Test: Posterior Pelvic Pain Provocation

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Background/Purpose

This test is know by different names including the Thigh Thrust Test, PPPP test,
P4 test, Posterior shear test and POSH test.
The goal of this test is to help differentiate pain of pelvic pain from lumbar pain. In a study by Annelie Gutke et al showed good differentiation in identifying patients with pelvic girdle pain from those with an established disc herniation.
The test is also commonly used to identify pelvic girdle pain in pregnant patients.
Because there is hip flexion involved up to 90 degrees, there is some assumption that the hip should be without pathology to get an accurate assessment.

Procedure

The subject is placed supine on the examination table . The clinician stands on the opposite side the patient's leg being tested . The testing side hip and knee placed in 90 degrees of flexion. The clinician applies a manual downward pressure on the knee directing a pressure through the femur. The test is considered a fail if the subject notes a familiar well-localized pain deep in the gluteal area on the provoked side.
Alternate versions of this test include placing a hand underneath the sacrum on the side being tested to increase shear in the SIJ (Laslett) as well as a gradual axial loading of pressure beginning at 45 degrees of hip flexion with the final test position being 90 degrees.
Performed: Unilaterally

Dialog

Posterior pelvic loading through a flexed hip.

Criteria

• No pain radiating into pelvis or gluteal area.

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail