SIJ Pain: How do we diagnose it????

It is suspected that 13-15% of individuals with low back pain likely have pain referred from the sacroiliac joint (SIJ).   There have been multiple proposed ways to assess for dysfunction in this area, but due to a lack of a diagnostic reference standard, the validity for testing for disorder is unknown.  Despite this, the most convincing evidence for the diagnosis of SIJ “pain” is provocation testing.  When comparing provocation testing to nerve root blocks to the SIJ, it has been determined that the tests have a sensitivity of 94% and specificity of 78% (when 3+ are positive).  The Gillets, standing flexion, long sitting(leg length discrepency) and other previously used palpatory tests have been shown to have poor interexaminer reliability, as well as lack sensitivity and specificity.
Bottom line: When attempting to differentiate pain at the SIJ, use provocation.
You can learn more about how to use these tests here.

 Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. JMMT 2009; 16: 142-152.
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  • While it is rare that a “true” SIJ mechanical diagnosis is made, it like others is not impossible. Other than the Laslett 7 Provocation tests, it is also suggested to rule out with a repeated motion exam first to see if the Sx are affected. If so, the mechanical Dx of lumbar derangement is then assigned. That’s what is suggested in the literature anyway. In practice, if a patient responds to MDT and OMPT, but seems to plateau early, I check the SIJ and treat accordingly.
    The cases of SIJ only pathology (hypermobility) without accompanying hip and lumbar dysfunction usually respond very well to stabilization with a belt.

    Erson Religioso III February 10, 2012 8:48 am Reply
  • From Laslett’s paper and publications post-this-paper on the SIJ, authors are very hesitant on using the diagnosis “SIJ dysfunction” and suggest we call it “SIJ pain”. I agree that movement examinations are necessary…especially when attempting to discover the “comparable sign” for the patients “chief complaint”.

    josephbrence February 10, 2012 7:01 pm Reply

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