Squish test: How to perform, interpret, and document findings

Key Takeaways

The squish test is a manual pelvic compression provocation test used to assess sacroiliac joint dysfunction and pelvic ring integrity.

A positive result reproduces familiar pain in the SI joint or groin. It doesn’t confirm a diagnosis alone, so use it as part of a test cluster.

Common errors include incorrect hand placement and failure to distinguish provoked local pain from referred pain, which distorts your findings.

Pabau’s SOAP-style clinical notes let you standardize squish test documentation across your team, capturing pain location, VAS score, and force applied in one structured record.

What is the squish test and why does it matter in clinical practice?

A sacroiliac joint diagnosis depends on including a dedicated pelvic provocation test in the examination sequence. The squish test is one of the fastest tests to add to that sequence.

The squish test is a manual pelvic compression provocation test. The clinician applies anterolateral-to-posteromedial force across the iliac crests while the patient lies supine, stressing the sacroiliac joint and anterior pelvic ligaments. A positive result reproduces the patient’s familiar pain in the SI joint region or groin, suggesting sacroiliac joint dysfunction or pelvic ring compromise.

The name is informal but the mechanism is precise. By compressing the iliac wings toward each other, the test gaps the posterior SI joint and loads the anterior ligamentous structures. That directional stress is what differentiates it from tests that distract or rotate the pelvis.

This guide covers what a practicing clinician needs: indications, technique, result interpretation, published diagnostic accuracy data, comparison with related tests, common errors, and documentation. Only qualified clinicians should perform this test. It is not a self-administered procedure.

Clinical indications: When to use it

The squish test earns its place in the examination when the clinical picture points toward pelvic or sacroiliac pathology. Using it indiscriminately adds noise. Using it selectively adds diagnostic signal.

Consider adding the squish test when a patient presents with any of the following:

• Unilateral or bilateral low back pain below L5 with a gluteal or posterior pelvic distribution
• Groin pain without a clear hip joint origin on FABER or hip scour testing
• Post-partum pelvic girdle pain or peri-menopausal musculoskeletal complaint
• Post-trauma presentation where pelvic ring fracture needs rapid triage (emergency or acute care setting)
• Suspected sacroiliitis in a patient with inflammatory arthropathy history
• Persistent low back pain that has not responded to lumbar spine treatment

Contraindications are equally important. Do not perform the squish test if there’s a known or suspected acute pelvic fracture, active osteoporosis with high fragility fracture risk, or confirmed pregnancy. This applies especially in the second and third trimester. Stop the test immediately if severe pain, neurological symptoms, or cardiovascular instability arise during application.

Physiotherapists, chiropractors, osteopaths, orthopedic surgeons, and emergency physicians all use the squish test, depending on scope of practice and clinical setting. For guidance on which assessments fall within your professional scope, the American Physical Therapy Association’s clinical practice resources provide a useful reference point. In the UK, the Chartered Society of Physiotherapy’s national evidence-based guidance covers musculoskeletal assessment standards.

Practitioners working in physical therapy or sports medicine settings will encounter this test most frequently, particularly in pelvic girdle pain and post-trauma triage pathways. Practitioners new to physiotherapy practice compliance requirements should note this. Documenting which tests were performed, by whom, and with what outcome is part of clinical governance.

How to perform the squish test: Step-by-step technique

Consistent technique is what makes provocation tests repeatable across clinicians and appointments. Vary the hand placement or force direction and you change what structure you are actually testing.

1. Position the patient supine on a firm examination plinth. The legs should be relaxed and extended. Ensure the patient is not guarding or bracing before you begin.
2. Stand beside the patient at the level of their pelvis. Either side works. Choose whichever gives you the most stable stance.
3. Place both hands on the anterior superior iliac spines (ASIS), with your palms flat over the iliac crests. Fingers point anteriorly. Do not grip the bony prominences.
4. Apply slow, steady, anterolateral-to-posteromedial force. You are compressing the iliac wings toward each other. The vector is inward and slightly downward toward the examination table, not straight down.
5. Sustain the force for 5-10 seconds. Maintain constant pressure rather than a sharp impulse. Ask the patient to report any pain and to identify its location.
6. Release gradually and ask the patient to rate the intensity of any pain provoked using a numeric pain scale (0-10).
7. Record the response: location of pain (SI joint, groin, pubic symphysis, or referred pattern), whether it’s familiar or unfamiliar, and the pain score at provocation.

How to interpret squish test results

Interpreting the squish test is not simply a binary pass/fail. The quality of the pain response matters as much as its presence.

A positive squish test increases clinical suspicion but does not confirm a diagnosis. The test must always form part of a broader examination strategy, not stand alone as a definitive finding.

Sensitivity, specificity, and diagnostic accuracy of the squish test

Published data on the squish test’s diagnostic accuracy varies by study population and reference standard. The honest summary: it has moderate sensitivity for SI joint pain and lower specificity used in isolation.

In the context of sacroiliac joint assessment, individual provocation tests including the squish test typically show sensitivity of 40 to 69%. Specificity typically falls between 69 and 80%, depending on the study and reference standard used. These figures should be cited with caution because exact values differ across publications. Always refer to primary literature for the specific numbers you use clinically.

