About Sacroiliac (SI) Pain
Sacroiliac (SI) pain isn’t as common as other conditions, such as lower back pain, but it’s often found among pregnant and postpartum women, and men and women who have experienced trauma to the area. For patients with lower back pain, the incidence of SI pain is 13% (9-26%) (1). Most patients in this group report buttock pain (94%), groin pain (14%), lower lumbar pain (72%) and lower extremity pain (50%) (3).
Problems with the SI joint used to be tough to diagnose due to a lack of a gold standard diagnostic test, along with diagnostic limitations related to movement based tests and static palpation tests. Both tests have shown positive for patients who are asymptomatic in reducing their specificity for diagnoses (2).
One helpful way to rule in or rule out lumbar spine involvement with SI pain is to conduct a repeated motions examination of the lumbar movements. Those with (+) provocative testing without centralizing lumbar motions show a 80% post test probability of experience SI pain (+ LR 6.97). Those who have a (-) provocation testing and did not centralize show a 5% post test probability of having SI pain (-PR 0.10) (4).
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How is it treated?
Medical experts agree that a multimodal treatment that includes joint mobilization /manipulation exercises, along taping and bracing, is the most effective approach for treating SI pain.
Laslett Et Al. Si Testing
- In the Distraction Test (testing right and left SI simultaneously), vertically oriented pressure is applied to the anterior superior iliac spinous processes directed posteriorly, distracting from the sacroiliac joint.
- In the Thigh Thrust Test (testing the right SI), the sacrum is fixated against the table with the left hand, and a vertically oriented force is applied through the line of the femur directed posteriorly, producing a posterior shearing force at the SIJ.
- In Gaenslen’s Test (testing the right SI in posterior rotation and the left SI in anterior rotation, the pelvis is stressed with a torsion force by a superior/posterior force applied to the right knee, and a posterioly directed force applied to the left knee.
- The Compression Test is used to test right and left SI.
- In the Sacral Thrust test (testing right and left SI simultaneously), a vertically directed force is applied to the midline of the sacrum at the apex of the curve of the sacrum, directed anteriorly, producing a posterior shearing force at the SIJ’s with the sacrum rotated.
What does the evidence say?
In Tullberg et al, there was a noted reduction in short-term pain and movement, without a change in the bony landmarks in the results of the CT scan (4). For a sub group of patients with lower back pain, there have been positive short and long-term outcomes for both pain and disability observed (5,6).
A randomized controlled trial of spinal stabilization training compared with usual medical management conducted by Hides et al. found a decreased recurrence (30% vs. 84% and future medical care (42% vs. 15%) in the stabilization group. For those in the medical management group, the risk of recurrence stayed high for up to 3 years (7). Among those patients that meet the spinal stabilization sub group criteria, there doesn’t appear to be a bigger effect on local versus global stabilization training (8).
Are you suffering from SI pain?
If you suffer from lower back pain, pelvic pain and groin pain along with what could be SI pain, then you could greatly benefit from physical therapy. Early manual therapy and exercise intervention helps to reduce SI pain and long-term disability. Interested in learning more? Contact Total Motion Physical Therapy today.
- Maigne, J. et al. Results of Sacroiliac Joint Double Block and Value of Sacroiliac Pain Provocation Tests in 54 Patients with Low Back Pain. Spine. 1996. 21(16):1889-1892
- Dreyfuss, P. et al. Positive sacroiliac tests in asymptomatic adults. Spine. 1994. 19:1138-1143.
- Slipman CW. Et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehab. 2000;8 1:334-8.
- Tullberg, T. et al. Manipulation Does Not Alter the Position of the Sacroiliac Joint: A Roentgen Stereo photogrammetric Analysis. Spine. 1998. 23(10_:1124-1128.
- Flymm T et al. A clinical prediction rule for classifying patients with low back pain who demonstrate a short-term improvement with spinal manipulation. Spine. 2002; 27(24):2835-2843.
- Childs, J. >Fritz. Et al. A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study. Annals of Int Med. 2004/920-928.
- Hides, J. et al. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. Spine. 2001. 26(11):243-248.
- Koumantakis, G. et al. Trunk Muscle Stabilization Training Plus General Exercise Versus General Exercise Only: Randomized Controlled Trial of Patients With Recurrent Low Back Pain. Phys Ther. 2005;85:209-225