According to a study by Bernard and Kirkaldy-Willis (1987), over twenty two percent (22%) of individuals who presented with lower back complaints actually had problems in their sacroiliac joint (SI Joint).1 There may be up to a million patients annually with low back complaints actually may have SI Joint problems like degenerative arthritis and/or mal-unions of pelvic trauma.
Yet, despite the large number of patients with SI Joint symptoms, most of the treatment focus in the spine has been centered on the disc. Orthopedic residents and neurosurgical residents are rarely taught to consider SI Joint arthritis and/or old SI Joint trauma as the cause of the patient’s problems. In addition, few, if any, lumbar MRI’s extend below S1 to examine the SI Joint.
Diagnosing SI Joint pathologies can be difficult. Clinical testing is typically not highly reliable. In the distant past, infected or pathological SI Joints were surgically treated, as performed by Smith-Peterson, 1926. This approach involved a major operation and had only a 56% rate of positive results as evidenced by the literature. It is because of these marginal results and the diagnostic difficulties that the orthopedic community has insufficiently addressed this important joint. More recent interest in the diagnosis and treatment of SI Joint dysfunction has lead to increasing publications with data suggesting test composites / multitest scores becoming more of the consensus in diagnosis of SI Joint dysfunction.
