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