This is Brent of the Brookbush Institute in this video we're going over another
special or orthopedic tests for sacroiliac joint pain, this is the thigh
thrust test. I'm going to have my friend Melissa come out she's going help me
demonstrate. Now I think you guys will find that the trickiest part of this
test is setup, and it all comes down to trying to get this hand on the sacral
base. Now notice that Melissa is in supine and it should be that wherever
she's having symptoms, the sacroiliac joint that we think is involved is
further from us, and what we're going to do in this test is I'm going to brace her
sacrum with this hand, and then using her thigh I'm going to create a posterior force
that's going to take her pelvis and shear that joint. Alright so we're going to
shear the innominate on a stabilized sacrum. So now the question is how do I
get this underneath your sacrum, and this is where all sorts of awkwardness
happens if you don't do a little practicing before you see a patient
using this test. I'm going to lift this leg up, I'm going to then pull Melissa over
towards me, this way I can put my hand into position this way and roll her back
over my hand. Don't try to slide your hand underneath their
backside that is that is not going to gain you any rapport with a new patient or
client that you're doing an assessment on. Now I will say it is a little tricky
to get this hand in the right spot, because remember we have to stabilize
the sacrum but not the innominate. If you put this like let's say that the sacrum
ends up on this side of my hand and like her PSIS over her innominate is on this side
of the hand and I push down, nothing's going to happen.
I'm just going to push both of those things right down into my hand, rather than me
having the sacrum in this hand with the innominate coming off the edge. All right so what
you're going to end up having to do is try to kind of find her ilium and then
maybe her PSIS as we've been using that bottom corner of the PSIS as a
landmark and then try to get medial to that PSIS. Now it's okay for your hand to
end up all the way on this innominate, that's
fine. I can stabilize her, in this case left and innominate and sacrum and then
push her right innominate over the edge, what I can't do is have sacrum and right
innominate stabilized. So for those of you guys with bigger hands what you
might want to do is kind of find even if you had to the middle of the sacrum and
then roll them back, and I just missed a little bit, let me get a little further
over. Alright now I can feel I have her sacrum stabilized, but all
this side is hanging off the side of my hand. Now I'm going to use this arm,
notice that my elbow is in line with the direction that I want to push, and I'm
going to do a little thrust, right did that provoke your symptoms? No that didn't
provoke her symptoms. Alright and I might give it a couple, how about that? Almost,
you feel like there might be something there. Alright and if you guys can, if
you happen to be tall enough, different enough in size you could try getting
more of a thrust with your torso. How was that? Okay, alright so she's probably not
positive she's only getting a hint of uncomfortableness, which it's a
special test meant to provoke symptoms it's probably not going to be that
comfortable. So let me review that set up one more time. She's supine, the side that
we think is involved is furthest away from me. I want to get this hand on her
sacrum, I want this in innominate hanging off my hand. So the way I'm going to do that
is pull this leg up like this, tilt her really far over towards me. Notice
I'm bracing my thigh right against the table so she can't fall off the table.
I'm then going to bring this hand down, it's okay that I stabilize the opposite
innominate as long as I get this part of my hand over her sacrum, and this pelvis is
hanging off. Alright so I found her PSIS, I went off medially, now as I roll her
back I've just got to make sure that
my hand doesn't slide over with it. Now I can feel that her sacrum is stabilized and
this side moves. Once I'm there I'm then going to make sure that my elbows in
line with the force I'm trying to create, and I'm actually using my chest here to
kind of stabilize her thighs so it doesn't move around on me
and I give her a good little thrust. How did that feel? That didn't
provoke any of the complaints you were talking about when you walked in?
Remember we're not just looking for pain, uncomfortableness, soreness, we're
looking for the concordant sign, the complaints that she walked into the
office with. So there you go, this isn't a great test as most SI joint
tests are not great tests, they tend to be pretty specific, if they are positive
they probably are sacroiliac joint dysfunction. But all of these tests
have a hard time with sensitivity, this is one of those tests that is going to
be used in our clusters though so keep this test in your repertoire, get some
practice in with that hand positioning. It's as you can imagine it could get a
little awkward and maybe a little inappropriate kind of fast,
absolutely accidentally, grab a couple of your colleagues who know of the tests
and and get some practice in before you try this with a patient. I look
forward to hearing about any questions you have in the comments box below. I'll
talk with you soon.