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SI Joint Dysfunction Test: A Comprehensive Guide for Diagnosis

Sacroiliac joint dysfunction, commonly referred to as SI joint dysfunction, is a condition that causes pain in the lower back and buttocks due to abnormal motion or malalignment of the sacroiliac joint. This joint is located at the junction of the sacrum (the triangular bone at the base of the spine) and the ilium (the upper part of the hip bone), and it plays a crucial role in transferring the weight of the upper body to the lower extremities. SI joint dysfunction is considered to be a significant source of pain in 15% to 30% of individuals with mechanical low back pain.

Diagnosing SI joint dysfunction can be challenging as its symptoms often mimic those of other spinal conditions. To accurately identify this specific issue, a combination of physical tests, medical history, and imaging techniques may be used by healthcare professionals. The effectiveness of individual tests in isolation may be limited; however, when used collectively, they can provide more accurate results. These tests often involve pressing on the hips and buttocks to locate the pain source or moving the legs into various positions to gently stress the sacroiliac joint for further assessment.

Ultimately, a comprehensive evaluation of SI joint dysfunction is essential to determine the appropriate treatment plan for patients experiencing persistent pain. The range of therapeutic options may consist of conservative treatments, such as physical therapy or medications, as well as more advanced interventions, including injections or surgery when necessary. As with any medical condition, early detection and intervention can significantly improve patient outcomes and overall quality of life.

Sacroiliac Joint Dysfunction

Causes of SI Joint Dysfunction

Sacroiliac (SI) joint dysfunction occurs when there is abnormal motion or malalignment in the sacroiliac joint, which connects the sacrum to the ilium. Several factors can lead to SI joint dysfunction, including:

  • Arthritis: Osteoarthritis can cause degeneration in the SI joint, resulting in pain and reduced mobility.
  • Spondyloarthropathies: This group of inflammatory conditions, such as ankylosing spondylitis and reactive arthritis, can affect the SI joint, causing pain and stiffness.
  • Hypomobility: Reduced motion of the SI joint can result from muscle imbalance, trauma, or a history of low back pain, leading to joint dysfunction.
  • Hypermobility: Excessive motion in the SI joint can be due to ligament laxity, pregnancy, or repetitive stress, resulting in instability and pain.

Symptoms of SI Joint Dysfunction

The primary symptom of SI joint dysfunction is pain in the lower back, which may also radiate to the hips, buttocks, and back of the thigh. Other symptoms may include:

  • Pain while sitting or standing for extended periods
  • Stiffness in the lower back
  • Increased discomfort during certain movements, such as hip flexion, abduction, and external rotation
  • Difficulty turning over in bed

To diagnose SI joint dysfunction, a complete history and physical examination are necessary. Some specific clinical tests, such as provocative maneuvers and SI joint block injections, can help confirm the diagnosis. Imaging studies like X-ray and MRI might also be helpful in ruling out other causes of low back pain.

Once diagnosed, treatment for SI joint dysfunction usually involves conservative approaches, such as pain management, physical therapy, and activity modification. In some cases, more invasive treatments like injections or surgery may be needed to address the underlying issue and relieve pain.


Physical Examination

During the diagnosis of sacroiliac joint dysfunction, the clinician will begin with a thorough history and physical examination. The history will focus on the onset and characteristics of the pain, as well as any previous injuries or treatments. The physical examination will include an assessment of the patient's posture, gait, and range of motion.

Several provocative tests can be used to help diagnose SI joint dysfunction, such as:

  • Gaenslen's Test
  • Thigh Thrust Test
  • Compression Test
  • Distraction Test

It is important to note that individual provocation tests have poor sensitivity and specificity when used in isolation. However, when three or more tests are positive, they can increase the accuracy of diagnosing SI joint dysfunction.

Imaging Tests

If the physical examination and history suggest the possibility of SI joint dysfunction, imaging tests may be ordered to further investigate the cause of the pain. These can include:

  • X-rays: This imaging modality can show signs of damage to the sacroiliac joint, such as joint space narrowing, sclerosis, or joint irregularities.
  • MRI: An MRI can provide more detailed information about the joint, including any inflammation, ligament damage, or underlying conditions like ankylosing spondylitis.

Occasionally, an injection test may be used to confirm SI joint dysfunction. A local anesthetic is injected into the sacroiliac joint, and if the patient experiences significant pain relief, it can help confirm the diagnosis.

It is essential to consider differential diagnoses during the evaluation process, as other conditions can present with similar symptoms to SI joint dysfunction. These may include:

  • Lumbar disc herniation
  • Facet joint arthritis
  • Hip pathologies
  • Pelvic girdle pain

In summary, diagnosing SI joint dysfunction involves a combination of a detailed history, physical examination, and appropriate imaging tests. The use of provocation tests and considering differential diagnoses can help increase diagnostic accuracy and ultimately lead to more effective treatment plans.

