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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