Sacroiliac Joint Nutation Assessment | SIJ Dysfunction Assessment

The manual technique to assess nutation of the sacrum is used to get information on joint play, movement in the SI joint (though there’s little available) and possible pain provocation.

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 nutation, have the patient in prone lying position. Place a pillar under the patient’s anterior superior iliac spine on the side you want to examine.

You are going to stand on the asymptomatic side and place the hand corresponding to the SI joint you want to examine on the sacrum. In the case of the right SI joint, this means the right hand in quadrant 2. For the left, it would be your left hand in quadrant 1.

Place your other hand on top and then apply a force in cranioventral direction and assess for end-feel or joint play.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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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 Counternutation
• 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.