Sacroiliac Joint Counternutation Assessment | SIJ Dysfunction Assessment

SIJ Joint Assessment on dysfunction has a low reliability. Overall, assessing isolated SI joint movements like counternutation using manual techniques is hard as barely any movement occurs. Nonetheless, these techniques can give you information on end feel, joint play, or pain provocation when compared with the other side.

To assess joint play, have the patient in prone lying position. We are going to assess the joint play of the right SI joint.

Let’s begin by dividing the SI joint into 4 quadrants, which makes it easier to describe the hand placements.

So we have quadrants 1 and 2 above sacral level S2 and quadrants 3 and four below that level.

To test counternutation, have the patient in prone lying position.

You are going to stand on the asymptomatic side and place the hand corresponding to the SI joint you want to examine on the iliac spine. In the case of the right SI joint, this means the right hand and vice-versa.

Place your other hand below sacral level S2 and then apply pressure with both hands in opposite directions. The hand on the ilium will push in cranioventral (& lateral) direction and the hand on the sacrum in ventrocaudal direction. Assess for end-feel or joint play.

Other  orthopedic tests for SIJ dysfunction are:

• Standing Bent Over Test/Vorlauf Test
• Gillet / Marching / Sacral Fixation Test
• Shimpi Prone SI Joint Test
• Sacroiliac Joint Nutation
• Sacroiliac Joint Play

Due to the low reliability of SIJ dysfunction test, we advise leaving them behind and only focusing on SIJ provocation tests like the cluster of Laslett.

Robinson, H. S., Brox, J. I., Robinson, R., Bjelland, E., Solem, S., & Telje, T. (2007). The reliability of selected motion-and pain provocation tests for the sacroiliac joint. Manual therapy, 12(1), 72-79.