0:04 This is Brent of the Brookbush Institute in this video we're going to go over three 0:07 special orthopedic tests for the sacroiliac joint pain. We're going to go 0:11 over the sacral thrust test, the compression test, and the distraction 0:15 test which is sometimes referred to as the anterior sacroiliac joint stress 0:18 test. I think we'll just keep calling it the distraction test since that's a lot 0:21 easier to say. I think you'll see why we put these three tests together they're 0:25 all very similar in protocol. I'm going to have my friend Melissa come out she's 0:29 going to help me demonstrate. Now I'm going to have Melissa go ahead and start face 0:32 down, and the sacral thrust test is exactly what it sounds like. It is a 0:36 thrust to the sacral base. It actually looks a lot like a posterior to anterior 0:42 sacroiliac joint mobilization. So if you want a little bit more coaching on hand 0:47 position, palpations, how to set your body up and your patient 0:51 up a little bit better, I would recommend going ahead and watching our video on 0:55 sacroiliac joint mobilization, that'll make this test seem really really easy. 0:59 Now just a quick recap on palpations, you want to be able to find the posterior 1:05 superior iliac spine, and what I like to do is kind of come from the iliac crests, 1:10 work my way down and then find the bottom corner of the PSIS, so I have one 1:15 distinct point I'm going after. You know your PSIS has a little bit of breadth 1:19 to it, once I find that I'm going to fall off immediately medially, alright so 1:23 just fall right into that little gap that's created after the PSIS as we 1:29 fall into the sacral base there, that's the S2, S3 segment. So now I know 1:33 I'm right in the middle of my sacroiliac joint, which is where we want to be for 1:36 this test. Now I'm going to go ahead and put my pisiform over the top of that, and now 1:41 I can apply my posterior to anterior pressure. Now textbooks at this point 1:46 usually say do five or six thrusts, I don't really like to start with thrusts. 1:51 I think you're asking for a little bit of trouble if somebody has for example, 1:54 some lumbar spine pathology, or they are very flared up or very sensitive and you 2:00 start pushing down with thrusts you could scare them right off the table. 2:04 What we're going to do is we're going to start with just a little bit of pressure just 2:07 like we're going to do a mobilization. Once I find a little bit of pressure I want 2:11 to communicate with my patient or client, hey Melissa is that okay, 2:14 that's not provoking any of your symptoms? 2:17 Good and once I know I'm comfortable and I know that she's not going to get any sort 2:22 of flare-up from this, essentially to clear it and to actually do the sacral 2:27 thrust test itself. Now I'm going to apply my five or six thrusts and I'm going to 2:31 think just like I would for a manipulation. Low amplitude all right so 2:35 we're not going to move very much but it's going to be very quick bursts. So 2:40 I get myself set up, my chest is over and over her sacrum, my arms are nice and 2:45 straight, and I'm going to go one, two, three, four, five, hey Melissa 2:51 did that provoke any of your symptoms, and if that didn't provoke her symptoms 2:55 we're probably in pretty good shape. Although I do have to admit with all of 3:00 these three tests and I'll wrap this up at the end, specificity is pretty good 3:04 right we know if the any of these tests are positive they're probably coming 3:06 from the SI joint. Unfortunately sensitivity is not great, 3:10 so they don't always pick things up. Let's go ahead and have you lay on your 3:13 side let's do the compression test. Now the compression test again we're 3:19 applying pressure to the sacroiliac joint, only this way or this time rather 3:24 we're going to do this by okay she has her pelvis, her sacrum, her other 3:30 pelvis and we're going to squish them together like we're squishing a sandwich 3:33 together. The way I'm going to do that is I'm going to use one hand to cup 3:37 the top of her top iliac crest, I'm then going to put the other hand on top of it 3:42 and you have to apply a significant amount of force, like it can't just be 3:47 like me like trying to do a tricep press down, like that's not going to work. Here's 3:52 what I recommend, make a nice broad base, apply some pressure, make sure your 3:56 