About Posterior SI Joint Provocation Test | Physiotherapy

Posterior SI Joint Provocation

What is posterior SI joint provocation?

Posterior SI Joint Provocation tests are a method commonly used by healthcare professionals to determine if the pain is originating from the SI joint. The maneuvers are used to isolate the sacroiliac joint as a source of pain.


The posterior pelvic pain provocation test is a pain provocation test used to determine the presence of sacroiliac dysfunction. It is used (often in pregnant women) to distinguish between pelvic girdle pain and low back pain.

The test is also known as:

  • PPPP test
  • Test P4
  • Thigh push test
  • Post shear test
  • POSH test

The technique for posterior SI joint provocation

With the patient supine, the hip is flexed 90 ° (with the knee bent) to stretch the posterior structures. By applying axial pressure lengthways, the femur is used as a lever to push the ilium back. One hand is located under the sacrum to fix its position while the other hand is used to smear a descending force to the femur. Broadhurst and Bond suggest adding midline hip adduction, while Laslett & Williams recommend avoiding excessive adduction due to patient discomfort.

What provocation test evaluates the hip and sacroiliac joints?

In cases of limited or painful movement of the hip joint, our practice is to use the distraction test. Some have described Patrick’s test as having superior sensitivity and specificity, while others have documented that the distraction test is one of the most predictive of SIJ pain.

How do I know if my SI joint is hypermobile?

The condition is the result of the joint becoming too loose and the ligaments designed to hold it in place have become too loose. Pain from a hypermobile sacroiliac joint can be sharp and intense. It is usually felt on one side of the lower back or buttocks and can radiate down the leg.

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