SI Joint Provocative Tests
Diagnosis of SI joint dysfunction and/or inflammation can be challenging because the symptoms may mimic symptoms of problems in other parts of the body, such as with the lower part of the spine. As a result, many patients seeking low back pain relief do not receive the therapy they need. That’s why proper diagnosis is crucial and can include manual provocative tests designed to gauge the scope and degree of SI joint pain.
After your physician has taken your medical history, reviewed your diagnostic images (MRI, CT, X-rays, etc.), and performed a general back pain exam to rule out red flags or other potential causes for your pain, the next step is to perform a series of SI Joint specific exams or provocative tests.
The purpose of provocative tests is to reproduce, or provoke, the pain that is being experienced as a result of the suspected SI joint dysfunction. A confirmed SI joint dysfunction diagnosis is typically achieved when at least three or more of the provocative tests are positive, meaning they succeed in reproducing the same pain you are experiencing. Of these positive tests, at least one should be compression or thigh thrust.
FABER Provocative Test
The FABER exam applies tension to the front (medically referred to as anterior) parts of the SI joints. During this exam, you will lay on your back, facing up. The physician will bring the foot on your affected side across your body to rest on your opposite knee. Your physician will then place a hand on the opposite hip bone (iliac crest) while applying a downward force to the knee and away from the body’s midline.
Compression Provocative Test
This test applies compression across the SI joints. During this provocative test, you will lie on on the side of the body that is not exhibiting the pain symptoms. The painful side will be closest to the physician, with both hips and knees flexed. Once in the appropriate position, the physician will stand behind you and with both hands, push downward on the hip bone (front side of the iliac crest), towards the floor. This provocative test creates pressure across the pelvis, thus compressing the SI Joints.
Thigh Thrust Provocative Test
This exam applies a sliding/shearing to the SI joint. During this test you will lie flat on your back. Your physician may place a hand underneath your sacrum for support. You will be instructed to extend your unaffected leg up, with the knee bent at a 90 degree angle. The physician will then stand next to the side that is affected by the pain and will flex that leg at the hip into an angle of approximately 90 degrees, with a slight adduction and light pressure
on the bent knee.
Distraction Provocative Test
This provocative test also calls for you to be lying with your back flat on the exam table, with your legs extended flat as well. Your physician will then apply outward pressure to each of the hips while pushing down and back towards the base of the spine. This movement is designed to “distract”, or stretch apart, the SI Joint.
Gaenslen Provocative Test
This test begins with you lying on your back on the exam table, with the painful side closest to the table’s edge. The leg on the non-painful side is bent at the hip and the knee is pressed towards the chest. Pressure is then applied so that the knee is pushing against the abdomen. The physician then applies a light downward pressure on the knee of the affected leg.
If three or more of the SI Joint provocative tests used to identify SI joint pain are able to reproduce the pain and one or more of them are a compression or thigh thrust exam, then the physician is closer to a diagnosis of SI joint dysfunction. To further confirm the suspicion of an SI joint as a pain source, you may also receive a diagnostic SI joint injection.
Low back pain can be debilitating and has a number of potential causes. In over 20 percent of patients suffering from chronic low back pain, the cause is a problem with the sacroiliac joint. For this reason, it is extremely important that your pain be evaluated by a physician trained in recognizing and treating SI Joint Dysfunction. With a proper and thorough examination, including the provocative tests highlighted here, your spine specialist can help get to the bottom of what’s causing your pain.