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Posterior Shear Test

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Other Names

  • PPPP Test
  • P4 Test
  • Thigh Thrust Test
  • Posterior Shear Test
  • POSH Test
  • Femur Thigh Thrust Test
  • Ostgaard Test
  • 4P Test


Demonstration of hand positioning in the femur thigh thrust test[1]
Demonstration of the posterior shear test[2]
  • Evaluate the Sacroiliac Joint
  • Help distinguish between pain originating from the pelvic girdle and lower back


  • The patient is supine, hip and knee flexed to 90°
  • One hand is placed beneath the sacrum in an attempt to stabilize its position
  • The examiner then loads the femur axial pressure, applying a posterior force the the acetabulum and ilium
  • Some have suggested to add hip adduction
  • Positive test:
    • Pelvic girdle pain is more likely if axial pressure provokes pain
    • Sacroiliac pain is more likely to not be provoked by this maneuver



See Also


  1. von Heymann, Wolfgang, Horst Moll, and Geraldine Rauch. "Study on sacroiliac joint diagnostics." Manuelle Medizin 56 (2018): 239-248.
  2. Image courtesy of https://www.thestudentphysicaltherapist.com/, "POSH Test"
  3. Broadhurst NA, Bond MJ. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J. Spinal Disord. 11(4), 341-345 (1998).
  4. JK Freburger, DL Riddle. Using published evidence to guide the examination of the sacroiliac joint region. Phys Ther. 2001; 81:1135–1143
Created by:
John Kiel on 7 August 2019 22:38:31
Last edited:
23 May 2023 17:17:00