Gaenslen’s Test

Gaenslen’s Test (Gaenslen’s Maneuver) is one of the five classical provocation tests used to identify musculoskeletal disorders and chronic inflammatory conditions of the lumbar spine and sacroiliac (SI) joint. The other commonly used SI joint pain provocation tests include the Distraction Test, Thigh Thrust Test, Compression Test, and Sacral Thrust Test.

When SI joint pain is suspected, evidence suggests that a cluster approach should be used – at least three positive tests – to improve diagnostic accuracy, particularly in patients with low back pain that does not centralize with repeated movement testing. Centralization is highly specific for discogenic pain, and in such cases, positive SI joint tests should be disregarded.

Gaenslen’s Test may also be helpful when evaluating pubic symphysis instability, hip joint pathology, L4 nerve root involvement, or femoral nerve stress. For this reason, it is often applied in the differential diagnosis of spondyloarthritis, sciatica, and other rheumatological conditions affecting the SI joint.

Purpose

The primary aims of Gaenslen’s Test are to:

• Identify pain originating from the sacroiliac joint

• Differentiate SI joint pathology from other causes of low back or pelvic pain

• Support diagnostic certainty when combined with other SI joint provocation tests

Clinical Signs

• Localized pain in the SI joint, hip joint, or pubic symphysis

• Pain radiating along the L4 nerve root distribution

• Reproduction of the patient’s familiar pain is considered a key positive indicator

Test Procedure

Patient position:

• The patient lies supine with the painful leg positioned at the edge of the treatment table.

Asymptomatic leg:

• The hip and knee are flexed to approximately 90°, and the patient holds the knee to the chest with both arms.

Symptomatic leg:

• The examiner stabilizes the pelvis with one hand and applies gentle downward pressure with the other hand to extend the symptomatic leg beyond the edge of the table.

Movement:

• This maneuver creates a torsional stress on the pelvis: the asymptomatic leg is forced into flexion while the symptomatic leg is extended.

• This differential movement provokes the SI joint.

Tips:

• In cases of bilateral pain, the test should be performed on both sides to assess asymmetry and pain localization.

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Interpretation

• Positive test: Reproduction of the patient’s typical pain in the SI joint, hip, or pubic symphysis. In some cases, it may also indicate L4 nerve root irritation.

• Negative test: No pain or discomfort during the maneuver.

Evidence

• Sensitivity: 37–61.5% (variable across studies)

• Specificity: 33.3–100% (protocol-dependent)

• Positive likelihood ratio (LR+): 1.02–2.29 (limited to moderate diagnostic utility)

• Negative likelihood ratio (LR–): 0.65–1.11 (not sufficient to rule out SI pathology alone)

• Inter-tester reliability (Kappa): 0.54–0.76

Best diagnostic accuracy is achieved when Gaenslen’s Test is positive in combination with at least two other SI joint provocation tests.

Clinical Relevance

Gaenslen’s Test is particularly valuable for:

• Provoking pain from the sacroiliac joint in patients with non-centralizing low back pain

• Differentiating SI joint dysfunction from hip joint pathology, pubic symphysis instability, or L4 radiculopathy

• Assisting in the diagnostic work-up for spondyloarthritis, sciatica, and inflammatory spinal disorders

Following a positive test, further diagnostic confirmation with imaging (e.g., MRI) or diagnostic anesthetic injection into the SI joint is recommended. Fluoroscopic guidance is considered the gold standard for accurate needle placement.

Limitations

• Low to moderate sensitivity and specificity – should not be used as a standalone test

• Can yield false positives in cases of hip pathology, L4 root irritation, or pubic symphysis dysfunction

• Must always be interpreted in the context of history, other clinical tests, and imaging findings

Summary

Gaenslen’s Test is a practical and widely used provocation test for assessing sacroiliac joint dysfunction. It should always be performed bilaterally and interpreted as part of a multi-test battery. A positive result is indicated by reproduction of the patient’s familiar pain in the SI joint or related pelvic structures. While easy to perform, the test has limited diagnostic accuracy in isolation and should be combined with other clinical assessments and, when necessary, advanced imaging for diagnostic confirmation.

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