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How to differentiate Low back pain vs SIJ Pain

This post is dedicated to all the physiotherapist friends and colleagues working actively in clinical setting dealing with lots of patients specially with back problems. Back pain in general is a broad term. There are various causes with can create this problem but often it is tricky to differentiate the source of pain; coming from back itself or Sacroiliac joint.

There must be other algorithms that could come to the same conclusions but I am going to share what I have been practicing for so long.

Basically, there are several test that we use to differentiate SIJ pain. But all of these tests when done alone have insufficient reliability and poor validity, specially kinetic test and positional/palpation tests.

Fortunately, there are clusters of provocation test that have much higher reliability and validity. These even show better sensitivity and specificity once lumbar spine has been ruled out with an MDT assessment. (Laslett M. (2008) Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. J Man Manip Ther 16:3:142-152)

After a detailed MDT assessment has ruled out Lumbar spine as a source of spine, the presence of two positive response out of first four provocative tests or three positive response out of six strongly predicts SIJ as a source of pain. These provocative tests are as follows:

1) Distraction or Gapping Test

2) Posterior Shear or Thigh Thrust (performed on both sides)

3) Compression Test

4) Sacral Thrust

5) Pelvic Torsion (Gaenslen's test)


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