Note on SIJ Special Tests:

Most palpation, motion, and position assessments for the sacroiliac joint (SIJ) have questionable reliability. However, research has demonstrated that Laslett's Cluster II: Sacroiliac Joint Pain Test-item Cluster is reliable and accurate for diagnosing the sacroiliac joint as a source of pain (4, 5, 22, 23). It is worth noting that SIJ pain provocation tests are more specific than sensitive (4 - 21), indicating a positive result carries more weight than a negative result. In summary, a positive result using Laslett's Cluster II is strongly indicative that pain is originating from SIJ dysfunction.

A review of SIJ movement assessment research is included in this course. The intent of the review is the suggestion of a possible cluster for identifying dysfunctional/altered motion. The research has demonstrated that the Gillet Test is reliable when confined to a narrow set of findings (24), and one observational study by Grieve et al. (70) demonstrated good reliability and accuracy from a grouping of findings. Additional refinements to the Grieve et. al grouping can be made based on additional research and may imply a useful SIJ movement assessment cluster.

Brookbush Institute Recommendation:

The Brookbush Institute recommends that all clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are aware of Laslett's Cluster II: Sacroiliac Joint Pain Test-item Cluster . However, in practice, pain provocation has little utility for improving clinical decision-making and refining intervention selection. In practice, the Brookbush Institute recommends evidence-based modifications to the Grieve et al. cluster to determine the less and more mobile sides, and to treat the SIJ according to their relative stiffness (mobilize/manipulate the stiff side, glute activation on the more mobile side). 

Brookbush/Grieve (70) Recommended Cluster:

Assess:

Treat:

For an Introduction to Special Tests

  • For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:
  • Special Tests: Introduction

Courses covering Special Tests for the Lumbo Pelvic Hip Complex

Introduction

Sacral Thrust, Compression, and Distraction

Sacroiliac Joint Motion (SIJ) Exam

Research Review for the Development of a Movement Cluster

Bibliography

Copyright

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