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Tests to assess and monitor sacroiliac joint dysfunction

Hadyn Luke posted this on Friday 7th of June 2013 Hadyn Luke 07/06/2013

Tags: Special populations


Today’s fitness blog covers the tests that fitness professionals can use to assess and monitor pain or dysfunction in the sacroiliac joint.

In our blog on lower back pain, we discussed non-specific lower back pain, which can be caused by a wide range of issues, one of which is sacroiliac joint dysfunction.

Generally, when personal trainers have a client with lower back pain, they will complete psychological screening tests to assess the client’s attitude towards exercise in relation to their back problems. In addition, there are specific tests they can employ to investigate muscular imbalances, as these can lead to a distortion in bio-mechanics, which can be a key cause of lower back pain.

What is the sacroiliac joint?

The sacroiliac joints are synovial planar joints, found where the sacral part of the spine meets the iliac crest. Cartilaginous joints, they have to be strong enough to transfer weight from the trunk and the legs and act as shock absorbers. However, they also need to permit a certain amount of limited movement in the pelvis area in order to relieve stress on the pelvic ring during walking or running.

Because of the constant compressive forces that go through this area, some individuals may suffer from a “sticky” sacroiliac joint, causing restricted movement and leading to back pain.

Transitional exercises

A personal trainer may instruct their client to carry out an overhead squat to establish any problem areas (see our overhead squat analysis blog). This is a transitional exercise: where the individual moves without changing their base of support.

Dynamic exercises

The most common dynamic exercises that fitness instructors might use to assess sacroiliac joint dysfunction are:

  1. Standing flexion test
  2. Stork test

These tests monitor the function and mobility of the sacroiliac joint and highlight any problem areas.

Standing flexion test

This test will asses whether the sacroiliac joints are moving freely.

The client is asked to bend forward from the waist, while the fitness instructor kneels behind them, with their hands resting with light pressure on the client’s iliac crests and their thumbs on the Posterior Superior Iliac Spinous (PSIS) process.

If one thumb is pulled into a higher position than the other, this suggests a restriction that indicates the joint on that side is not moving as it should.

Stork test

If there are no indications of any problems from the Standing flexion test, a personal trainer can then perform a Stork test to check for any bilateral restrictions.

As the name suggests, the Stork test requires the client to stand on one leg, while holding on to a stable support. Again the fitness instructor will be kneeling behind the client with both thumbs on the PSIS process.

As the client raises their knee in front of them as far as it will comfortably go, the fitness professional should check whether the thumb on the PSIS of the leg that is moving moves down below the level of the other thumb. This indicates that the sacroiliac joint is functioning correctly and allowing the ilia to rotate. If the fitness instructor’s thumb remains where it was or moves upwards, this suggests a dysfunctional sacroiliac joint.

Exercises for mobility

If a client is found to have problems with their sacroiliac joints, the personal trainer can incorporate hip mobilising exercises into the client’s warm up routine and between other exercises.

Another option is for the fitness instructor to apply self myofascial release (SMR) stretching techniques with the client, to release muscle tension and increase the range of movement.

Lower back pain qualifications

If in doubt, fitness professionals should refer a client with back pain to an appropriate specialist.

However, considering the number of people who suffer from lower back pain at one time or another, a personal trainer may like to consider taking a Level 4 Lower Back Pain course as an additional qualification.

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