▶️ The sacroiliac compression test is a clinical test that is used to assess the integrity and function of the sacroiliac joint (SIJ), which is the joint between the sacrum and the ilium in the pelvis.
– The SIJ is involved in transmitting forces between the spine and the lower limbs, and it can be a source of pain and disability in some people.
– The sacroiliac compression test is one of several pain provocation tests that are designed to reproduce the patient's symptoms by applying stress to the SIJ structures, especially the posterior SIJ ligament.
The sacroiliac compression test is performed as follows:
1). The patient lies on their side, with the symptomatic side facing up. The hips are flexed to about 45 degrees and the knees are bent to about 90 degrees.
2). The examiner stands behind the patient and places both hands over the anterior aspect of the iliac crest, applying downward pressure toward the floor. The pressure should be moderate and gradually increased, with 3 to 6 thrusts of short duration.
3). The test is considered positive if the patient reports pain or reproduction of their familiar symptoms in the SIJ region or buttock area. The test is considered negative if there is no pain or if the pain is located elsewhere.
– The sacroiliac compression test is based on the biomechanical principle that compressing the pelvis in a lateral direction causes a shear force across the SIJ, which can elicit pain if there is inflammation, instability, or dysfunction in the joint.
– The test also indirectly assesses the ability of the sacrum to counternutate, which is a slight backward rotation relative to the ilium that occurs during normal pelvic motion. If counternutation is impaired, the SIJ may become more vulnerable to stress and injury.
– The sacroiliac compression test has been widely used in clinical practice and research as a diagnostic tool for SIJ pain. However, its validity, reliability, and diagnostic accuracy have been questioned by some studies. A systematic review by Laslett et al. (2005) found that the sacroiliac compression test had a sensitivity of 69% and a specificity of 69%, which means that it can correctly identify about 69% of people with SIJ pain and exclude about 69% of people without SIJ.
– However, these values are not very high and may vary depending on the population, setting, and criteria used for diagnosis. Therefore, the authors suggested that the sacroiliac compression test should not be used alone, but rather as part of a cluster of tests that have higher diagnostic value when combined.
Some examples of other pain provocation tests for the SIJ are:
🔅 Distraction test
– The examiner applies an outward force on both anterior superior iliac spines (ASIS) while the patient lies supine.
🔅 Thigh thrust test
– The examiner applies an axial force along the femur while flexing the hip to 90 degrees and stabilizing the opposite ASIS while the patient lies supine.
The examiner maximally flexes one hip and extends the other hip while applying downward pressure on both knees while the patient lies supine near the edge of the table.
🔅 Sacral thrust test
– The examiner applies a posterior-anterior force on the sacrum while stabilizing both iliac crests while the patient lies prone.
– The sacroiliac compression test can be a useful screening tool for SIJ pain, but it should not be relied upon as a definitive diagnosis. It should be interpreted in conjunction with other clinical findings, such as history, physical examination, imaging, and response to treatment. It should also be performed with caution and respect for the patient's comfort and safety, as it can cause discomfort or aggravation of symptoms in some cases.
CAUSES OF SACROILIAC JOINT PAIN?
– Sacroiliac joint pain is a condition that affects the joint between the sacrum and the ilium in the pelvis. The sacroiliac joint is involved in transferring forces between the spine and the lower limbs, and it can become painful or dysfunctional due to various causes.
– Some of the possible causes of sacroiliac joint pain are:
• A sudden impact, such as a fall, a car accident, or a sports injury, can damage the sacroiliac joint or the ligaments that surround it. This can cause inflammation, instability, or misalignment of the joint.
• Osteoarthritis which is a degenerative condition that affects the cartilage and bone of the joints, can occur in the sacroiliac joint due to aging, wear and tear, or injury. This can cause pain, stiffness, and reduced range of motion of the joint.
• Another type of arthritis that can affect the sacroiliac joint is ankylosing spondylitis, which is an inflammatory condition that causes fusion of the spine and sacroiliac joints. This can cause chronic pain, stiffness, and loss of mobility of the spine and pelvis.
• During pregnancy, the hormones relaxin and progesterone cause the ligaments of the sacroiliac joint to loosen and stretch to prepare for childbirth. This can make the joint more unstable and prone to injury or inflammation. The increased weight and altered posture of pregnancy can also put more stress on the sacroiliac joint.
• Having one leg shorter than the other can affect the way a person walks and stands, which can create an imbalance in the pelvis and spine. This can put more pressure on one side of the sacroiliac joint and cause pain or dysfunction.
• In rare cases, the sacroiliac joint can become infected by bacteria or fungi that enter the bloodstream from another source, such as a wound, a surgery, or an intravenous drug use. This can cause severe pain, fever, swelling, and redness of the joint.
– Sacroiliac joint pain can be a challenging condition to diagnose and treat, as it can mimic other causes of low back pain or hip pain. It is important to consult a doctor or a specialist who can perform a thorough physical examination, imaging tests, and other diagnostic procedures to confirm the diagnosis and rule out other possible causes. The treatment options for sacroiliac joint pain may include medication, physical therapy, injections, braces, or surgery, depending on the cause and severity of the condition.
▶️ What are the symptoms of sacroiliac joint pain?
– The common symptoms of SIJ include:
• Pain in the lower back or buttocks, which may radiate to the groin, thigh, knee, or foot.
• Stiffness or reduced range of motion in the lower back, hips, or pelvis.
• Difficulty standing up from a sitting position, walking, climbing stairs, or bending/twisting.
• Worsening of pain with certain movements or positions, such as sleeping or sitting on one side, standing on one leg, or taking large steps.
