Sacroiliac Distraction Test: Difference between revisions

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<br>Note: Cook and Hegedus (2013) suggest applying a sustained force for 30 seconds before applying a repeated vigorous force in an attempt to reproduced the patient’s symptoms. However, Laslett (2008) does not suggest any timings or changes in force.  
<br>Note: Cook and Hegedus (2013) suggest applying a sustained force for 30 seconds before applying a repeated vigorous force in an attempt to reproduced the patient’s symptoms. However, Laslett (2008) does not suggest any timings or changes in force.  


Because of the lack of standardisation in the technique it is quite feasible different therapists will practise this test different ways, giving rise to variability in response and lowering the inter-tester reliability (Laslett et al 2005, Levin et al 2005). No evidence to suggest either method is preferable (Levin et al 2005), therefore, more evidence needed.
Because of the lack of standardisation in the technique it is quite feasible different therapists will practise this test different ways, giving rise to variability in response and lowering the inter-tester reliability (Laslett et al 2005, Levin et al 2005). No evidence to suggest either method is preferable (Levin et al 2005), therefore, more evidence needed.  


<br>2. The presumed effect is a DISTRACTION of the anterior aspect of the sacroiliac joint. (Laslett et al 2005, Laslett et al 2003)
<br>2. The presumed effect is a DISTRACTION of the anterior aspect of the sacroiliac joint. (Laslett et al 2005, Laslett et al 2003)  


<br>3. A test is positive if it reproduces the patient's symptoms. This indicates SIJ dysfunction or a sprain of the anterior sacroiliac ligaments (Cook and Hegedus 2013, Cook et al 2007, Laslett 2008, Laslett et al 2005, Laslett et al 2003)  
<br>3. A test is positive if it reproduces the patient's symptoms. This indicates SIJ dysfunction or a sprain of the anterior sacroiliac ligaments (Cook and Hegedus 2013, Cook et al 2007, Laslett 2008, Laslett et al 2005, Laslett et al 2003)  


<br>'''However, this test should be used in concordance within a SIJ testing cluster to ensure maximum reliability and validity when confirming hypotheses''' (Albert et al 2000, Kokmeyer et al 2002, Laslett 2008, Laslett et al 2005,Laslett et al 2003, Ozgocmen et al 2008, Robinson et al 2007). See Laslett SIJ testing cluster for further information<br><br>
<br>'''However, this test should be used in concordance within a SIJ testing cluster to ensure maximum reliability and validity when confirming hypotheses''' (Albert et al 2000, Kokmeyer et al 2002, Laslett 2008, Laslett et al 2005,Laslett et al 2003, Ozgocmen et al 2008, Robinson et al 2007). See Laslett SIJ testing cluster for further information<br><br>  
 
(Picture Goes here)
 
 
 
Laslett 2008 -&nbsp;"The distraction test” (testing right and left SIJ simultaneously).<br>Note: Vertically oriented pressure is applied to the anterior superior iliac spinous processes directed posteriorly, distracting the sacroiliac joint.<br>
 
(Youtube videos go here) &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;


== Evidence  ==
== Evidence  ==

Revision as of 17:30, 19 January 2013

Original Editor - Justin Gray

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Description and Purpose
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The SIJ (Sacroiliac Joint) Distraction (Colloquially know as Gapping) test is used to add evidence, positive or negative, to the hypotheses of an SIJ sprain or dysfunction when used in the”Laslett SIJ Cluster testing”. This test stresses the anterior sacroiliac ligaments (Cook and Hegedus 2013, Cook et al 2007, Laslett 2008, Laslett et al 2005, Laslett et al 2003). This test has also been described as the Transverse Anterior Stress Test or the Sacroiliac Joint Stress Test[1][2].

Technique
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1. The patient lies supine and the examiner applies a vertically orientated, posteriorly directed force to both the anterior superior ilac spines (ASIS) (Cook and Hegedus 2013 , Laslett 2008, Laslett et al 2005, Laslett et al 2003).


Note: Cook and Hegedus (2013) suggest applying a sustained force for 30 seconds before applying a repeated vigorous force in an attempt to reproduced the patient’s symptoms. However, Laslett (2008) does not suggest any timings or changes in force.

Because of the lack of standardisation in the technique it is quite feasible different therapists will practise this test different ways, giving rise to variability in response and lowering the inter-tester reliability (Laslett et al 2005, Levin et al 2005). No evidence to suggest either method is preferable (Levin et al 2005), therefore, more evidence needed.


2. The presumed effect is a DISTRACTION of the anterior aspect of the sacroiliac joint. (Laslett et al 2005, Laslett et al 2003)


3. A test is positive if it reproduces the patient's symptoms. This indicates SIJ dysfunction or a sprain of the anterior sacroiliac ligaments (Cook and Hegedus 2013, Cook et al 2007, Laslett 2008, Laslett et al 2005, Laslett et al 2003)


However, this test should be used in concordance within a SIJ testing cluster to ensure maximum reliability and validity when confirming hypotheses (Albert et al 2000, Kokmeyer et al 2002, Laslett 2008, Laslett et al 2005,Laslett et al 2003, Ozgocmen et al 2008, Robinson et al 2007). See Laslett SIJ testing cluster for further information

(Picture Goes here)


Laslett 2008 - "The distraction test” (testing right and left SIJ simultaneously).
Note: Vertically oriented pressure is applied to the anterior superior iliac spinous processes directed posteriorly, distracting the sacroiliac joint.

(Youtube videos go here)          

Evidence[edit | edit source]

The Diagnostic Accuracy of the Distraction test is described below.

Reliability Sensitivity Specificity LR+ LR-
Russel[1] 11 90 1.1 .98
Laslett[2] [3] .69 60 81 3.2 .5
Albert[4] .84 14 100

Resources[edit | edit source]

www.ncbi.nlm.nih.gov/sites/entrez/18458988/ 

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ 8. Russell A, Maksymovich W, LeClerq S. Clinical examination of the sacroiliac joints: a prospective study. Arthritis Pheumatism. 1981;24:1575-1577.
  2. ↑ 6. Laslett M, Aprill C, McDonald B, Young S. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of test. Man Ther. 2005;10:207-218.
  3. ↑ 7. Laslett M, Williams M. The reliability of selected pain provocation test for sacroiliac joint pathology. Spine. 1994;19(11):1243-1249
  4. ↑ 5. Albert H, Godskesen M, Westergaard J. Evaluation of clinical test used in classification procedures in pregnancy related pelvic joint pain. Eur Spine J. 2000; 9(2):161-166
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