SIJ:
● Roles: provide stability and offset the load of the trunk on the lower limbs
● Movements occur as sacrum, innominates or innominates + sacrum
● Nutation: sacrum rotated forward relative to the ilia (innominates)
● Counternutation: sacrum rotated backwards relative to the iliac bones
● Form closure: the fit of the wedge-shaped sacrum between the ilia
● Force closure: the compressive force of muscles and ligaments
Sacroiliac Joint Dysfunction:
● Pain at SIJ caused by abnormal motion (hyper or hypo mobility) or malalignment of
the SIJ.
● Difficult to distinguish from other types of LBP.
● NB to rule out LBP and hip pathologies.
● Symptoms:
○ Localised pain over buttock
○ Sharp, stabbing and/or shooting pain which radiates down posterior thigh
(above knee)
○ Pain may mimic + be misdiagnosed as radicular pain (pinched nerve)
○ Pain with prolonged sitting
○ Local tenderness of posterior aspect of the SIJ – near the PSIS
○ Pain with mechanical stress of SIJ (e.g. forward flexion)
○ Absence of neuro deficit/ nerve root tension signs
○ Abnormal sacroiliac movement pattern
○ Pain with sitting/ ipsilateral side lying/ climbing stairs
, Sacroiliac Joint Provocation Tests:
Gillet’s test (Stork test):
● Pt flexes hip to 90
● Palpate both PSIS – shld be same level as ● Normal: PSIS drops below S2
S2 ● Dysfunctional (blocked or hypomobile): min or
● Palpate S2 and R SIJ w/ each thumb no drop of PSIS
Standing flexion: SI dysfunction
● Pt standing palpate BL PSIS ● Evaluate whether the movt of both PSIS are
● Ask pt to bend forward towards the midline symmetrical
● Normal: expect counter nutation at 60* of flex –
at that point the PSIS start to travel upwards
● Positive: side that PSIS moves further cranially
(hypomobility – less nutation btw sacrum and
ilium)
Compression test
Side-lying: Supine:
● Lie on asymptomatic side ● Tests: SI dysfunction and ligamentous
● Hips flexed to 45* instability
● Place hands on ant rim of ilium ● Fix of BL ASIS
● Apply 3-6 vertical thrusts of moderate velocity ● Direct oblique medial force through the ilia
of gradually increasing pressure ● Positive: reproduction of pain
● Roles: provide stability and offset the load of the trunk on the lower limbs
● Movements occur as sacrum, innominates or innominates + sacrum
● Nutation: sacrum rotated forward relative to the ilia (innominates)
● Counternutation: sacrum rotated backwards relative to the iliac bones
● Form closure: the fit of the wedge-shaped sacrum between the ilia
● Force closure: the compressive force of muscles and ligaments
Sacroiliac Joint Dysfunction:
● Pain at SIJ caused by abnormal motion (hyper or hypo mobility) or malalignment of
the SIJ.
● Difficult to distinguish from other types of LBP.
● NB to rule out LBP and hip pathologies.
● Symptoms:
○ Localised pain over buttock
○ Sharp, stabbing and/or shooting pain which radiates down posterior thigh
(above knee)
○ Pain may mimic + be misdiagnosed as radicular pain (pinched nerve)
○ Pain with prolonged sitting
○ Local tenderness of posterior aspect of the SIJ – near the PSIS
○ Pain with mechanical stress of SIJ (e.g. forward flexion)
○ Absence of neuro deficit/ nerve root tension signs
○ Abnormal sacroiliac movement pattern
○ Pain with sitting/ ipsilateral side lying/ climbing stairs
, Sacroiliac Joint Provocation Tests:
Gillet’s test (Stork test):
● Pt flexes hip to 90
● Palpate both PSIS – shld be same level as ● Normal: PSIS drops below S2
S2 ● Dysfunctional (blocked or hypomobile): min or
● Palpate S2 and R SIJ w/ each thumb no drop of PSIS
Standing flexion: SI dysfunction
● Pt standing palpate BL PSIS ● Evaluate whether the movt of both PSIS are
● Ask pt to bend forward towards the midline symmetrical
● Normal: expect counter nutation at 60* of flex –
at that point the PSIS start to travel upwards
● Positive: side that PSIS moves further cranially
(hypomobility – less nutation btw sacrum and
ilium)
Compression test
Side-lying: Supine:
● Lie on asymptomatic side ● Tests: SI dysfunction and ligamentous
● Hips flexed to 45* instability
● Place hands on ant rim of ilium ● Fix of BL ASIS
● Apply 3-6 vertical thrusts of moderate velocity ● Direct oblique medial force through the ilia
of gradually increasing pressure ● Positive: reproduction of pain
