Posted by Steve Middleton, MS, ATC, CSCS, CES, CKTP

Chronic low back pain affects a large percentage of the population. Yet, it is difficult to diagnose due to the variety of pain producing components: the intervertebral discs, facet joints and sacroiliac joints. An inaccurate diagnosis leads to both treatment failure and wasted health care dollars.

The researchers reviewed 103 previously published studies. 18 studies evaluated diagnostic injections of the sacroiliac joints. Another 13 studies evaluated pain provocation testing and other clinical evaluation techniques. 43 studies evaluated diagnostic imaging while a final 4 studies evaluated SI joint injections under imaging. (23 studies were excluded).

The results indicate that diagnostic injections have a fair to good level of support to identify SI joint derived low back pain. While most physical medicine clinicians have limited access to this technique, pain provocation tests (either a series of [Gillet test, thigh thrust, Patrick test, Gaenslen test and midline sacral thrust] or [thigh thrust, sacral thrust, Gaenslen, distraction and compression]) have also been shown to have fair results in evaluating for SI joint dysfunction. However, unlike previously thought, a combination of tests with a minimum of three positive findings has a higher sensitivity as opposed to stand alone tests > from Simopoulos et al.; Pain Physician. 15 (2012) E305-344. All rights reserved to Pain Physician Journal.