patient or client is comfortable, alright so Melissa looks comfortable with my 3:59 hand there. I'm going to put my other hand over it and then what I'm going to do is 4:03 just lean right down on top of her. Alright so now I have the whole weight of 4:07 my torso, we're then going to hold this for 30 seconds right and it's got to be a 4:12 lot of pressure. I know this is not comfortable but does it provoke your 4:17 symptoms, and that's always the right question, like you don't want 4:23 to ask is this uncomfortable, is this painful. Yeah it's uncomfortable I'm 4:26 laying on top of her pelvis, like that's not going to be comfortable for anybody, 4:31 and then if you wanted to clear this you could add some vigorous force. 4:35 No provocation of symptoms, alright just to essentially clear the joint, so 4:41 we saw 30 seconds of compression no symptoms, vigorous force no symptoms. 4:47 She's definitely clear this is definitely a negative compression test. 4:52 So so far we've done the sacral thrust which looks like a sacroiliac joint PA 4:56 and we've done the compression test, which essentially takes her pelvis and 4:59 squishes it like a sandwich. Now we have the distraction test. 5:04 Alright so Melissa's going to flip on her back. This is the one that I said is also 5:07 called the anterior sacroiliac joint stress test, distractions a lot easier to 5:13 say. This one's a little tougher to get your hands in the right position so 5:17 you're going to need to kind of communicate with your client here, and 5:21 what you're going to do is you're actually going to cross your arms this 5:24 way, you're going to put your hands and this is the hard part, you got to try to 5:30 get their ASIS in the softest part of your hand so that you can apply some 5:35 pressure without any pain. How's that? It's not going to be comfortable guys, but 5:43 you got to find the least uncomfortable one the one that's not like jabbing the 5:46 bones, their ASIS bones right into their skin. So once you find that 5:51 place then you can start pressing down, and because your arms are crossed you're 5:57 actually doing distraction of her ASIS a little bit, and what this is supposed to 6:02 be doing is gapping the anterior portion of her sacroiliac joint while 6:07 compressing the posterior aspect of her sacroiliac joint. So we know if 6:11 there are certain types of sacroiliac joint problems for example a strain to 6:16 the anterior ligaments, this will provoke those particular symptoms. So 6:21 I'm going to start here and we got to hold this for 30 seconds so as to try to get 6:26 into a position that's both comfortable for you and them, or at least as 6:29 comfortable as you can. Again adjust your hands if you need to and then of course 6:34 we're going to clear this once I know she's okay, no symptoms, with a little bit of 6:40 vigorous force, right and you could do that vigorous force a few times. 6:44 So with all these test you'll see in books a couple of them say hold for 6:49 30 seconds, a couple of them say vigorous force, a couple of them say use a thrust. 6:53 Generally in the back of my mind for all three of these tests I'm thinking okay 6:57 is pressure enough to provoke symptoms, is holding pressure enough to provoke 7:03 symptoms or is a thrust enough to provoke symptoms. If any of those are 7:08 positive then this is a positive test. If I can get through all three of those and 7:12 there's no symptoms, there's no concordance sign right that does not 7:16 provoke the complaints that she came in with, then they're negative, right all of 7:22 these tests are negative. Thank you Melissa, Now one thing we do have to 7:26 mention with these tests, the sacroiliac joint tests are fairly specific, meaning 7:33 if you get positives on these tests chances are it is a sacroiliac joint 7:39 problem. The only problem with all sacroiliac joint tests seemingly is that 7:44 they're not particularly sensitive so people fall through the cracks, 7:48 people with sacroiliac joint dysfunction can also end up being negative to these 7:54 tests. So how are we going to kind of fix that problem, well we're going to use these 7:59 three tests often together, and we're also going to add a few more tests which 8:06 we'll talk about later in future videos on sacroiliac joint pain clusters. I hope 8:12 you enjoyed this video, if you have any questions please leave them in the 8:16 comments below.
