Goldthwait's Test: Differentiating SI Joint vs. Lumbar Pain

Goldthwait's Test is a useful clinical maneuver used to determine if a patient's low back pain is originating from the Sacroiliac joint or the Lumbar spine. It uses palpation of the spinous processes during a leg raise to differentiate the source.

[Image of Goldthwait's Test]

1. Purpose

The primary purpose of Goldthwait's Test is to **differentiate** between pain arising from the Sacroiliac (SI) Joint versus pain arising from the Lumbar Spine (lumbosacral junction).

2. How to Perform

1. The patient is positioned in supine (lying on their back).
2. The examiner places one hand under the patient's lumbar spine (specifically palpating the interspinous spaces of L5-S1) to monitor for movement.
3. With the other hand, the examiner performs a passive Straight Leg Raise (SLR).
4. The examiner notes exactly when the patient reports pain and whether the lumbar spine processes have moved yet.

3. Interpretation of Results

This test helps pinpoint the source of pain based on timing:

• SI Joint Dysfunction: Pain is felt BEFORE the examiner feels the lumbar spine move (typically 0-30 degrees of flexion). The stress is on the SI joint before it reaches the spine.
• Lumbar Spine Dysfunction: Pain is felt AFTER the examiner feels the lumbar processes separate (typically after 40+ degrees of flexion). The stress has moved from the hip/SI joint into the lumbar spine.

Negative Test: No pain is produced during the maneuver.