Execution
- 1Position the patient prone on a firm surface.
- 2Place the heel or base of the hand over the midline sacrum.
- 3Apply a posterior-to-anterior force through the sacrum.
- 4Direct the force cranially when performing Magee’s sacral apex pressure variation.
- 5Ask whether the pressure reproduces the patient’s familiar sacroiliac region pain.
Positive outcome
Pain produced over the sacroiliac joint is positive. A cranially directed force shears the sacrum on the ilium, while a more anterior force creates rotational stress through the SI joints. Familiar pain reproduction is more meaningful than nonspecific local pressure pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Laslett et al. (2005) | NA | 63 | 75 | 2.52 | 0.49 |
| Stuber (2007) — systematic review | NA | NA | NA | NA | NA |
CommentSacral thrust has moderate standalone accuracy and is most useful as part of the SIJ provocation cluster. Magee lists both sacral apex pressure and sacral thrust concepts, so the force direction should be documented. A single positive sacral thrust does not prove the SI joint is the pain generator.
Moderate Clinical Value