Gaenslen's Test | Sacroiliac Joint Provocation

Gaenslen's Test is one of the five provocation tests that can be used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and Sacroiliac joint (SIJ). The subsequent tests include; the Distraction Test, Thigh Thrust Test, Compression Test and the Sacral Thrust Test.

Gaenslen's Test

The clinical prediction rule of three or more positive provocation tests that provoke familiar back pain and non-centralisation of pain is a useful tool to identify patients that are more likely to have SIJ pain than some other painful condition. Diagnostic accuracy of composites of SIJ tests improves when interpretation is confined to back pain patients whose symptoms cannot be made to ‘centralise’ with repeated movement testing. Centralisation is highly specific to discogenic pain and positive SIJ tests in these patients should be ignored.

Specifically, Gaenslen's test can indicate the presence or absence of a SIJ lesion, pubic symphysis instability, hip pathology, or an L4 nerve root lesion. It can also stress the femoral nerve.

Technique

The patient begins positioned in supine with the painful leg resting on the edge of the treatment table. The examiner sagitally flexes the non symptomatic hip, while the knee also flexed (up to 90 degrees). The patient should hold the non-tested (asymptomatic) leg with both arms while the therapist stabilizes the pelvis and applies passive pressure to the leg being tested (symptomatic) to hold it in a hyperextended position. A downward force is applied to the lower leg (symptomatic side) putting it into hyperextension at the hip, while a flexion based counterforce is applied to the flexed leg pushing it in the cephalad direction causing torque to the pelvis.

If the patient’s normal pain is reproduced, the test is considered positive for a SIJ lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. Meanwhile, the femoral nerve may also be stressed by this test.

It is recommended to test both sides if the patient complains of pain bilaterally. Importantly, at least three positive signs of the SIJ provocation tests are required before a possible diagnosis of SIJ pathology.