Prevalence in Different Populations

Sacroiliac (SI) joint dysfunction is a common cause of lower back pain, affecting approximately 25% of adult patients with chronic low back pain1. This condition can occur in both men and women, with different prevalence rates among different populations.


In general, women tend to have a higher prevalence of SI joint dysfunction compared to men. A study found that the prevalence of SI joint dysfunction was 33.3% in their research population, with a higher proportion of women in the group with SI joint dysfunction (P < 0.05)2. This could be attributed to differences in pelvic anatomy, hormonal factors, and other physiological factors that may increase the risk of developing SI joint dysfunction in women.


While men are less likely to experience SI joint dysfunction compared to women, it is still a relevant issue for this population. In a study, 36.8% of the patients diagnosed with SI joint dysfunction were male2. It is essential for healthcare providers to consider the possibility of SI joint dysfunction as a cause of lower back pain in male patients and provide appropriate diagnostic tests and treatments.


Pregnancy is a unique period where women might experience a higher risk of developing SI joint dysfunction due to various factors. The increased prevalence in pregnant women could be attributed to hormonal changes, weight gain, and changes in joint laxity during pregnancy, which can result in an altered biomechanical relationship between the sacrum and ilium, leading to SI joint dysfunction. While the specific prevalence rate for pregnant women is not provided in the search results, it is essential for healthcare providers to consider the potential for SI joint dysfunction as a cause of lower back pain in this population and provide appropriate interventions and support.


Physical Therapy

A primary treatment for sacroiliac (SI) joint dysfunction is physical therapy. A trained physical therapist can help strengthen and stabilize the muscles surrounding the SI joint, ultimately reducing pain and increasing mobility. Exercises may include:

  • Stretching and flexibility exercises
  • Strengthening exercises for the muscles around the joint
  • Postural training to improve body mechanics and reduce stress on the joint

It is essential to follow a consistent exercise program to achieve long-term improvement and relief from SI joint dysfunction symptoms.


Medication is often used to reduce pain and inflammation associated with SI joint dysfunction. This may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
  • Analgesics, such as acetaminophen, for pain relief
  • Muscle relaxants to help alleviate muscle spasms

It is important to consult your primary care provider, rheumatologist, or orthopedic surgeon to determine the most appropriate medication for your specific condition.


SI joint injections can serve both diagnostic and therapeutic purposes. A steroid injection within the joint can help reduce inflammation and provide pain relief. This procedure is often performed using X-ray guidance to ensure accurate placement of the medication.

  1. Joint injections: Involves injecting a corticosteroid directly into the SI joint to reduce inflammation and pain.
  2. Radiofrequency ablation (RFA): A minimally invasive procedure using heat to damage or destroy the nerves causing pain in the joint, providing longer-term relief.
  3. Prolotherapy: Involves injecting an irritant solution into the ligaments around the SI joint to stimulate the body's natural healing response, repairing damaged tissues and relieving pain.

It is crucial to discuss these treatment options with a specialist, such as a rheumatologist or orthopedic surgeon, to determine the most suitable intervention for your specific situation.

Lifestyle Modifications

In managing sacroiliac (SI) joint dysfunction, it's essential to incorporate certain lifestyle modifications that can help alleviate symptoms and prevent further discomfort.

One key aspect to consider is maintaining a healthy body weight. Carrying excess weight puts extra pressure on the SI joint, contributing to dysfunction and pain. Focus on a balanced diet, rich in whole foods, and practice portion control to manage weight effectively.

Regular exercise is also crucial for those with SI joint dysfunction. Engaging in low-impact activities can strengthen the muscles that support your SI joint and increase flexibility. Some suitable options include:

  • Swimming
  • Walking
  • Stationary cycling
  • Yoga
  • Pilates

While staying active is essential, it's also important to avoid activities that may aggravate SI joint pain. Refrain from high-impact sports, heavy lifting, or repetitive motion exercises that may strain the joint. Modify your movements and adjust workout intensity as needed.

Proper posture can significantly impact SI joint comfort, both in stationary positions and while engaging in daily activities. Maintain neutral spine alignment while sitting, standing, and walking. Consider investing in ergonomic furniture and accessories to support proper alignment in various settings, such as at home or work.

Lastly, it's important to recognize the role that stress can play in exacerbating SI joint pain. Practicing stress management techniques, such as mindfulness meditation or deep breathing exercises, can help you cope better with discomfort and prevent aggravation of symptoms.


  1. "Sacroiliac Joint Dysfunction: Diagnosis and Treatment | AAFP." Accessed 23 May 2023.

  2. "Determination of the Prevalence From Clinical Diagnosis of Sacroiliac ..." Accessed 23 May 2023. 2