Provocation test of the SI joint:

• These tests are applied to the clinic to check the dysfunction of the SI joint.
• These clinical tests are applied by a doctor or therapist when the patient is complaining about SI joint pain(Sacroiliitis).
• These tests are applied to the examination part of the assessment of the SI joint.

Name of the special test of the SI joint:

• Femoral shear test
• Gapping test
• Ipsilateral prone kinetic test
• Passive extension & medial rotation of ilium on the sacrum
• Passive flexion &lateral rotation of ilium on the sacrum
• Passive lateral rotation of the hip

Femoral shear test:

• Purpose = This femoral shear test is used to check the anterior-to-posterior shear stress of the SI joint.

• Technique = the patient lies in the supine position.
• The examiner slightly flexes, abducts & laterally rotates means externally rotates the patient’s thigh at approximately 45′ from the midline.
• The examiner [ therapist ] applies a graded force through the long axis of the femur, which causes anterior-to-posterior shear stress to the sacroiliac joint on the same side.

Gapping test:

• This test is used to transverse anterior or distraction provocation test.

• Purpose = This gapping test is used to check the sprain of the anterior sacroiliac ligaments.

• Technique = The patient lies supine while the examiner [ therapist ] applies crossed-arm pressure to the ASIS.
• Then the therapist [ examiner ] pushes down & out with the arms.

• Result = The test is positive only if unilateral gluteal or posterior leg pain is produced, indicating sprains of the anterior sacroiliac ligaments.

• Care must be taken when performing this test.
• The examiner’s hand pushing against the ASIS can elicit pain because the soft tissue is being compressed between the examiner’s hands & the patient’s pelvis.

Ipsilateral prone kinetic test:

• This test is designed to assess the ability of the ilium to flex & rotate laterally/posteriorly.

• Purpose = this ipsilateral prone kinetic test is used to check the hypo mobility of the posteriorly rotated ilium.

• Technique = this patient lies prone while the examiner [ therapist ] places one thumb on the PSIS & the other thumb parallel to it on the sacrum.
• Then the therapist instructs the patient is for doing actively extend the leg on the same side.

• Normally, the PSIS means posterior superior iliac spine should move superiorly & laterally.

• If it does not, it indicates hypermobility with a posteriorly rotated ilium or outflare.

Passive extension & medial rotation of ilium on the sacrum:

• Purpose = This passive extension & medial rotation of ilium on sacrum test is used to check the hypomobility & posterior rotated ilium / out flare.

• Technique = the patient is in a side-lying position for the test.
• In the side-lying position on the side that is not being tested.
• The examiner [ therapist ] places one hand over the ASIS area of the anterior ilium.
• The other hand is placed over the PSIS In such a way that the fingers of the hand palpate the posterior ilium & sacrum.
• The examiner [ therapist ] then pulls the ilium forward with the other hand over the ASIS & Pushes the posterior ilium forward with the other hand while feeling the relative movement of the ilium on the sacrum.
• The unaffected side is then tested for comparison.
• If the affected side moves less, it indicates hypomobility & a posteriorly rotated ilium, or outflare.

Passive flexion &lateral rotation of ilium on the sacrum:

• Purpose = This passive flexion &lateral rotation of ilium on sacrum test is used to check the hypomobility & anterior rotated ilium / out flare.

• Technique = The patient position of this test is the same as the passive extension & medial rotation of ilium on sacrum test.
• in this case, the examiner [ therapist ] pushes the anterior ilium backward with the anterior hand,& the posterior hand & arm pull the ilium posteriorly while palpating the relative movement.
• the unaffected side is then tested for comparison.
• if the affected side moves less, it is a sign of hypomobility & an anteriorly rotated ilium, or inflare.

• If both this test & the previously mentioned one are positive, it means a upsilp has occurred to the ilium relative to the sacrum.

Passive lateral rotation of the hip :

• The patient lies supine.
• The examiner [ therapist ] flexes the hip joint & knee joint to 90 ‘ & then laterally rotates the hip.
• This movement provided the hip is normal, stress the sacroiliac joint = SI joint on the test side.

Author: Vaishali Ladva