The Gaenslen test (Gaenslen test) is one of five provocative tests that can be used to detect musculoskeletal abnormalities and primary chronic inflammation of the lumbar spine and sacroiliac joints (SIJ).  Subsequent tests include; Distraction Test Thigh Thrust Test Compression Test and Sacral Thrust Test.
The clinical prediction rule of three or more positive provocation tests eliciting familiar back pain and pain non-concentration is a useful tool for identifying patients who are more likely to have SIJ pain than some other pain conditions.  SIJ Tests Diagnostic Accuracy of Composite Materials When the explanation is limited to back pain patients whose symptoms cannot be “focused” by repetitive motion tests, the situation improves. Centering is highly specific for discogenic pain and positive SIJ tests in these patients should be ignored. 
Specifically, Gaenslen’s test can indicate the presence of SIJ lesions, pubic symphysis unstable hip pathology, or L4 radiculopathy. It can also put pressure on the femoral nerve.  This test is commonly used to test for sciatica or other forms of SIJ rheumatism.
The patient starts lying supine with the painful leg resting on the edge of the treatment table. The examiner flexes the asymptomatic hip sagittally, while also flexing the knee (up to 90 degrees).  The patient should hold the untested (asymptomatic) leg with both arms while The therapist stabilizes the pelvis and applies passive pressure to the tested leg (symptomatic) to keep it in a hyperextended position. Apply downward force to the calf (symptomatic side) to hyperextend it at the hip while applying a flexion-based counterforce to the calf The bent leg pushes it toward the head, creating torque on the pelvis. 
If the patient’s normal pain is reproduced, the test is considered a positive result of SIJ-injured hip pathology pubic syndrome instability or L4 nerve root injury. At the same time, the test may also put pressure on the femoral nerve. 
If the patient complains of bilateral pain, a bilateral examination is recommended. Importantly, at least three positive signs of SIJ challenge testing are required before a possible diagnosis of SIJ pathology is possible. 
The inter-examiner Kappa reliability was 0.54-0.76. 
Cook and Hegedus ReviewStudyReliabilitySensitivitySpecificityPositive likelihood ratio (LR+)Negative likelihood ratio (LR-)QUADAS (0-14)Laslett & Williams0.72NTNTNANANADreyfuss et al0.6171261.021.1110Koslett et al NA et al . (right leg)  NT53711.80.6612 Laslett et al. (Left leg)  NT50772.20.6512 Ozgocmen et al. (right leg)  NT44802.290.6810 Ozgocmen et al. (Left leg) NT36751.50.8310
Sensitivity – the likelihood that a positive test result will result in someone having pathology Specificity – the likelihood that a negative test will result in someone not having pathology Positive likelihood ratio (LR+) – the difference between a positive test result in a person with pathology ratio of sex test results A positive test result in a person without pathology. Negative Likelihood Ratio (LR-) – The ratio of negative test results in people with pathology to those without pathology. Reliability – the likelihood of reproducing test results again (expressed as a percentage or decimal)
QUADAS score: Copied from Cook and Hegedus, originally produced by Whiting et al. It is a quality tool for assessing diagnostic accuracy studies, reducing sampling bias operator bias and/or poor study design that may affect risk of outcome.  Scores 7-14 “Yes” is generally considered to indicate high-quality diagnostic accuracy studies, while a score below 7 indicates poor-quality diagnostic accuracy studies.  However Cook and Hegedus suggested that 10 points or more of “yes” should be High quality studies and scores below 10 should be associated with poorly designed studies. 
Sacroiliac intra-articular block with local anesthesia has been considered the ultimate gold standard in the diagnostic differentiation of SIJ pain that can demonstrate an SIJ origin. Fluoroscopic guidance is necessary when approaching SIJ anesthetic infiltration due to unguided placement Only 12% of patients had the needle reach the joint. This allows accurate positioning of the joint cavity, which is then confirmed with contrast material. A local anesthetic may then be infiltrated.  However, the reference standard for diagnostic injections has limitations. Since only the internal The structure of the SIJ was not identified by surgical anesthesia SIJ extra-articular ligament pain. 
Positive injection occurs when the patient’s normal pain is relieved by the SIJ block, implying that the SIJ is the ultimate source of pain. Dreyfuss et al.  indicated a positive injection when Laslett et al. reported 90% pain relief  indicated that 80% pain relief was Suitable for triage positive injections.
In our study, Gaenslen’s test had a sensitivity value of 61.5% and a specificity value of 33.3%. Laslett et al. found the sensitivity-specificity and positive and negative predictive values of the test to be 37%, 71%, 47%, and 76%, respectively. Specificity of the test in the study Broadhurst was reported as 100%, which may be due to the use of a different protocol (eg, setting a higher cutoff and injecting 4 cc of lidocaine only to patients with positive Gaenslen test results). 
- Sacral Thrust Test
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