Sacroiliac Compression Test

Purpose

The Sacroiliac Joint (SIJ) Compression Test or “Approximation Test” is a pain provocation test that emphasizes SIJ structures especially the SIJ posterior muscles in an attempt to replicate the patient’s symptoms (Laslett and Williams; 1994) .

Technique

The patient lies on his side with the examiner’s hand on the upper part of the iliac crest pressing downward. The movement increases pressure on the sacrum. Increased pressure in the sacroiliac joint indicates possible sacroiliac ulcers and /or hernias of the posterior sacroiliac ligaments.[2]A positive outcome is determined by recurrence of pain or patient symptoms

Negative Test: No pain or discomfort other than the patient’s pain birth

[3]

Evidence

Results of Literature Search:

A comprehensive literature search was conducted using keyword searches to synthesize the search results. Articles and documents written only in English were included. Scientific Websites Cochrane Library OVID MEDLINE and PUBMED databases were used to search for the articles. Key words such as: SIJ Test; SIJ Pressure Test; and Reliability & Specificity of SIJ Testing were used and combined to optimize the study.

Review of Literature:

Validity reliability and diagnostic power of specific SIJ tests are questionable (Schwarzer et al; 1995) [4] Stendal-Robinson et al (2005)[5] examined the reliability of seven SIJ tests in small numbers in both sexes in the intermediate age range of 18-50 years (n = 61). Two experienced people clinicians were used to complete the experimental protocols and independent investigators to ensure protocol consistency. All were blinded to participant’s diagnosis reducing experimental bias. Results were generally positive for the pain stimulus tests (percentage agreement = 67%-97%); however considerable reliability variability was reported for the results of the stress test between therapists – perhaps because of how the results measured the subjective nature of the pain. The results indicated that a combination of pain evoked tests for the SIJ could be used with some accuracy for confirmation SIJ injury assessment. The reliability of the SIJ stress test alone cannot be inferred from these findings but several tests for clinical use can be used as a reliable measure.

The SIJ Compression test can be a useful diagnostic tool along with other pain stimulus tests (Stanford and Burnham; 2010) In this study Stanford and Burnham examined the reproducibility of the SIJ erotic stimulus test before analgesia and back pain control have been performed in 34 subjects who were found to be relatively mild statistically significant result (p=0.3) in SIJ pain diagnosis. The study used a low random sample and used only one physician; increased bias and question the validity of the results.

Cook and Hegedus (2013) [6] cited studies (n=12) that used the SIJ Compression Test to discuss their reliability sensitivity and specificity giving each a Quality of Diagnostic Accuracy Research Studies (QUADAS )score (0-10). 14). A number of the studies only assessed inter-rater reliability. Of studies that examined sensitivity and specificity found specificity to be adequate with low to moderate sensitivity indicating limitations in using the test as a screen. QUADAS scores ranged from 5-12 with several being inappropriate because sensitivity and specificity had not been assessed.

A systematic review of the literature on the reliability of blinded pain stimulation testing of the SIJ was completed by Van Der Wurff et al (2000) [7] The study classified the power of 11 Randomized Controlled Trials in by their study population testing procedures and test results giving each a score out of 100. The study examined the reliability of several SIJ tests including SIJ Compression which was a commonly used test. Of the four studies that examined SIJ Compression, only Laslett and Williams (1994) [1] reported recall SIJ Compression tests to be reliable based on their Kappa scores. Reliability was ruled out in the other three trials (Potter and Rothstein 1985; McCombe et al. 1989; and Strender et al. 1997) [8] [9] [10] The interrater reliability of the study was judged to be ‘good great agreement’ (k= 0.63) thus weakening the view that the Compression test along with other pain evoked tests is not a reliable diagnostic tool.

Conclusion

SIJ Compression testing appears to be an unreliable and insensitive tool for the diagnosis of SIJ conditions. The consensus seems to be that the Compression test may be a valid assessment when combined with other SIJ pain trigger tests; but as an individual test, it is unreliable. The reliability of SIJ pain stimulation testing can be influenced by external factors – pain perception and the more subjective characteristics of clinicians using the method (Arab et al.; 2008).

See also

http://www.physio-pedia.com/Posterior_pelvic_pain_provocation_test_(aka_Thigh_Thrust_aka_Back_Shear)http://www.physio-pedia.com/Sacral_Thrust_Testhttp://www.physio-pedia.com/Gaenslen_Test