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SI Techniques
Covering:
Nutation / Counter-nutation techniques
Prone
1. Counter nutation / Nutation of Sacrum
Gapping/Shearing Techniques
Sidelying
2. Gapping / Shearing
Supine
3. Gapping / Shearing
Anterior / Posterior Rotation Techniques
Prone
4. Anterior rotation of innominate x-handed – short lever
5. Anterior rotation of innominate – long lever
6. Posterior rotation of innominate
Sidelying
7. Anterior & Posterior rotation of the innominate (in front of patient)
8. Anterior rotation of the innominate (behind the patient)
Supine
9. Anterior rotation of the innominate
10. Posterior rotation of the innominate – cosy technique
1st year techniques not included in this booklet
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1. Prone – Counter nutation / Nutation of Sacrum
1.
2.
3.
4.
Patient lies prone
With the cranial hand, palpate one of the SI joints
With the caudal hand, fix below S2 and push downwards
Repeat palpating the other SI Joint
Note: Palpate for the sacrum moving against the innominate and you should feel the sulcus
getting smaller as the sacrum moves posteriorly
1. Nutation is the same as the Counter-nutation except this time caudal
hand is fixing and pushing above S2
2. Sidelying –Gapping / Shearing
1. Patient sidelying facing op
2. With cranial hand, palpate the upper SI joint
3. Put caudal forearm between the iliac crest and greater trochanter and
push down
Note: You can use either the anterior or posterior aspect of the forearm
1. Shearing is the same as posterior gapping except drive through in the
opposite direction
3. Supine – Gapping / Shearing
1.
2.
3.
4.
Patient lies supine
Op sits on plinth facing patient
Lift the nearest patient’s leg in to knee and hip flexion
Encircle the patient’s knee with cranial arm with palm resting on the
patient’s knee
5. Adduct thigh and with caudal hand slide under patient to palpate the SI
joint
6. Return the thigh to neutral
7. Move the thigh in to a number of positions:
a. Flex the hip to move the innominate posteriorly
b. Push down through the knee and hip to produce shearing
c. Adduct the thigh to gap the SI joint
Note: not good if patient has OA in hip or knee
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4. Prone - Anterior rotation of innominate x-handed – short lever
1. Patient lies prone
2. Fix cranial hand on sacrum below S2 fixing it in to counter-nutation with
fingers pointing distally
3. Put heel of the caudal hand on to PSIS furthest from op with fingers
pointing laterally
4. Push through cranial hand through apex of sacrum whilst applying a
caudal force in an antero-lateral direction.
Note: You may need to play with the direction through the caudal hand
5. Prone - Anterior rotation of innominate – long lever
or
Normal method
1.
2.
3.
4.
Patient lies prone
Flex the patient’s knee furthest from op
With caudal hand, lift leg and grip under thigh
Adduct the thigh

This ensures the direction of force is in-line with the sacrum
5. With cranial hand, spring through the PSIS
Applied Anatomy: This will put a stretch through rectus femoris which will help pull the ASIS
anteriorly
Alternative method
This method is for a patient with a tight rectus femoris.
1. Patient lies prone
2. Bring caudal hand under nearside knee and put palm on posterior
aspect of thigh furthest from you.
3. Put cranial forearm on PSIS and rotate
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6. Prone - Posterior rotation of innominate
1.
2.
3.
4.
Patient lies prone
Put caudal hand on lateral pelvis
Use cranial hand to fix sacrum in to nutation (above S2)
Lean back to pull on the caudal hand
Note: If ticklish, have patient put their own hand on ASIS and you grab it.
Note: Avoid grabbing the ASIS or pillow.
7. Sidelying – Anterior / Posterior rotation of innominate (In front of patient)
1. Patient sidelying facing op
2. Flex top leg and roll patient toward you

Bottom leg should remain fully extended
3. Rest leg on op’s abdomen / thigh
4. Put heel of hand on ASIS and forearm on ischial tuberosity
5. Brace the arms and move the body as a unit in to anterior and posterior
rotation
Note: You can use either the 1st year handhold where fingers are interlocked if prefer
Note: Bottom leg of patient should remain extended throughout to reduce tension in the
capsule and surrounding ligaments.
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8. Sidelying Anterior rotation of innominate (behind patient)
1.
2.
3.
4.
Patient sidelying facing away from op
Patient flexes bottom leg to 90° and grips with both hands
Caudal hand to bring top leg in to hip extension/adduction
Cranial hand to fix / push on upper PSIS in antero/superior direction

Small, rocking movement
Note: Plinth needs to be quite high so can drop it into adduction
Note: Alternative handhold to tuck patient’s foot under op’s arm but only works if long rectus
fermoris as means more than 90° of flexion.
Note: Traditional handhold is harder to hold but more adaptable as able to introduce varying
degrees of knee flexion. The alternative hold is lighter work but less adaptable
9. Prone Anterior/Posterior rotation – leg off table
and
1. Patient prone
2. Head rotated facing op

The rotation movement will track through the trunk towards neck
3. Bring the nearside leg off the table and support it on op’s cranial thigh

Ensure ankle is also supported on op’s caudal thigh
4. Position hands on ichial tuberosity / ASIS and perform anterior &
posterior rotation as did in sidelying position
Note: Plinth needs to be quite high
Note: No pillows necessary (unless patient’s feet are on the table) as not pushing lumbar spine
in to extension
Note: Only do this movement if the patient can abduct hip well
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10. Supine Anterior rotation
1. Patient Supine
2. Sit on plinth facing patient
3. Caudal hand palpates the SI Joint

Be sure to position this hand first
4. Cranial hand encircles thigh &with a broad applicator fix just below iliac
crest on the gluteals

Do not grab the iliac crest
5. Lean backwards
11. Supine Posterior rotation – “cosy” technique
1.
2.
3.
4.
Patient Supine
Flex the nearside hip and with caudal hand place on ischial tuberosity
Abduct the hip controlling it with abdomen and thigh
Cranial hand on ASIS

Fingers should point laterally
5. Pull the ischial tuberosity up whilst pushing the ASIS down
Note: Useful technique on pregnant women
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will donate at www.justgiving.com/SP2Technique