Non-Painful SIJ Dysfunction

We recently have had a change in stance regarding the assessment of SIJ Dysfunction. In the past, we had been strong advocates for primarily utilizing clusters of pain provocation tests for SIJ Dysfunction as they consist of greater specificity/sensitivity and reliability values than motion restriction tests. In fact, we have even had posts about avoiding those motion restriction tests altogether.

Upon reviewing the APTA SIJ monograph by Jackson and Porter, the topic of non-painful SIJ Dysfunction was introduced. When we assess other joints, we are always accounting for any restrictions present. Take the cervical spine, for example. If a patient has cervical pain, we always assess the shoulder and thoracic spine for restrictions as well and follow up with treatment in the area. The reason being that hypomobility in the shoulder can lead to hypermobility in the cervical spine in order to fulfill movement requirements. This added stress often becomes painful. The same applies to the sacroiliac joint. Low back pain often results from hypermobility, secondary to hypomobility in nearby joints. The hip is one of the usual suspects (and rightly so), but shouldn't we also consider the chance that SIJ restrictions contribute to the excessive motion in the lumbar spine?

Jackson and Porter bring up the fact that there is essentially no research on the topic of non-painful SIJ Dysfunction. Once again, just because there is no research in an area, does not indicate that it should be dismissed as non-existent. We tend to become overly reliant on our pain provocation tests. So what do we do? We definitely recommend still utilizing your clusters, palpating soft tissue, and utilizing subjective information such as Fortin's Sign to aid in diagnosing painful SIJ Dysfunction. As for non-painful dysfunction, practice and implement the motion restriction tests that you are taught in school. We are trained to be competent in tests like Lachman's and Drawer Tests that require identification of differences in movement around a few millimeters. In theory, we should be able to identify some abnormalities in the sacroiliac joint as well. Now, we recognize that research has shown poor reliability for those tests and for good reason, but they may still aide in picking up severe restrictions that will lead to diagnosis and treatment in order to facilitate the return to normal mobility.

Reference:
Jackson R and Porter K. The Pelvis and Sacroiliac Joint: Physical Therapy Patient Management Utilizing Current Evidence. Current Concepts of Orthopaedic Physical Therapy, 3rd Ed. La Crosse, WI. 2011.