Diagnosing and Managing Sacroiliac Joint Pain

Sacroiliac joint pain commonly occurs because of anatomic disruption within the joint. Sacroiliac joint pain and sacroiliac joint mimics create a broad differential, adding difficulty to diagnosis. Clinically, this disruption presents with a mobility limitation relative to baseline and sharp pain inferolateral to the posterior superior iliac spine. While attempting to rule out other causes of low back pain, provocation tests such as FABRE, distraction, thigh thrust, sacral compression, Gaenslen's, and sacral thrust can be a useful diagnostic tool for the diagnosis of sacroiliac joint pain. Although recently, the provocation tests' validity has been challenged. Currently, the most accurate way to assess sacroiliac joint pain is with image-guided injections of local anesthetic. Pain reduction after the injection indicates the pain originating from the sacroiliac joint. Once confirmed, it is recommended to use a patient-centered approach that focuses on pain control, followed by restoration of function through noninvasive measures such as therapeutic exercise, manual medicine, sacroiliac joint belts, and orthotics. If these noninvasive procedures have not provided adequate treatment, then more invasive procedures should be considered.