Sacroiliac Joint Pain and the Provocation Test Cluster

Sacroiliac joint pain is far less common than lumbar or hip pain and should be diagnosed with care. It usually sits around the posterior superior iliac spine and the buttock, and is often provoked by sit-to-stand transitions and moving from double-leg to single-leg loading, since the joint transfers load between the lower limb and spine. Single tests have high false positive rates, so the speaker uses the cluster described by Laslett: the thigh thrust, distraction, compression, sacral thrust and Gaenslen's test, each demonstrated in turn. More than three positive tests raise the likelihood of a sacroiliac source, and a diagnostic anesthetic injection remains the gold standard. Palpation, motion palpation and leg length assessment are not supported by research. Management starts with education that the joint is not out of place, addressing fear of movement, and early modification of stairs, sudden direction changes and high-impact loading. Strengthening progresses from squats, hinges and planks to split squats, lunges, step-ups and single-leg RDLs, then jumping and finally hopping.