Execution
- 1Position the patient so the sacrum and ilium can be palpated while the pelvis is moved.
- 2Palpate the sacral sulcus, PSIS region, or sacroiliac joint line to monitor relative movement.
- 3Guide the innominate into a movement expected to encourage counternutation or posterior rotation of the ilium.
- 4Compare the amount and quality of motion with the opposite side.
- 5Record pain, restriction, asymmetry, and end feel.
Positive outcome
Reduced movement, pain over the SIJ, or clear asymmetry is considered abnormal. Magee describes counternutation as the opposite motion to nutation, sometimes called sacral unlocking. Because the expected motion is small, palpatory diagnosis is weak.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| van der Wurff et al. (2000) — systematic review | NA | NA | NA | NA | NA |
| Sturesson et al. (2000) — radiostereometric motion study | NA | NA | NA | NA | NA |
CommentCounternutation assessment is a traditional SIJ motion-palpation concept, but its clinical reliability is poor. The movement is small and difficult to distinguish from lumbar, hip, and soft-tissue motion. It should not be used as a standalone diagnosis of SIJ dysfunction.
Low Clinical Value