Pain emanating from sacroiliac joint dysfunction is tricky to assess. I used to use just four tests that I was taught to believe were pretty reliable.
Three of these are:
1. The standing flexion test – whereby you palpate and compare the PSIS movement (or lack of) while the standing patient bends forward at the waist.
2. The ‘stork’ test – whereby you palpate and compare the PSIS movement (or lack of) while the standing patient lifts one leg, then the other.
3. The Derbolowski test – whereby you assess the movement (or lack of) the medial malleoli of the supine patient as they progress to an upright sitting position.
The other one was:
4. The compression test – whereby you squashed down on the outer ilium of a side-lying client to provoke pain.
But, these tests, and others, don’t inform much about the actual relationship of one side of the joint to the other – just that there is a fixation, or that something is wrong causing pain.
Some SIJ background.
The SIJ joint can move a bit. Nutation has the sacrum ‘nodding’ in an anterior rotation and counter-nutation has the opposite movement happening. This is important when you walk. When you step forward with the right leg the ilium rotates posteriorly on that side leading to a relative right nutation of the sacrum, and so on. This movement is tiny – possibly only a few degrees – but very important. To be really pure think of the rotation in a diagonal plane – upper left relating to lower right and vice versa. Most of all, think of the whole deal as a great way to absorb shock and provide elastic recoil with any locomotive movement.
Things can go wrong, sometimes in seemingly innocuous ways. If you were to unexpectedly catch your foot on something as you stepped forward this would put an eccentric contraction stress on your hip flexors that could pull your ilium into anterior rotation, just as your SIJ was expecting the opposite.
I have my own experiences leading to SIJ malposition. I remember a time where I took a step toward my massage table and I caught my way-too-grippy sneaker in the carpet. I felt my pelvis jerk out of position. I almost passed out with pain. After an hour spent grimly smiling and chatting to my client I was able effect a self-cure because a similar thing had happened before..
Here’s my ‘cure’. You lie on your unaffected side close to the posterior edge your massage table. Dangle your affected leg over the back of the table. Let gravity take your leg below the table top. Wait. Wait a bit more. Sometimes fifteen minutes can pass before a clunk (seemingly audible) realigns the two surfaces. The relief is instant.
I have used this technique on my patients. All we have to do is to lie them down on the non-painful side, dangle the top-most leg off the back and wait. To speed the process up I also get them to isometrically contract their hamstrings, bending their upper knee so that their heel hits your own leg. Try it out.
There are many more SIJ tests to the ones outlined above. Asymmetry of left/right ASIS/PSIS position is especially helpful. These tests and others will be taught in our practical postural assessment classes. We will also discuss many other corrective techniques.