Identifying the cause of pain is vital in providing proper patient treatment. This guide from physical therapist Valerie Phelps, PT, ScD, of the International Academy of Orthopedic Medicine, can be used to help identify one of the most common musculoskeletal problems in the lower back and buttock region – sacroiliac joint dysfunction.

Patient background information

Always begin with an established system to gain information including patient history. This allows you to:

• Easily recognize common pathologies
• Identify new patterns of pain or clinical findings that can lead to detection of other specific disorders
• Educate and reassure your client on the possible problem
• Assist in selecting further consulting professionals

Patient history

The patient history should be an established system of seeking information and would include:

• Age of the patient
• A pain drawing used to help identify the pain
• Identifying what provokes or improves symptoms

Clinical testing

The clinical testing would include a mechanical provocation test that helps answer the following questions:

• Is it painful?
• What provokes/improves symptoms?
• Where is it painful?
• Is this pain familiar (pain that has been bothering you for a period of time) vs. discomfort caused by the clinical test itself?

Battery of tests to determine areas of pain

• Trunk motions
  • Forward flexion
  • Forward flexion with the addition of a chin-tuck
  • Extension
  • Side-bending to each side
• Straight-leg raise performed supine on a table
• Slump test (a dural test performed while sitting)
• Sacroiliac joint provocation
  • Dorsolateral provocation
  • Ventromedial provocation
  • Asymmetrical in side lying

Pathologies for sacroiliac joint dysfunction

• Arthropathy
  • Synovitis
  • Hyper/hypomobility
• Pubic Symphysis
• Pelvic Ring Dysfunction

Common contributors to sacroiliac joint pathology

• Age (generally 18-35 years)
• Pregnancy
• Participation in sports that require strong unilateral movements, such as soccer

Common identifiers of sacroiliac joint pathology

• Painful with asymmetrical movements, like standing on one leg, or taking stairs two at a time
• Generally, shows localized region of pain at about the area of the PSIS
• About 40% of the time the patient will show some referral pain pattern to the greater trochanter
• If complaining of pain in lumbar region or down the leg, it’s rarely associated with SI joint pathology

Clinical test results that help identify sacroiliac joint dysfunction

• Trunk and hip motions will potentially be painful at the end range where the joint gets a torque or tension to it
  • End range flexion
  • End range extension
• Straight-leg raise test and slump testing will be negative
• Painful provocation tests
  • Pain reduced/relieved when a stabilizing belt is applied, and the test is repeated

Additional tests when the patient also complains of midline or groin pain

• Resisted adduction in 45°
  • This test is classically painful with a pubic symphysis problem
  • Pain resolves when repeated adduction is performed with a pelvic ring stabilizing belt

Sacroiliac joint and pubic symphysis often create pelvic ring dysfunction

• May or may not be associated with pain
• Patient may complain of vague discomfort in the “panty area”
• A straight leg raise test can be done to test strength of each side

Ways to manage sacroiliac joint dysfunction

• Education
• Manipulation to restore the position of the SI joint, as needed
• Injections
  • SI joint
  • Pubic symphysis
• Stabilization training
  • Diaphram
  • Abdominals
  • Gluteals
  • Latissimus Dorsi
• SI-LOC Support Belt application
  • Often 24/7 for up to 2 years to allow for connective tissue to turn over, resulting in “tighter” ligamentous support
  • Can be worn less often, (during the pain producing activity, for instance) in less severe cases

The SI-LOC Support Belt is effective for treating SI joint dysfunction. Its lightweight, breathable fabric can be worn against the skin and conceals easily under clothes.

Learn more about the SI-LOC Support Belt

For more information about SI joint dysfunction and other physical therapy topics, visit IAOM-us.com

Valerie Phelps, PT, ScD, is a physical therapist and the founder and director of Advanced Physical Therapy. She is also the founder of the U.S. branch of the International Academy of Orthopedic Medicine (IAOM) where she serves as education director.