A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain

Steven Falowski, Dawood Sayed, Jason Pope, Denis Patterson, Michael Fishman, Mayank Gupta, Pankaj Mehta
Journal of Pain Research 2020, 13: 3337-3348

Introduction: The sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients.

Methods: The literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies. Treatment options reviewed include conservative measures, as well as interventional and surgical options.

Results: Proposed criteria for diagnosis of sacroiliac joint dysfunction can include pain in the area of the sacroiliac joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ. Conventional non-surgical therapies such as medications, physical therapy, radiofrequency denervation, and direct SI joint injections may have some limited durability in therapeutic benefit. Surgical fixation can be by a lateral or posterior/posterior oblique approach with the literature supporting minimally invasive options for improving pain and function and maintaining a low adverse event profile.

Conclusion: SIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer diagnostic and treatment pathway to establish an algorithm for patients that can include conservative measures and interventional techniques once the diagnosis is identified.

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j-p kaukonen

From a basis of long and extensive experience on back pain, and mechanical and anatomical studies of pelvis and the SI-joint, I think that the percentage is far too high. Very often the pain assumed to came from the SI-joint is actually from discs and vertebrae, mainly form facet joints.
The real SI-patients are pelvic trauma patients and SPA-patients.

J-P Kaukonen
adj. prof. in orthopaedics and traumatology


Stephen Craig

Excellent article


Tanis Bolton

Glute max


Tanis Bolton

So add FABER to hip exam look for posterior pain for sij or anterior for hip (do fair, do scour); TX add tva and piriformis strength and loos at ipsilateral glute and contra lats. This chain as Rx.


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