Sacroiliac Joint Pain: Practical Management

Physicians managing the variety of musculoskeletal problems that athletes develop will at one time or another evaluate and treat an athlete with sacroiliac joint (SIJ) pain. Arriving at the diagnosis and prescribing treatment can be confusing. Controversy has surrounded the diagnosis for several reasons. First, the SIJ moves only a small amount in the young adult and moves less with aging. Past arguments suggesting that the relative lack of quantity of motion in a joint negates its significance as a pain generator have been replaced by a better understanding of quality and symmetry of joint motion. Second, no specific historical point or clinical examination technique will solidify the diagnosis. Third, imaging is often not helpful as radiographs, MRI, or bone scan, and CT scans do not differentiate symptomatic from asymptomatic patients. Fourth, the biomechanics of the SIJ and its interactions with the surrounding joints including the hip, pubic symphysis, and spine are complex, and researchers are still producing new information on force and load transmission across the pelvis. Fifth, there is no gold standard for treatment, leaving clinicians to use their experience in making recommendations. Sixth, there is confusion about whether the SIJ dysfunction is the chicken or the egg. Often patients may have had a history of lumbar discogenic pain, radiculopathy, facet syndrome, hip pathology, or pubic symphysitis that has resolved, but because of secondary adaptive changes that have occurred as a result of the primary problem, SIJ pain may develop. Theoretically, the inverse of this situation could happen as well. Any of these factors can contribute to problems in making a diagnosis or providing treatment of patients with SIJ pain. To date, there are no studies that outline or describe SIJ pain as it relates specifically to athletes.