Squish test

As its name suggests, the squish test involves pressing firmly on the pelvis. It takes its name from the English word “squish,” meaning to compress or squash. The Integrative Manual Therapy textbook compiled by Sharon Weiselfish-Giammatteo and Thomas Giammatteo introduces it as one of the tests used to compare pelvic joint mobility. It resembles the osteopathic ASIS compression test in that it uses the bony prominence at the front of the pelvis (ASIS, anterior superior iliac spine) to assess the joint’s response.

The pelvic joints are the sacroiliac joint and the pubic symphysis. This test looks at how the sacroiliac joint and the ilium respond.

In IMT, a healthy joint is considered to have a small but distinct amount of accessory movement. This is called joint play. If the joint yields through this available movement, the ilium simply moves inward when pushed. If the joint is stiff, however, it has no room to yield, so the applied force travels across the pelvis to the opposite side.

The practitioner therefore slowly pushes one ilium backward and inward, then checks whether the opposite ASIS moves forward. If the opposite ASIS moves, it means that the joint on the side being pressed has not absorbed the force; in this approach, that side is interpreted as hypomobile. In IMT, the side with greater hypomobility is treated first. Applying a steady force is also important, so the textbook recommends pushing slowly while keeping the physical law of inertia in mind.

You wear comfortable clothes and lie on your back. The practitioner slowly pushes one ilium with one hand while resting the other hand lightly over the opposite ASIS. Through the fingertips of that hand, the practitioner feels what movement is transmitted, how quickly it occurs, and how little force is needed to produce it. The practitioner alternates sides to compare their responses.

There is very little for you to do. You simply relax and lie still. You may feel a little pressure, but this is not a test in which pressure is applied hard enough to hurt.

• People with persistent aching along the side of one buttock or the pelvis who want to know which side is stiffer
• People who feel that their pelvis tilts to one side when standing or sitting
• People who have been told they have a sacroiliac joint problem and want to understand the order of treatment

IMT does not draw a conclusion from this test alone. The practitioner first compares the palpable pelvic landmarks at the front and back of the pelvis to assess the position in which the ilium is restricted, then uses the standing flexion test and squish test to determine which side is stiffer. For example, if the right ASIS is more medial than the left and both mobility tests indicate right-sided hypomobility, the right ilium is considered to be turned inward (inflare). The identified side is treated first using a method such as the Muscle Energy and Beyond technique, and the ASIS positions are compared again afterward to check for a change.

• Because this test compares what the practitioner feels through their fingertips, explanations may vary between practitioners. If you are curious, ask which side felt stiffer.
• Tell the practitioner beforehand if you have had lower back or pelvic surgery, or if you have severe pain.
• After the test, try asking the practitioner to explain “which side you will start releasing today, and how.” This can help you see how the assessment connects to the treatment.

The standing flexion test looks at how far the bony landmarks at the back of the pelvis rise when you bend forward while standing, assessing what happens as the body moves. The squish test is performed while you lie relaxed and assesses how the joints respond to an externally applied force. Using both tests allows the practitioner to compare findings in standing with responses in lying.