Sacroiliac Distraction/Compression Test: a protocol to provoke SI joint pain

Once you've run the usual mobility and provocation tests and still suspect the sacroiliac (SI) joint, the sacroiliac compression and distraction tests are a great way to add more evidence. Both try to reproduce pain by applying pressure to the pelvis in opposite directions, and combining them with other tests considerably improves screening reliability.

What does this test measure?

These tests check whether compression or distraction forces applied to the pelvis reproduce the client's familiar sacroiliac pain:

• Compression test: the two iliac crests are pushed toward each other, "squeezing" the pelvis
• Distraction test: the two iliac crests are pulled apart, "opening" the pelvis

If either maneuver reproduces pain in the sacroiliac region, it's considered a positive provocation sign for that joint.

Equipment needed

• A treatment table
• No additional tools required, although some variants use a table with a movable section

Protocol

Compression test (side-lying)

1. The client lies on their side, with hips and knees slightly flexed
2. Stand behind them and apply downward pressure on the iliac crest (toward the table, compressing the pelvis)
3. Hold the pressure for a few seconds and ask whether it reproduces their usual sacroiliac pain

Distraction test (supine)

1. The client lies on their back
2. Cross your hands over both anterior superior iliac spines (ASIS)
3. Apply outward and downward pressure (as if trying to "open" the pelvis), gradually increasing
4. Hold the pressure for a few seconds and ask whether it reproduces their usual sacroiliac pain

Common mistakes

• Applying pressure abruptly instead of gradually and in a controlled way
• Not distinguishing between the client's "familiar" sacroiliac pain and simple discomfort from the pressure itself (which can be felt even without pathology)
• Not combining both tests (compression and distraction) with other sacroiliac tests to improve screening reliability

How to interpret the result

Result	Interpretation
Positive: compression and/or distraction reproduces the client's familiar sacroiliac pain	Suggests sacroiliac joint involvement
Negative: neither maneuver reproduces pain	Lowers the likelihood that the SI joint is the main pain source

Current evidence recommends not relying on a single sacroiliac test, but rather on a cluster of several positive tests (compression, distraction, Gaenslen, etc.). The more positive tests in the cluster, the higher the likelihood the SI joint is the actual pain source.

Related tests

These tests complete the sacroiliac battery along with:

• Gaenslen Test — another provocation test to add to the diagnostic cluster
• Gillet Test — to also assess whether there's an associated mobility restriction, not just pain

How to log the full cluster in Movalytics

Since the interpretation of sacroiliac tests depends on how many of them are positive, it's most useful to log them all together at each assessment. In Movalytics you can record the result of each test in your sacroiliac battery (compression, distraction, Gaenslen, Gillet) and see the full pattern at a glance, along with how it evolves over the course of treatment.

Frequently asked questions

Are these tests painful? They can create uncomfortable pressure, and if the SI joint is irritated, they may reproduce pain of varying intensity. Pressure should be applied gradually and stopped if pain is severe. Does a single positive test confirm a sacroiliac origin of pain? No. The recommendation is to assess a cluster of several tests; a single positive test on its own has lower diagnostic value. Can these be done with people experiencing severe acute low back pain? It's worth being cautious and adapting the pressure applied, or postponing these tests if acute pain is too severe to allow safe examination.