Sacroiliac Compression Test

What is a sacroiliac lesion?

The sacrum is a triangular bone at the base of the spine, wedged between the two halves of the pelvis (ilium) at the sacroiliac (SI) joints. These joints play a crucial role in transferring weight and forces between the upper body and legs, and in providing stability to the pelvis. The SI joints are supported by a network of strong ligaments and surrounded by complex muscle groups that help in maintaining joint stability and alignment.

An SI lesion generally refers to any injury or dysfunction within the SI joint. This term can encompass various conditions affecting the joint such as sacroiliitis, which is the inflammation of the sacroiliac joints; SI joint syndrome, a term often used to describe the pain associated with sacroiliac joint dysfunction (SIJD); and SIJD itself, which refers to abnormal movement or alignment of the joint.

Causes and symptoms of a sacroiliac lesion

SI lesions are often caused by a combination of factors including trauma, biomechanical stresses, pregnancy, or degenerative joint disease. Overuse or repetitive motion can also lead to wear and tear on the SI joints.

Symptoms of SI lesions typically include:

• Chronic low back pain
• Pain in the buttocks or hips
• Pain radiating down the legs
• Stiffness or a burning sensation in the pelvis
• Increased pain with standing or walking

Complications these lesions may lead to

If SI lesions are not properly managed, they can lead to significant long-term issues. Chronic pain and persistent discomfort in the SI region can significantly impair mobility. Over time, untreated SIJD can also lead to changes in walking patterns, which in turn may cause compensatory injuries in the knees, hips, or lower back. Additionally, chronic inflammation in the SI joints can contribute to the development of arthritis, further exacerbating discomfort and reducing quality of life.

The consequences of leaving SI lesions untreated underline the need for early diagnosis and treatment. Next, let's discuss what can be done to detect SI lesions.

What is the Sacroiliac Compression Test?

The Sacroiliac Compression Test is a physical examination for diagnosing painful sacroiliac joints and evaluating their integrity. It is also known as the SI joint compression test, sacral thrust test, sacral spring test, sacroiliac pressure test, or downwards pressure test.

Sacroiliac Compression Tests help diagnose SIJD by applying mechanical stress to the area to elicit symptoms. The test is valued for its simplicity and effectiveness, making it a staple in both clinical and field settings for quickly assessing potential SI lesions.

How is this test conducted?

The Sacroiliac Compression Test is straightforward and can be conducted in various settings without the need for specialized equipment. Here’s how it is performed:

1. The patient lies on their back on an examination table with their legs straight
2. The examiner stands on the side of the patient's pelvis that is being tested
3. The examiner locates the posterior superior iliac spine (PSIS) on the side being tested.
4. The examiner places their thumbs on the PSIS and their fingers on the patient's anterior superior iliac spine (ASIS) on the same side.
5. The examiner applies downward pressure on the PSIS with their thumbs while simultaneously lifting the ASIS upward with their fingers. This compression of the SI joint is held for several seconds as the examiner asks the patient if they experience any pain or discomfort.
6. Observe the patient for any signs of pain or discomfort in the SI joints.

How are the results interpreted?

The results of the Sacroiliac Compression Test are categorized as either negative or positive:

• Negative: The test is considered negative if no pain is elicited during the application of pressure, indicating no SIJD.
• Positive: A positive test occurs when the patient experiences pain or when their specific symptoms are replicated during the test. This result suggests potential SIJD or SI lesions.

A positive result typically prompts further diagnostic investigation to confirm the diagnosis and to plan appropriate treatment strategies.

Sacroiliac lesion treatments

Effective management of SI lesions is crucial for alleviating pain and restoring function. Here are the primary treatment options:

• Physical therapy: Physical therapy is foundational in treating SI lesions. It includes exercises to strengthen the muscles around the SI joint, improve flexibility, and increase range of motion. Therapists may also use manual therapy techniques to mobilize the joint and reduce pain.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and manage pain associated with SI lesions. For more severe pain, stronger pain relievers may be prescribed under careful medical supervision.
• Joint injections: Corticosteroid injections directly into the SI joint can help reduce inflammation and provide significant pain relief. This treatment is often used when other conservative methods have not been effective.
• Supports and braces: Wearing a pelvic brace or belt can help stabilize the SI joints and relieve pressure, which aids in reducing pain and improving mobility.
• Surgery: While rare, surgery may be considered for severe cases of SIJD that do not respond to other treatments. Surgical options may involve fusion of the joints to reduce movement and alleviate pain.

These treatments, often used in combination depending on the severity and specifics of the condition, help manage symptoms and improve quality of life for those suffering from SI lesions.

Is this test reliable?

The reliability of clinical tests for diagnosing SIJD has been a topic of significant academic investigation, with findings evolving over time. The study by van der Wurff et al. (2000) examined both mobility tests and sacroiliac pain provocation tests, concluding that while mobility tests did not demonstrate reliable outcomes for standard clinical use, some pain provocation tests like the Gaenslen test and thigh thrust test showed promise under certain study conditions.

Following this, Stuber's systematic review in 2007 analyzed the sensitivity, specificity, and predictive values of SI joint tests. The findings indicated that no single test could definitively diagnose SIJD on its own, emphasizing the need for multiple tests to improve diagnostic accuracy.

More recent research by Telli et al. (2018) claimed that individual provocation tests are limited. Thus, they supported the use of a multi-test approach, finding that several sacroiliac joint pain provocative tests used together yielded reliable diagnostic results. Particularly, the Thigh thrust and sacral thrust tests demonstrated very good agreement in their reliability, underlining their effectiveness when used in combination.

References

Stuber, K. J. (2007). Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: A systematic review of the literature. The Journal of the Canadian Chiropractic Association, 51(1), 30–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924656/

Telli, H., Telli, S., & Topal, M. (2018). The validity and reliability of provocation tests in the diagnosis of sacroiliac joint dysfunction. Pain Physician, 21(4), E367–E376. https://pubmed.ncbi.nlm.nih.gov/30045603/

van der Wurff, P., Hagmeijer, R. H. M., & Meyne, W. (2000). Clinical tests of the sacroiliac joint. Manual Therapy, 5(1), 30–36. https://doi.org/10.1054/math.1999.0228