Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Assistant Online Professor, University of St. Augustine for Health Sciences, St. Augustine, FL, USA
Consultant, Shelbourne Physiotherapy Clinic, Victoria, BC, Canada
This article will be published in Dutch in Rehabilitacja Medyczna (Vol. 8, No. 1, 2004).
Low back pain (LBP) is a health problem with a major societal impact. Histology and injection1-11 studies have established the nociceptive potential and clinical reality of LBP originating in the sacroiliac joint (SIJ) and its periarticular tissues. Table 1 lists the pathological processes, which can involve the SIJ12-20. This article mainly deals with the diagnostic entity of sacroiliac joint dysfunction (SIJD). Paris21 defined a joint dysfunction as a state of altered mechanics, characterized by an increase or decrease from the expected normal or by the presence of an aberrant motion. This positions SIJD as a patho-mechanical rather than pathological diagnosis14,22.
The accepted gold standard or reference test for thediagnosis of SIJ-related pain is the fluoroscopically guided intra-articular anaesthetic injection or joint block2-11,14. Data on the prevalence of SIJ-related pain, therefore, is limited to highly selected populations of patients with chronic LBP referred for injection studies4-6,11. Schwarzer et al4 found a 30% prevalence with single blocks. Maigne et al5 reported a prevalence of 18.5% after double joint blocks. Dreyfuss et al6 noted a 53% positive response to a single SIJ block and Laslett et al11 confirmed SIJ-related pain in 33% of their subjects with single and double blocks.
A joint block is a highly specialized procedure, hardly available in everyday clinical practice; it is also not indicated for every patient with LBP. Generally, the only means available to the clinician to reach a diagnosis of SIJD are patient history and physical examination. SIJ physical examination comprises an active range of motion (AROM) examination consisting of cardinal and non-cardinal plane motions and special tests considered specific to the SIJ. These special tests fall in three categories22-24:
- Positional palpation tests
- Motion palpation tests
- Provocation tests
For history items and physical tests to be clinically useful, the data they yield needs to be reliable, valid, and responsive to clinically relevant change25. The goal of this article is to discuss reliability and validity of history items and physical tests thought relevant for making a diagnosis of SIJD. To this end, we will first discuss definitions pertinent to the concepts of reliability and validity relating them to the diagnosis of SIJD. We will then review, in chronological order, research on reliability and validity of history items, AROM tests, individual special tests, multiple test regimens, and a comprehensive examination used for the diagnosis of SIJD. We will conclude the article with a discussion of research validity of the studies reviewed and a conclusion with clinical implications.