SIJ Dysfunction: How do we identify it and which cluster do we use?

SIJ Dysfunction is a pathology that is still under debate, regarding its prevalence. There are some PT schools and some physicians that believe pain can not originate from the joint and that movement is not possible. This can be questioned by the presentation of patients with asymmetrical pelvic alignment that is corrected with Muscle Energy Techniques (METs), often with a relief of pain. Other studies have shown that injections of anesthesia in the Sacroiliac Joint can relieve symptoms. This is frequently known as the gold standard for identifying SIJ Dysfunction but is not necessarily practical due to the skill and cost required. Physical tests are much preferred.

As you might be aware, there are quite a few tests out there for the Sacroiliac Joint, many of which are based on alignment. Due to the low inter-rater and intra-rater reliability of these tests based on identifying asymmetries, pain provocation tests are preferred when identifying pain arising from the Sacroiliac Joint. Unfortunately, there is not one pain provocation test that has been shown to have sufficient diagnostic accuracy by itself. This has led to the use of clusters. Two of the commonly used clusters include: a) SIJ compression, SIJ distraction, POSH Test, Sacral Clearing Test, Resisted Abduction Test; b) POSH Test, Resisted Abduction Test, FABER Test. But how do we decide which one to use? This is an example of why we need to review the literature to assess the methodological quality.

Broadhurst and Bond performed a double blind study that utilized placebo and active injections to find the effects of each test. Pain had to be decreased by 70% to be determined as originating from the SIJ. None of those injected with saline had a sufficient decrease in pain. The study found that when Resisted Abduction Test, POSH Test, and FABER Test were clustered together, there was a high likelihood of pain of SIJ origin. This test, upon initial examination, appears to have respectable methodological quality. Stuber performed a systematic review that ended up including 6 studies that looked at special tests identifying SIJ Dysfunction. Broadhurst and Bond's study was included in the review. One of the components of the study was to assess methodological quality of each one. Broadhurst and Bond's study was ranked 3rd overall, due to deficits in number of participants, drop outs, and lack of description of the examiners and tests performed.  While the cluster suggested by Broadhurst and Bond may still be useful, we should be cautious given the methodological flaws.

The cluster with the highest evidence according to Stuber includes:
-SIJ Compression
-SIJ Distraction
-POSH Test
-Sacral Thrust
-Resisted Abduction Test

When any three tests out of the five listed below are positive, there is a sensitivity of .87 and a specificity of .91