Execution
- 1Position the patient supine near the edge of the table.
- 2Flex the test hip to approximately 90° with the knee flexed.
- 3Slightly adduct the thigh toward the midline as needed to align force through the femur.
- 4Stabilize the opposite ASIS or pelvis with one hand.
- 5Apply a graded posterior force through the long axis of the femur to shear the sacroiliac joint.
Positive outcome
Reproduction of the patient’s familiar posterior pelvic or sacroiliac pain is positive. The test is also called the posterior shear, POSH, or 4-P test. Hip or anterior thigh discomfort alone should be differentiated from true SIJ provocation.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Laslett et al. (2005) | NA | 88 | 69 | 2.84 | 0.17 |
| Szadek et al. (2009) — systematic review | NA | 91 | 66 | 2.68 | 0.14 |
CommentThigh thrust is one of the more sensitive single SIJ provocation tests, but its LR+ is still only moderate. The test is most useful inside a multi-test provocation cluster because single SIJ tests are not reliable enough to diagnose SIJ pain alone. Be careful to avoid interpreting hip joint pain as an SIJ positive.
Moderate Clinical Value