Ruling out SIj
Often masquerading as Lumbar Spine pain, SIj pain can be hard to pin point. Most commonly, pain around the Lower back and Gluteals is Lumbar in origin and so it can be helpful to rule out the Sij.
The two most sensitive tests I’ve found in the literature are the Thigh thrust and the Compression tests.
The Thigh thrust- sensitivity 0.88
With the patient in supine, place the hip in 90 degrees of flexion and add adduction. Then apply a posteriorly directed force through the femur at varying angles of abduction/adduction, looking for pain.
The Compression test- sensitivity 0.69
With the patient in side-lying, place one hand on the outside of each iliac crest & compress the pelvis by squeezing both iliac crest together, looking for pain
Should both tests fail to reproduce pain, it remains unlikely that the origin of pain is SIj especially if a Lumbar or other origin for the pain has been flagged.
1Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther 2005;10:207-218
