SI Joint Pain Physical Exam

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Can a Physical Exam Diagnose Your SI Joint Pain?

A directed physical exam, following a focused medical history, is the first phase of diagnosing whether your lower back pain is being caused by sacroiliac (SI) joint dysfunction or alternative conditions. An accurate diagnosis is critical to determining the proper course of treatment to relieve pain.

Understanding How a Physical Exam Can Diagnose SI Joint Pain

In order to understand how a physical exam can isolate the SI joints as the focal point of lower back pain, it is useful to take a look at where the joints are and how they are designed to perform. The sacroiliac joints form at the points where the sacrum region of the spine and the two ilium (hip) bones meet, one on the left and one on the right side of the spine. The two ilium bones are the major structures of the pelvis. The SI joints play a major role in supporting the upper body and helping to transmit motion through the hips and legs. There are several components to the SI joints, each of which is subject to pressures that can cause friction, inflammation, and long term wear and tear.

The SI joints are basically opposing bony surfaces covered by cartilage and bound together by extremely strong ligaments. By design, SI joints have a narrow range of movement. But they need to be fluid enough to allow the hips and legs to move smoothly while at the same time supporting the spine and upper body. Any stressors to this balance of function can damage the joints and introduce SI joint dysfunction.

Over the course of a lifetime, people are as likely to suffer some form of back pain as they are to catch a cold. But back pain takes on many forms, and expresses itself in many ways. The first order of business for a clinician is to get a sense of each individual patient’s personal experience. It’s critical to know precisely where it hurts, how long it has hurt, and any activities that generate discomfort and pain. A clinician needs to know what other health issues a patient has and what injuries a patient has experienced that may contribute to functional limitations and pain in the lower back.

With a solid background in place, the clinician can perform a physical exam to determine if the pain is emanating from the SI joints or other areas of the body. There are a series of orthopedic procedures known as provocative tests that are meant to induce or provoke the tenderness and pain in the SI joints. These are Distraction, FABER (Patrick’s), Gaenslen, Thigh Thrust, and Compression tests. These are various ways to spread, rotate, and pressure the SI joints to determine if they are the source of pain. A positive result in at least three of the five procedures strongly supports the diagnosis that the lower back pain is being caused by dysfunction in the SI joints.

SI joint pain typically results from hypo-mobility or hyper-mobility. Hypo-mobility simply means low movement. The ligaments that hold the SI joints together tighten and lose elasticity. Cartilage of the SI joints can erode, bone spurs can develop, and the joints can freeze or lock up. The result is limited motion and chronic pain. Hyper-mobility means high movement. The ligaments stretch out and become more elastic. This can cause undue friction within the joint, misalignment of the bones, uneven wear, and subsequent pain. There are also many nerves in proximity to the SI joints that can become irritated and inflamed. The range of pain can vary from dull to acute.

SI joint pain can express itself on either the left or right side of the lower back. SI joint dysfunction can produce pain in the buttocks, groin, and thighs as well.

While an accurate diagnosis of SI joint pain begins with a thorough physical exam, further imaging tests and joint injections may be necessary to confirm. If you are experiencing symptoms of lower back pain, get in touch with a medical expert in spine health. Early diagnosis and treatment of SI joint dysfunction can slow progression of the disease, relieve low back pain, and help to restore healthy joint function.

Tips for Preventing and Managing SI Joint Pain at Home

  • Regular stretching and exercise can help prevent and ease low back pain.
  • When lifting heavy objects, use your legs for leverage, not your back.
  • Walk cautiously and wear shoes with good traction when walking on slippery surfaces.
  • When carrying something, be sure to distribute its weight evenly, not favoring one side.
  • Consult a spine specialist for severe low back pain that hasn’t resolved with conservative methods in a few weeks.

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