Common Provocative Tests for SI Joint Pain Diagnosis
G. â€œTyâ€� Thaiyananthan MD, FAANS: One ofthe ways that we as s can diagnose SI joint pain is to perform some maneuvers inthe called provocative test that place stress on the joint to replicate SI jointpain. Some of the more common provocative al exams for diagnosing SI joint dysfunctionresulting in SI joint pain include a Gaenslen's test. With this test is we are actually goingto have the side that's affected hanging off the edge of the table and we are goingto apply a downward force and a rotational force across the joint to see if we can replicatethe pain in that joint. Unlike the other test, this test specifically creates a rotationalforce across the joint. So, I need you to
have you come over the edge of the table andthe key to this test is really to have the joint off the edge of the table and what weare going to do is we are going to let this leg hang, so it gives us a plain where weactually rotate the joint through and I am going to bend this leg and I am going to applyforce that pushes out on this knee and down on this afflicted joint creating a rotationalforce across the joint. Do you feel pain over thaté Patient: I do. Ty: Okay. The Faber's test or flexion abductionexternal rotation test, for this test I need
to make a figure four with your leg and thiscase we are going to be testing the left side. am going to apply some pressure to your hip,on your right hip and I am going to push downwards on your left knee. It is that where you arehaving a low back pain after the side. Patient: Yes. Ty: Does it radiate down to your leg. Patient: Yes. Ty: Okay, perfect. The thigh thrust, I amgoing to have you bend your leg here, it is a same concept what we are going to do is,we are going to be applying a downward force
through your SI joint to see if this replicatesyour pain. It a constant force where we push down on your knee straight down perpendicularto the table. Do you feel thaté Patient: I do. Ty: Okay, and the compression and distractionexams. For this, I need to have you lie on your side okay we are gong to have you lieon your right side, and typically what I do is we put the afflicted side up and thereis a couple of different techniques we are doing this. We could actually do it eitherway, my preferences is to have the afflicted side up and I am going to apply a constantdownward force pushing straight down through
your SI joint to see if we can replicate thepain. Do you feel anythingé Patient: I do.Ty: Okay, perfect. The next test that we are going to do is for the converse of the compressiontest called the distraction exam, and what we are going to do is we are going to applyforce distract over the joint to see if we can replicate your pain. The concept is toapply force going outwards, so we are going to apply some force going outwards like that,does I creat pain. Patient: Yes, it does. Ty: Okay, the key with this test is the mixtureof the force is going outwards and not necessarily
pushing down. If you have at least three ofthese tests which are positive, there is a good likelihood you may be having pain thatis originating from SI joint and you may be a good candidate for some of the treatmentsthat are out there for treating SI joint dysfunction.
3 Steps to Permanent Relief for SI Joint and Pelvic Pain
Today we are going to cover the 3 steps topermanent relief for pelvic and SI joint pain. Now what is SI joint painé The SI joint, ifyou do have SI joint pain, is pain on either side of the tailbone where the tailbone connectsto the pelvis. So this is a drawing of the pelvis. This is your tailbone. This isyour lumbar spine or your lower back, the bones in your lower back called vertebraesitting on top of your tailbone. Then on either side of that you have your right hip or yourleft hip if we are looking at a person from the front. When we see somebody with SI jointpain, they will typically have pain on that given side. 70% of the time, it is on theright side. Don't ask me why that is but
70% of the time we know it is on the right. You canalso get shooting groin pain, buttocks pain and symptoms down the outside of the leg thatis affected. It might be pain, numbness, tingling, burning. Typically, that personsuffers from a heaviness as well. It can also cause some incontinence and leaking issuesas along to effect sexual performance as well. It can be absolutely devastating ifthe pelvic problem is bad enough. Fortunately, most people just have pain on one side. Sowhat can you do about ité That person who has SI joint problems typically has troublerolling over in bed, getting in and out of a car, crossing one leg over the other. Usuallythey have trouble sitting for long periods
of time especially if it is on a couch or a softsurface. So it can be absolutely devastating. Now what are the steps to permanent relieffor thaté Number 1 is this. Most people when we seethem if they are going to try exercises on their own and they only have a little bitof SI joint pain or pelvic pain, they are doing stretches. Yes, there is a very basic stretchwhich most people show me on Day 1. It is a piriformis stretch which is where you grabthe knee and pull it up and across to the opposite shoulder. It will give the personwho suffers pelvic or SI joint problems and pain temporary relief. However, long termwe don't want to stretch. We want to
strengthen or stabilize. Why is thaté Whensomebody has an SI joint problem, so the center of gravity of your entire body is inthe center of your pelvis. That needs to move the right way and it needs to be stable whenyou are doing day to day activities. If it is not stable enough, what will happen is thejoint will move so far that it becomes stuck. So if we are looking at the tailbone, we havethe tailbone and we have the pelvis and you get a normal gliding day to day. If morestress, more force is put through the pelvis than the pelvis itself can handle, that SIjoint can handle, what will happen is you actually become stuck. Now that creates allsorts of problems for the muscle around it.
What most people do is try to stretch theirway out of it. The problem is not stretching and it is not flexibility. It is actuallya stability issue. If we want to stabilize, we need to do strengthening exercises. If you go on ourYouTube channel, on the Madden PT official YouTube channel, there is a tutorialcalled Top 3 Exercises for SI Joint and Pelvic Stability. They are very low grade, kindergartenlevelexercises where you can at least begin stabilizing the muscles that controlyour pelvis. But we don't want to stretch, we want to think stabilize. Step 2 is we want to take a look at our habits.So what are some habits that lead to
pelvic instability and problemsé Number oneis standing with the weight shifted. So if I'm standing like this with my weight shiftedside to side for long periods of time, what that does is over years and years and yearsit weakens the ligaments which are tissue that hold joints together that we can't control.Think about somebody with an ankle sprain. They sprained a ligament. They stretchedthe ligament but it is not a muscle. It is different than a muscle. There are littlehabits that we do. If I stand like this and let's say I weigh 175 pounds and if I'm standinglike this, I have 150 pounds on one side and 25 pounds on the other. Where if I'm standingbalanced, I have 87 Â½ pounds on each