In patients with lumbar disc herniation, how many patients have sacroiliac joint dysfunction? Answering this question was the aim of a study published in the Journal of Back and Musculoskeletal Rehabilitation in 2013. From an outpatient clinic at a university hospital, 202 patients with lumbar disc herniation (paracentral or intraforaminal) on imaging and clinical findings suggesting lumbosacral nerve root irritation were included. Excluded were patients who pregnant, had prior lumbar surgery, osteoporosis, fractures, diabetes, severe hip DJD, and neurological deficits. Clinical examination tests for SIJ dysfunction included seated forward flexion test with palpation of the PSIS, Patrick-Faber test, long-sitting test, Gillet test, Sphinx test, and palpation tests for sacral base asymmetry. Pressure provocation tests were applied to the sacrum and the pelvic innominates, palpation to long dorsal sacral ligament and lumbosacral junction. "Positive" sacroiliac dysfunction diagnosis meant that the patient had a cluster of at least 4 anatomical and 2 provocative tests. Patients ranged in age from 19-70 years with a mean age of 42.
Greater than 72% of the patient sample with known lumbar disc herniation also presented with sacroiliac joint dysfunction. Females, patients with recurrent pain, those who performed heavy work, and patients with a positive straight leg raise test were more likely to have sacroiliac joint dysfunction. Of the 72% of patients who were diagnosed with SIJ dysfunction, nearly 60% were female. No correlation was found between the presence of sacroiliac joint disease, working hours, duration of low back pain, or body mass index and the rate of SIJ dysfunction. The authors conclude that sacroiliac joint dysfunction has a "…high possibility of occurrence in low back pain" and should be included in the clinical examination and decision-making process. They also point out that while the differential diagnosis of back versus SIJ pain is well-defined in manual medicine texts, the medical books do not highlight screening of the SIJ when presented with a patient who has back pain.
If you would like to learn skills to perform differential diagnosis of the sacroiliac joint, sign up for the Sacroiliac Joint Treatment continuing education course taking place this July in Baltimore with Peter Philip.