Special Tests: Sacroiliac Joint (SIJ)

Special Tests Covered in this Course

• Laslett's Cluster II: Sacroiliac Joint Pain Test-item Cluster
  • Sacral Thrust Test
  • Compression Test
  • Distraction Test
  • Thigh Thrust Test
  • Gaenslen's Test
• Additional Pain Provocation Tests (not included in test):
  • Mennel's Test
  • FABER (Patrick's) Test
• Additional Pain Provocation Cluster
  • Van der Wurff et al.
• Motion Assessment
  • Stork/Gillet Test
  • Brookbush/Grieve Cluster
    • Appendix: Research Review on SIJ Movement Assessment

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:

• Overhead Squat Assessment (OHSA) : Stiff SIJ on the side opposite of an asymmetrical shift with "heel rise"
  • "Top tier exam" used to identify asymmetry and imply further SIJ assessment
• Unilateral Pelvic Tilt: Posterior tilted innominate correlated with stiffer side
• Gillet Test : Less motion on the stiffer side
• Hip Rotation Range of Motion : Less motion on the stiffer side

Treat:

• Mobilize or Manipulate : Hypomobile SIJ (Side)
• Glute Activation : Hypermobile SIJ (Side)

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

• Special Tests: Sacroiliac Joint (SIJ)
• Special Tests: Hip Joint
• Special Tests: Lower Body Neurodynamic Tests

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

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3. Magee, D. J. (2013). Orthopedic physical assessment. Elsevier Health Sciences.
   • Sacrul Thrust
4. Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.
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   • Compression Test (1 - 7)
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    • Distraction Test (1-8, 11-14)
    • Thigh Thrust Test (1-7, 9, 12)
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    • Gaenslen's Test (1-5, 7, 9, 18)
    • Laslett's Cluster II
22. Laslett, M., Young, S. B., Aprill, C. N., & McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Australian Journal of Physiotherapy, 49(2), 89-97.
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    • Stork Test
24. Hungerford, B. A., Gilleard, W., Moran, M., & Emmerson, C. (2007). Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork test on the support side. Physical Therapy, 87(7), 879-887.
    • Injection demonstrates contribution of SIJ to low back pain
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    • Sacroiliac Joint Motion
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36. Sturesson, B., Uden, A., & Vleeming, A. (2000). A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine, 25(3), 364-368.
37. Sturesson, B., Uden, A., & Vleeming, A. (2000). A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine, 25(2), 214.
    • Comparison
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    • Motion and Dysfunction
40. Kibsgård, T. J., Röhrl, S. M., Røise, O., Sturesson, B., & Stuge, B. (2017). Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clinical Biomechanics, 47, 40-45.
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    • Changes in Motion Following Manipulation:
48. Tullberg, T., Blomberg, S., Branth, B., & Johnsson, R. (1998). Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 23(10), 1124-1128.
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50. de Toledo, D. D. F. A., Kochem, F. B., & Silva, J. G. (2019). High-velocity, low-amplitude manipulation (HVLA) does not alter three-dimensional position of sacroiliac joint in healthy men: A quasi-experimental study. Journal of Bodywork and Movement Therapies.
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    • Testing
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62. Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.
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