Diagnosis Using SI Joint Tests

Your doctor will determine whether you have sacroiliac joint disease by reviewing your medical history, taking x-rays, and reviewing the results from other tests you have completed. Sometimes doctors make a definitive diagnosis through treatment. Doctors may also perform a series of provocative tests.

Is the SI joint the cause of my pain? - (01:21)

Dr. Carter Beck describes the process of ruling out other causes of the pain that may mimic the symptoms of SI joint disease. He says the main diagnostic tool for SI joint disease is an injection directly into the SI joint. Dr. Beck is a neurological surgeon at Montana Neurosurgical Specialists in Missoula, Montana.
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Provocative tests are a non-invasive method for diagnosing pain from the sacroiliac (SI) joint. A clinician such as a physical therapist, pelvic health specialist, or pain management specialist can perform these tests to help you diagnose SI joint disease or SI joint dysfunction.

During a provocative test, the clinician will perform a specific physical maneuver while you are lying in a particular position, in an attempt to recreate the pain. A positive result means the test recreated pain.

Positive results for at least three of the five provocative tests indicate that your SI joint is causing your pain. The five provocative tests are called:

  • Distraction
  • Thigh Thrust
  • FABER (flexion, abduction, external rotation)
  • Compression
  • Gaenslen’s


With this test, you lie on your back, with support for your lower back to help maintain the natural curve of the lower back (lumbar spine). The clinician places his or her hands on each side of the pelvis and applies a slow and steady pressure on each side of the pelvis.

Sacroiliac Joint Dysfunction Distraction Provocative Tes


During the Thigh Thrust provocative test, you lie on your back with your hip flexed to 90 degrees and your knee bent. The clinician then applies a force through the femur.

Sacroiliac Joint Dysfunction Thigh Thrust Provocative Test


While you are lying on your back, the clinician crosses your foot to the opposite side. The crossed foot is associated with the side of your body where you feel symptoms of SI joint dysfunction. The clinician also places his or her hand on the pelvis of the opposite side of your body and applies pressure to your knee to exaggerate the motion of flexion, abduction, and external rotation.

Sacroiliac Joint Dysfunction Faber Provocative Test


With the compression test you are lying on your side with your symptomatic side facing up. Your knees are bent, with support between your knees. The clinician applies pressure to the pelvis.

Sacroiliac Joint Dysfunction Compression Provocative Test


During this test you lie on your back with your symptomatic side towards the side edge of the exam table and with your foot towards the floor. Your shoulders should be towards the middle of the exam table for safety reasons. The clinician will ask you to pull your non-symptomatic leg into the flexion position with your knee flexed. The clinician stabilizes your legs with his or her hands.

Sacroiliac Joint Dysfunction Gaenslens Provocative Test