Gaenslen’s Test

What is Gaenslen’s Test?

The Gaenslen’s Test is used to detect any pathology or dysfunction around the sacroiliac joint. It is a special test for detecting Sacroiliac dysfunction.

Gaenslen’s Test is performed around the Sacroiliac joint to detect any inflammatory process or anything wrong (dysfunction, pathology) around the SI joint.

It is one of the five provocation tests. There are usually five provocative tests that are used for diagnosing SIJ dysfunction. The names of these 5 provocative tests are as follows

What is the provocative test?

A provocative test places stress on the joints to get a response or reproduce the symptoms. Therefore doctors perform these provocative tests to find out whether the pain is originating from the SI joint. These tests are used to isolate the SI joint as the source of pain.

Gaenslen’s test is one of the five provocation tests

As mentioned above, Gaenslen’s test comes under these five provocative tests for diagnosing SIJ dysfunction. Therefore Gaenslen’s test is used in combination with these above-mentioned tests to get a more precise diagnosis of SIJ dysfunction.

In these five provocative tests, one positive test raises suspicion. More than three positive provocative tests could indicate that the SI joint is a pain generator.

According to the Laslett study, three or more positive provocative tests result in 78% specificity & 91% sensitivity.

Sensitivity means how accurately the test can identify or diagnose the condition. The combination of three or more positive provocative tests results in 91% sensitivity. This is a good indication.

Specificity means how accurately a test rules out or excludes the condition. The combination of three or more positive provocative tests results in 78% specificity. This is also a good indication.

Hence the clinical prediction rule of three or more positive provocation tests that provoke back pain. This helps to identify patients that are more likely to have Sacroiliac joint pain than any other painful condition.

How do you perform Gaenslen’s Maneuver/Test?

  • The patient should lie in a supine position with the tested leg resting on the edge of the table.
  • The examiner then asks the patient to flex his non-tested side leg’s hip and knee joint towards his chest. The examiner then asks the patient to hold this position by both of his hands.
  • On the side to be tested, the thigh should be unsupported and allowed to fall over the side of the examination table (hangs over the edge of the table).
  • The examiner then pushes the non-tested side leg (flexed hip and knee joint) towards the patient’s chest. While the tested leg which is allowed to fall over the side of the examination table is pushed towards the floor.

Note – Here pushes mean the examiner applies a firm pressure.

Gaenslen's-testTest Results

Gaenslen’s Test is considered positive if the patient complains of low back pain while the test is performed. The location of the low back pain (either left side or right side) will depend on the side being affected.

If the Left side SI joint is affected then the patient will complain of lower back pain on the left side. If the right side SI joint is affected then the patient will complain of lower back pain on the right side.

How to identify which side Sacroiliac joint is affected?

There are two sacroiliac joints in the body, the left SI joint and the right SI joint.

For checking Left Side SI joint Pain

If you are testing for the left side SI joint pain then the left leg would hang over the edge of the table. And the right leg’s hip and knee joint would be flexed towards the patient’s chest.  The examiner then pushes the right leg towards the patient’s chest and the left leg towards the floor. If positive then the patient will complain of lower back pain on the left side.

For checking Right Side SI joint Pain

If you are testing for the right side SI joint pain then the right leg would hang over the edge of the table. And the left leg’s hip and knee joint would be flexed towards the patient’s chest. Then the examiner then pushes the left leg towards the patient’s chest and the right leg towards the floor. If positive then the patient will complain of lower back pain on the right side.

Diagnostic Accuracy

According to Laslett et al. (2005),

When Gaenslen’s test was performed for the right SI joint, it has a sensitivity of 53% and a specificity of 71%. And when it was performed for the left SI joint, it has a sensitivity of  50% and a specificity of 77%.

SI joint Sensitivity Specificity
Left SI Joint 53% 71%
Right SI Joint 50% 77%

Due to low diagnostic accuracy (low sensitivity), this test is considered a weak test. That’s why Gaenslen’s is used in combination with the other tests to get a more precise diagnosis of SIJ dysfunction.

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Lasegue Straight Leg Drop Test –  To detect the problems or disorders in the lumbar spine or sacroiliac joint.

Neer test – For Detecting the presence of Shoulder Impingement Syndrome

90/90 Hamstrings Test – For Detecting Tightness in the Hamstrings Muscles

Prone Knee Bend Test – To assess mechanical functions and mechanosensitivity of nerve roots (L2 & L3), and the functions of the femoral nerve.

Apley’s Test – Both Compression and Distraction Test

Empty Can Test – For Examining the Supraspinatus Muscle and the Supraspinatus Tendon

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