A Neurological Description and Explanation of Four Functional Tests to Differentiate Sacroiliac Joint Dysfunction from Low Back Pain

Steven David Roffers



The objective is to provide a neurological explanation and a description of four functional tests to differentiate sacroiliac joint (SIJ) dysfunction from low back pain.


There are often complex and overlapping symptoms associated with lumbopelvic dysfunction that may be of singular or multiple causes.  Pain provocation tests have limited reliability in clinical practice. Pain provocation tests may be falsely negative in the presence of sacroiliac dysfunction; therefore the differential diagnosis of sacroiliac joint dysfunction versus lumbar or discogenic pain remains a difficult clinical problem. A neurological explanation for sacroiliac joint (SIJ) testing procedures to improve diagnosis and correction of SIJ dysfunction in the clinical setting is provided and described. 


Simple keyword searches related to the neuroanatomy and neurophysiology of the sacroiliac joints and spinal cord, including propriospinal tracts were performed over several years using Scopus, Index of Chiropractic Literature (ICL), Mantis and PubMed and Medline databases. Reference lists of the pertinent articles were also checked for additional resources as well as hand searches for information in current neuroscience and orthopedic textbooks. Abstracts referring to surgical corrections of SIJ instability (surgical fixation) were excluded.


While 283 studies have been found, only 51 of them related to sacroiliac joint dysfunction were deemed applicable to this study.


We found evidence to support that the usual pain provocation tests have limited reliability in published studies and clinical practice. Based on neuromuscular reflex changes that may occur with exacerbation of pre-existing joint dysfunction, a neurological explanation was developed and four functional tests for sacroiliac dysfunction were defined and confirmed.


A conceptual framework providing a neurological basis for the use of modified sacroiliac functional tests has been described and confirmed. These tests may detect a sacroiliac joint lesion that is undiagnosed by pain provocation tests, yet the lesion produces a neurological insult.  Sacroiliac lesions respond to a variety of manipulative strategies and while these tests have been found useful in clinical practice, formal reliability and validity studies are needed.


sacroiliac, neuroanatomy, neurophysiology, propriospinal, mechanoreception, cranio-sacral

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Otter R, A review study of the differing opinions expressed in the literature about the anatomy of the sacroiliac joint: European Journal of Chiropractic 1985;33:221-242.

Harrison DE, Harrison DH, Troyanovich S. The Sacroiliac Joint: a Review of Anatomy and Biomechanics with Clinical Implications. J Manipulative Physio Ther 1997;20:607-617.

Slipman C, Patel R, Shin C, Braverman D, Lenrow D. Pain Management: Studies Probe Complexities of Sacroiliac Joint Syndrome. J Biomechanics 2000 April.

Mooney V, Understanding, examining for, and treating sacroiliac pain. J Musculoskeletal Medicine July 1993;37-49.

Greenman P. Innominate shear dysfunction in the sacroiliac joint. Manual Medicine 1986;2:114-121.

Sutherland W. The Cranial Bowl. 1939; Private Publishing-Free Press Co.

Magoun,H. Osteopathy in the Cranial Field.1976; Journal Publishing Co., Kirksville MO.

Dejarnette B. Sacro-Ocipital Technic. 1967-1984; self published.

Dejarnette B. Cranial Technic 1968-1980; self published.

Upledger J, Vredevoogd J. Craniosacral Therapy. 1983; Eastland Press.

Chaitow L. Cranial Manipulation Theory and Practice. 2nd Edition 2005, Elsevier Ltd.

Miller KE, Douglas VD, Richards AB, Chandler MJ, Foreman RD. Propriospinal neurons in the C1-C2 spinal segments project to the L5-S-1 segments of the rat spinal cord. Brain Res Bull 1998;47(1):43-7.

Mooney V, Understanding, examining for, and treating sacroiliac pain. J Musculoskeletal Medicine July 1993;37-49.

Laslett M, Williams M. The Reliability of Selected Pain Provocation Tests for Sacroiliac Joint Pathology. Spine 1994;11:1243-1249.

Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The Value of Medical History and Physical Examination in Diagnosing Sacroiliac Joint Pain. Spine 1996;21:2594-2602.

Broadhurst N, Bond M. Pain Provocation Tests for the Assessment of Sacroiliac Joint Dysfunction. J Spinal Disorders 1998;11:341-345.

Slipman C, Sterenfield E, Chou L, Herzog R, Vresilovic E. The Predictive Value of Provocative Sacroiliac Joint Stress Maneuvers in the Diagnosis of Sacroiliac Joint Syndrome. Arch Phys Med Rehab 1998;79:288-291.

Toussaint R, Gawlik C, Rehder U, Ruther W. Sacroiliac Dysfunction in Construction Workers. J Manipulative Physio Ther 1999;22:134-138.

Hestboek L, Leboeuf-Yde C. Are Chiropractic Tests for the Lumbo-Pelvic Spine Reliable and Valid? A Systematic Critical Literature Review. J Manipulative Physio Ther 2000:23;258-275.

Stuber KJ. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. Journal of the Canadian Chiropractic Assn. 2007, 51:30-41.

Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician, 2009 Mar-Apr; 12(2):339-418.

Schmidt WH Jr, Yanuck SF. Expanding the neurological examination using functional neurologic assessment: part II Neurologic basis of applied kinesiology. Int. J Neurosci 1999, 97:77-108.


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