The most clinically important finding from the research literature is not about the squish test alone. Research published in Manual Therapy by Laslett and colleagues established a key finding. Using a cluster of three or more positive SI joint provocation tests substantially increases diagnostic reliability over any single test. The squish test is one valid member of that cluster, but it cannot carry the diagnostic load by itself.

For return-to-activity protocols in physical therapy, this matters practically: a single positive squish test should inform clinical reasoning, not trigger a diagnosis in isolation. Pair it with the Thigh Thrust, Distraction Test, and FABER as part of your standard pelvic provocation battery.

Squish test vs other pelvic provocation tests: A comparison

Understanding where the squish test fits in the broader toolkit matters. It stops clinicians from over-relying on it, and from dismissing it when it would add value. The Ottawa decision rules illustrate a useful principle: structured multi-test approaches outperform single-test clinical intuition for musculoskeletal triage. The same logic applies to the SI joint.

The squish test is the only test in this group that applies a medial compression vector. That makes it uniquely useful for stressing the anterior pelvic ligamentous complex, a structure the Thigh Thrust and Distraction tests do not directly target. Include it specifically when anterior SI ligament involvement is part of your differential.

Common technique mistakes to avoid

Technique errors are what typically produce false positives, false negatives, and unreproducible findings across appointments.

These are the errors most likely to compromise your squish test results:

• Wrong hand position. Placing palms on the greater trochanters instead of the ASIS applies force in a different plane and stresses hip structures, not the SI joint. Confirm bony landmarks before applying pressure.
• Using a downward-only vector. Pure downward pressure compresses the femoral heads and lumbar spine, not the iliac wings. The vector must travel inward (medially) as well as down.
• Too much force, too fast. A sharp impulse provokes guarding before the SI joint has time to respond. Ramp pressure slowly over 2-3 seconds and sustain it.
• Not documenting baseline pain first. If the patient already has pain at rest, a provocation test reading is meaningless without a pre-test baseline. Ask for a 0-10 pain score before you touch them.
• Accepting any pain as a positive result. Only familiar, concordant pain (the pain the patient came in with) counts as a positive provocation. Non-specific discomfort from the pressure itself is not a positive finding.
• Skipping the test because positioning looks difficult. A patient with hip pathology who cannot fully extend their legs can still receive a modified squish test in slight hip flexion. Document the modification and its rationale.

Practitioners working with populations at higher fracture risk, such as those at osteopathy practices or chiropractic practices, should treat pre-screening for contraindications as non-negotiable. APTA’s directory of evidence-based tests and measures is a useful starting point for reviewing established assessment standards.

Documenting squish test findings in clinical practice

Most clinical disagreements about provocation test findings come down to documentation, not clinical skill. Two clinicians can perform the same squish test at different appointments and reach different conclusions. The patient didn’t change. Neither clinician recorded the force applied, the patient’s position, or what “positive” meant in their notes.

Good squish test documentation captures the following six elements:

1. Baseline pain score (0-10) before any provocation
2. Patient position (standard supine, modified hip flexion, or other variant with reason noted)
3. Pain location on provocation (SI joint region, groin, pubic symphysis, referred pattern)
4. Pain concordance (familiar/unfamiliar with presenting complaint)
5. Provoked pain score (0-10) at time of test
6. Test outcome (positive, negative, inconclusive, aborted with reason)

Structured SOAP notes are the standard vehicle for capturing this. Safer clinical note-writing practices recommend using templated fields for examination findings rather than free-text descriptions. Free text introduces variability across clinicians and makes audit trails harder to follow. Platforms that offer pre-structured SOAP note frameworks reduce documentation time while improving the completeness of the record.

How Pabau standardizes provocation test documentation

Practice management software like Pabau turns this documentation standard into a repeatable clinical workflow.

Pabau’s clinical records module supports custom assessment templates. Practice managers can build a standardized pelvic provocation battery template that every clinician follows consistently. Digital intake forms can capture the patient-reported pain history before the appointment, giving clinicians the pre-test baseline they need before any provocation test begins. For chiropractic and musculoskeletal practices, having that baseline ready before the clinician enters the room saves time. That efficiency compounds across hundreds of appointments a year.

Standardize your clinical assessments from intake to follow-up

Pabau helps physiotherapists, chiropractors, and sports medicine clinicians capture structured clinical notes, track provocation test findings, and manage patient records across every appointment.

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Conclusion

The squish test is a simple, low-cost, high-value addition to any pelvic examination sequence. Its specific contribution is stressing the anterior SI ligamentous complex via a medial compression vector. No other standard provocation test in the SI cluster achieves that in the same way. Used alone, its diagnostic accuracy is moderate at best. Used as part of a three-test or five-test cluster, it materially improves the clinical picture.

The clinicians who get the most from this test apply consistent technique and document findings in enough detail to reproduce the examination next time. They treat a positive result as a prompt to investigate further, not as a conclusion. If your documentation workflow makes that harder than it should be, structured clinical templates can help. Book a demo to standardize your provocation test records across every practitioner on your team.

Continue your research

Need a structured framework for safer musculoskeletal notes? Safer clinical notes covers documentation standards that reduce clinical risk across provocation testing and examination workflows.

Managing a physical therapy or chiropractic practice? Pabau’s pelvic health software is built for clinicians specializing in pelvic girdle pain, sacroiliac assessment, and post-natal musculoskeletal care.

Want to reduce documentation variability across your clinical team? Capture forms software lets you build standardized assessment templates that every clinician completes the same way, every time.

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