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

Steven David Roffers

Abstract


Objective

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.

Background

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. 

Methods

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.

Results

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

Discussion

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.

Conclusion

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.


Keywords


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

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