SI joint

[Sillevis]

Although it seems that there is enough evidence that identifies the SI joint as a source of pain can we as clinicians establish if there is an SI dysfunction? Are there any reliable and validated tests that can aid us in the diagnostic process? Can we effectively treat SI dysfunction or should we let this joint go..?

[kwyss]

I like to add an additional question: 3-4 deg. of motion: can we palpate that especially when the patient is "well padded".

[Sillevis]

How about can we palapate that at all?

[Paula]

I use leg length and the patrick/fabre tests which have been excellent for identifying SI pain. Additionally, to treat the SI area if there is a leg length discrepancy, I perform pelvic mobs to correct and muscle energy with pretty good success. I then follow up the treatment with kinesio tex taping of the sacrum and lumbar spine and of course trunk stabilization.

[Sillevis]

Paula,
Looking at some of the test that have been used traditionally for patients suspected of SI dysfunction it seems that there is little current evidence supporting them. The Patrick test has a sensitivity and specificity ranging between 0.5-0.6. The positive likelihood for the Faber test is 1.4. This means that a positive Patrick test will not have any increase in probability that SI dysfunction is present. Additionally there is only fair inter-rater reliability using this test. Any assessment of palpation of bony landmarks either in standing or sitting is very unreliable. There have been some studies reporting slight agreement in inter-rater reliability, however not enough to hold on to this type of assessment. The leg length (supine to sit assessment) test sows poor inter-rater reliability and the positive likelihood ratio is only 1.22 making this not a test that increases the probability that you can identify a leg length difference in subjects. This leaves the question how do we assess it and how do we account for potential positive outcomes in our patients?

[Paula]

Where do you get all of this information...PT journal or do you use a particular website? What tests do you use and have found to be supported by evidence based findings?

[Sillevis]

Use pubmed as the main search engine to find articles. the issue is that there are no tests that are reliable..The use of a cluster of four or five test has been suggested in the past but doesnt seem to pass the rigor of studies into the + and - likelihood ratio's

[justCat]

I think if there is a dysfunction in the SI joint then what is the cause of the dysfunction? There could be a muscle imbalance, hypomobility n the lumbar spine and hypomobility of the hip joint. I don't believe you can fix a dysfunctional SI joint without finding the underlying cause of the problem.

[Jbeas]

As far as palpation is concerned. Patients who are heavier and have more weight DO limit quite a few landmarks to palpate. The SI joint is comprised of the articulation of the sacrum and ilium. We can still differentiate movements of the ilium and sacrum through palpation right(PSIS, etc.)? Maybe instead of labeling movements of the "SI" joint our desrciption of an assessment should be more towards just iliac or sacral movements with our palpations. yes/no?

[Paula]

And we can use observation in prone with deep breathing inhalation and exhalation and observe for nutation and counternutation of the sacrum.