Sacral Thrust Test

The Sacral Thrust Test is an orthopedic provocation maneuver used to assess sacroiliac joint (SIJ) dysfunction or pain. This test is commonly used as part of a cluster of SIJ provocation tests, helping to diagnose whether the SIJ is a likely contributor to low back or buttock pain.

Sacral Thrust Test

How the Test is Performed

  • Client position: Prone (lying face down) on the treatment table.

  • The examiner stands to one side and places the heel/base of one hand over the midline of the sacrum (usually at S2), fingers pointing toward the client’s head.

  • A posterior-to-anterior force is quickly or gradually applied, pushing straight down through the sacrum, creating an anterior shear force at both SI joints.

  • The maneuver may involve a steady pressure for up to 30 seconds, or 3–6 gentle but firm thrusts.

  • A positive test: Reproduction of the client’s familiar pain in the region of one or both SIJs.

Clinical Significance

  • Positive Sacral Thrust Test indicates likely SIJ dysfunction, sprain, or primary pain, especially when pain is located at or near the SIJ.

  • Sensitivity (~63%) and specificity (~75%) are moderate when used alone, but diagnostic value increases significantly when combined with at least two other positive SIJ provocation tests (e.g., thigh thrust, FABER, compression, Gaenslen).

  • Use of a test cluster is strongly recommended for reliable SIJ diagnosis.

Assessment

  • Use Sacral Thrust as part of an SIJ assessment when clients present with chronic low back or buttock pain, particularly when other orthopedic and neurological causes have been ruled out.

  • Note which side symptoms are provoked, quality and intensity of pain, and use this info for treatment planning and multidisciplinary communication.

Treatment

  • If positive:

    • Avoid aggressive deep tissue, joint mobilization, or direct high-velocity force over the SIJ.

    • Focus on gentle soft tissue therapy for gluteals, lumbar, and pelvic stabilizers, myofascial release, and strategies to relieve compensation.

    • Educate clients on proper body mechanics, SIJ protection techniques, and activity modification to prevent aggravation.

  • Combine soft tissue work with exercise-based pelvic stabilization and stretching for adjacent muscles as appropriate, in collaboration with physiotherapists as needed.

Safety and Referral

  • Refer for further evaluation if there are red flag symptoms (neurological signs, severe/progressive pain, inability to weight bear) or if SIJ pain is persistent despite conservative therapy.

  • Use clusters of SIJ tests and clinical history, not the sacral thrust test alone, to support diagnosis and interdisciplinary referrals.