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Sacroiliac Joint Special Test: Sacral Thrust, Compression and Distraction Tests

Learn how to perform Sacroiliac Joint Special Tests, including Sacral Thrust, Compression, and Distraction Tests. Improve your skills with helpful tips from an experienced physical therapist. Perfect for PT students and clinicians.

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00:04 - 00:07This is Brent of the Brookbush Institute in this video we're going to go over three
00:07 - 00:11special orthopedic tests for the sacroiliac joint pain. We're going to go
00:11 - 00:15over the sacral thrust test, the compression test, and the distraction
00:15 - 00:18test which is sometimes referred to as the anterior sacroiliac joint stress
00:18 - 00:21test. I think we'll just keep calling it the distraction test since that's a lot
00:21 - 00:25easier to say. I think you'll see why we put these three tests together they're
00:25 - 00:29all very similar in protocol. I'm going to have my friend Melissa come out she's
00:29 - 00:32going to help me demonstrate. Now I'm going to have Melissa go ahead and start face
00:32 - 00:36down, and the sacral thrust test is exactly what it sounds like. It is a
00:36 - 00:42thrust to the sacral base. It actually looks a lot like a posterior to anterior
00:42 - 00:47sacroiliac joint mobilization. So if you want a little bit more coaching on hand
00:47 - 00:51position, palpations, how to set your body up and your patient
00:51 - 00:55up a little bit better, I would recommend going ahead and watching our video on
00:55 - 00:59sacroiliac joint mobilization, that'll make this test seem really really easy.
00:59 - 01:05Now just a quick recap on palpations, you want to be able to find the posterior
01:05 - 01:10superior iliac spine, and what I like to do is kind of come from the iliac crests,
01:10 - 01:15work my way down and then find the bottom corner of the PSIS, so I have one
01:15 - 01:19distinct point I'm going after. You know your PSIS has a little bit of breadth
01:19 - 01:23to it, once I find that I'm going to fall off immediately medially, alright so
01:23 - 01:29just fall right into that little gap that's created after the PSIS as we
01:29 - 01:33fall into the sacral base there, that's the S2, S3 segment. So now I know
01:33 - 01:36I'm right in the middle of my sacroiliac joint, which is where we want to be for
01:36 - 01:41this test. Now I'm going to go ahead and put my pisiform over the top of that, and now
01:41 - 01:46I can apply my posterior to anterior pressure. Now textbooks at this point
01:46 - 01:51usually say do five or six thrusts, I don't really like to start with thrusts.
01:51 - 01:54I think you're asking for a little bit of trouble if somebody has for example,
01:54 - 02:00some lumbar spine pathology, or they are very flared up or very sensitive and you
02:00 - 02:04start pushing down with thrusts you could scare them right off the table.
02:04 - 02:07What we're going to do is we're going to start with just a little bit of pressure just
02:07 - 02:11like we're going to do a mobilization. Once I find a little bit of pressure I want
02:11 - 02:14to communicate with my patient or client, hey Melissa is that okay,
02:14 - 02:17that's not provoking any of your symptoms?
02:17 - 02:22Good and once I know I'm comfortable and I know that she's not going to get any sort
02:22 - 02:27of flare-up from this, essentially to clear it and to actually do the sacral
02:27 - 02:31thrust test itself. Now I'm going to apply my five or six thrusts and I'm going to
02:31 - 02:35think just like I would for a manipulation. Low amplitude all right so
02:35 - 02:40we're not going to move very much but it's going to be very quick bursts. So
02:40 - 02:45I get myself set up, my chest is over and over her sacrum, my arms are nice and
02:45 - 02:51straight, and I'm going to go one, two, three, four, five, hey Melissa
02:51 - 02:55did that provoke any of your symptoms, and if that didn't provoke her symptoms
02:55 - 03:00we're probably in pretty good shape. Although I do have to admit with all of
03:00 - 03:04these three tests and I'll wrap this up at the end, specificity is pretty good
03:04 - 03:06right we know if the any of these tests are positive they're probably coming
03:06 - 03:10from the SI joint. Unfortunately sensitivity is not great,
03:10 - 03:13so they don't always pick things up. Let's go ahead and have you lay on your
03:13 - 03:19side let's do the compression test. Now the compression test again we're
03:19 - 03:24applying pressure to the sacroiliac joint, only this way or this time rather
03:24 - 03:30we're going to do this by okay she has her pelvis, her sacrum, her other
03:30 - 03:33pelvis and we're going to squish them together like we're squishing a sandwich
03:33 - 03:37together. The way I'm going to do that is I'm going to use one hand to cup
03:37 - 03:42the top of her top iliac crest, I'm then going to put the other hand on top of it
03:42 - 03:47and you have to apply a significant amount of force, like it can't just be
