Using published evidence to guide the examination of the sacroiliac joint region

Although some people in the medical community accept the premise that the sacroiliac joint (SIJ) can be a source of pain secondary to pathology (eg, spondyloarthropathy, infection, malignancy, fracture),(1) whether SIJ dysfunction exists remains controversial. ''Sacroiliac joint dysfunction" is a term often used to describe pain in or around the region of the joint that is presumed to be due to biomechanical disorders of the joint leg, hypomobility, malalignment, fixation, subluxation).(2,3) Some people consider the term "SIJ dysfunction" to be a misnomer because it is difficult to determine whether the joint itself is the source of the pain.(4,5) Due to the anatomy and location of the SIJ, examination procedures presumed to test the joint may test other structures in the region. Others dismiss the SIJ as a source of pain because well-recognized pain-sensitive structures, such as the posterior facet joints and nerve roots, may refer pain to the SIJ region.(5,6) Still other investigators have reported that 22%(7) to 30%(8) of subjects with pain around the SIJ region experienced some relief following anesthetic injection of the joint. Pain relief following anesthetic injection, however, does not necessarily indicate dysfunction of the joint. Structures unrelated to the joint, but in the same region, may be affected due to infiltration of anesthetic to soft tissues beyond the SJJ.(9) Despite the controversy and differing views on the sources of pain in the SIJ region, we believe many therapists commonly examine some of their patients for the presence of what they call "SIJ dysfunction." Battie and colleagues,(10) for example, surveyed 186 Washington State therapists about the care of patients with low back pain (LBP) and found that 75% of the therapists would use screening procedures they believed tested SIJ function.