Sacroiliac Joint Dysfunction (syndrome)


While many conditions refer pain to the sacroiliac joint (SI), low back, and legs, the SI joint itself can also cause pain in those areas.  The cause of pain is differentiated by looking at clusters of signs and symptoms that help to implicate the SI joint as the origin of pain.

Implicating the Sacroiliac Joint

  • Pain upon palpation of the SI joint
  • Pain presentation that is with or without LE pain that is unilateral or bilateral
  • Tender points during palpation of the PSIS
  • Lower Lumbar pain in 72% of cases (rarely pain above L5 and usually not at midline)
  • Pain radiates over buttocks (94%) and posterior-lateral thigh (50%)
  • Pain in anterior thigh (10%)
  • Pain may be aggravated by sitting or lying on the affected side
  • Pain worsens with prolonged sitting, weight bearing through the affected side, Valsalva maneuver, and trunk flexion with straight legs
  • No signs or symptoms associated with constitutional symptoms

Sacroiliac Provocation Tests (see videos tab above)

  • Compression Test
  • Distraction Test
  • Patrick's Sign
  • Gaenslen Test
  • Thigh Thrust Test
  • Sacral Thrust Test
  • Drop Test
  • Fortin's Finger Test
  • Gillet Test
  • Supine Long-Sit Test
  • Prone Knee Bend Test
  • Standing Flexion Test

Sacroiliac Joint Pain Clinical Prediction Rule (probability exceeds 70%)

  1. Three or more provocation tests (of the bolded tests above) provoke the usual pain
  2. Centralization of pain is not achieved during a Mckenzie evaluation of repeated movements/sustained positions.

Who is at risk?

  • Leg length discrepancy
  • Abnormal gait pattern
  • Trauma
  • Scoliosis
  • Lumbar fusion surgery with fixation of the sacrum
  • Heavy physical exertion
  • Pregnancy (pregnancy related pelvic girdle pain raises probability of SIJP to 90% when following the CPR)


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