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.