03:47 - 03:52like me like trying to do a tricep press down, like that's not going to work. Here's
03:52 - 03:56what I recommend, make a nice broad base, apply some pressure, make sure your
03:56 - 03:59patient or client is comfortable, alright so Melissa looks comfortable with my
03:59 - 04:03hand there. I'm going to put my other hand over it and then what I'm going to do is
04:03 - 04:07just lean right down on top of her. Alright so now I have the whole weight of
04:07 - 04:12my torso, we're then going to hold this for 30 seconds right and it's got to be a
04:12 - 04:17lot of pressure. I know this is not comfortable but does it provoke your
04:17 - 04:23symptoms, and that's always the right question, like you don't want
04:23 - 04:26to ask is this uncomfortable, is this painful. Yeah it's uncomfortable I'm
04:26 - 04:31laying on top of her pelvis, like that's not going to be comfortable for anybody,
04:31 - 04:35and then if you wanted to clear this you could add some vigorous force.
04:35 - 04:41No provocation of symptoms, alright just to essentially clear the joint, so
04:41 - 04:47we saw 30 seconds of compression no symptoms, vigorous force no symptoms.
04:47 - 04:52She's definitely clear this is definitely a negative compression test.
04:52 - 04:56So so far we've done the sacral thrust which looks like a sacroiliac joint PA
04:56 - 04:59and we've done the compression test, which essentially takes her pelvis and
04:59 - 05:04squishes it like a sandwich. Now we have the distraction test.
05:04 - 05:07Alright so Melissa's going to flip on her back. This is the one that I said is also
05:07 - 05:13called the anterior sacroiliac joint stress test, distractions a lot easier to
05:13 - 05:17say. This one's a little tougher to get your hands in the right position so
05:17 - 05:21you're going to need to kind of communicate with your client here, and
05:21 - 05:24what you're going to do is you're actually going to cross your arms this
05:24 - 05:30way, you're going to put your hands and this is the hard part, you got to try to
05:30 - 05:35get their ASIS in the softest part of your hand so that you can apply some
05:35 - 05:43pressure without any pain. How's that? It's not going to be comfortable guys, but
05:43 - 05:46you got to find the least uncomfortable one the one that's not like jabbing the
05:46 - 05:51bones, their ASIS bones right into their skin. So once you find that
05:51 - 05:57place then you can start pressing down, and because your arms are crossed you're
05:57 - 06:02actually doing distraction of her ASIS a little bit, and what this is supposed to
06:02 - 06:07be doing is gapping the anterior portion of her sacroiliac joint while
06:07 - 06:11compressing the posterior aspect of her sacroiliac joint. So we know if
06:11 - 06:16there are certain types of sacroiliac joint problems for example a strain to
06:16 - 06:21the anterior ligaments, this will provoke those particular symptoms. So
06:21 - 06:26I'm going to start here and we got to hold this for 30 seconds so as to try to get
06:26 - 06:29into a position that's both comfortable for you and them, or at least as
06:29 - 06:34comfortable as you can. Again adjust your hands if you need to and then of course
06:34 - 06:40we're going to clear this once I know she's okay, no symptoms, with a little bit of
06:40 - 06:44vigorous force, right and you could do that vigorous force a few times.
06:44 - 06:49So with all these test you'll see in books a couple of them say hold for
06:49 - 06:5330 seconds, a couple of them say vigorous force, a couple of them say use a thrust.
06:53 - 06:57Generally in the back of my mind for all three of these tests I'm thinking okay
06:57 - 07:03is pressure enough to provoke symptoms, is holding pressure enough to provoke
07:03 - 07:08symptoms or is a thrust enough to provoke symptoms. If any of those are
07:08 - 07:12positive then this is a positive test. If I can get through all three of those and
07:12 - 07:16there's no symptoms, there's no concordance sign right that does not
07:16 - 07:22provoke the complaints that she came in with, then they're negative, right all of
07:22 - 07:26these tests are negative. Thank you Melissa, Now one thing we do have to
07:26 - 07:33mention with these tests, the sacroiliac joint tests are fairly specific, meaning
07:33 - 07:39if you get positives on these tests chances are it is a sacroiliac joint
07:39 - 07:44problem. The only problem with all sacroiliac joint tests seemingly is that
07:44 - 07:48they're not particularly sensitive so people fall through the cracks,
07:48 - 07:54people with sacroiliac joint dysfunction can also end up being negative to these
07:54 - 07:59tests. So how are we going to kind of fix that problem, well we're going to use these
07:59 - 08:06three tests often together, and we're also going to add a few more tests which
08:06 - 08:12we'll talk about later in future videos on sacroiliac joint pain clusters. I hope
08:12 - 08:16you enjoyed this video, if you have any questions please leave them in the
08:16 - 08:18comments below.

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