Sacroiliac joint dysfunction: evaluation, diagnosis, and treatment

Includes bibliographical references (pages 63-68)The sacroiliac joint has been recognized as a source of low back pain since the early 1900???s. By 1934 the notion of the sacroiliac joint as a pain generator became less popular as the focus shifted to the intervertebral disc. Over the years, clinicians were finding that treating the disc did not resolve their patients??? low back pain. The sacroiliac joint is complicated. It is a synovial joint posteriorly and is surrounded by a capsule anteriorly. It is surrounded by thick ligaments and a variety of muscles which contribute to its stability. Although it is a stable joint, it is capable of small motion which allows the transfer of forces from the upper extremity to the lower extremity. Stability is due to the rough surface of the sacroiliac joint which is termed form closure, and due to the muscles which provide compressive forces termed force closure. The issue with diagnosing the sacroiliac joint is the lack of access of a gold standard. Over the past decade motion tests have been found to be unreliable. However, research has supported the use of three functional tests and pain provocation tests to help diagnose sacroiliac joint dysfunctions. Lastly, a variety of treatment options have been advocated for the sacroiliac joint. Currently general low back pain exercises are used and future research is needed to address specific exercises for sacroiliac joint dysfunction