Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area

Thorvaldur S Palsson, William Gibson, Ben Darlow, Samantha Bunzli, Gregory Lehman, Martin Rabey, Niamh Moloney, Henrik B Vaegter, Matthew K Bagg, Mervyn Travers

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where the sacroiliac joint (SIJ) is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, where the SIJ may be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the sacroiliac joint(s); a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this perspective argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models to contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.

Original languageEnglish
JournalPhysical Therapy
ISSN0031-9023
DOIs
Publication statusE-pub ahead of print - 29 Jul 2019

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Sacroiliac Joint
Pain Management
Arthralgia
Patient Education
Low Back Pain
Therapeutics
Guidelines
Pain
Pregnancy
Wounds and Injuries

Cite this

Palsson, Thorvaldur S ; Gibson, William ; Darlow, Ben ; Bunzli, Samantha ; Lehman, Gregory ; Rabey, Martin ; Moloney, Niamh ; Vaegter, Henrik B ; Bagg, Matthew K ; Travers, Mervyn. / Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. In: Physical Therapy. 2019.
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abstract = "The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where the sacroiliac joint (SIJ) is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, where the SIJ may be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the sacroiliac joint(s); a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this perspective argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models to contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.",
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Palsson, TS, Gibson, W, Darlow, B, Bunzli, S, Lehman, G, Rabey, M, Moloney, N, Vaegter, HB, Bagg, MK & Travers, M 2019, 'Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area', Physical Therapy. https://doi.org/10.1093/ptj/pzz108

Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. / Palsson, Thorvaldur S; Gibson, William; Darlow, Ben; Bunzli, Samantha; Lehman, Gregory; Rabey, Martin; Moloney, Niamh; Vaegter, Henrik B; Bagg, Matthew K; Travers, Mervyn.

In: Physical Therapy, 29.07.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

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T1 - Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area

AU - Palsson, Thorvaldur S

AU - Gibson, William

AU - Darlow, Ben

AU - Bunzli, Samantha

AU - Lehman, Gregory

AU - Rabey, Martin

AU - Moloney, Niamh

AU - Vaegter, Henrik B

AU - Bagg, Matthew K

AU - Travers, Mervyn

N1 - © American Physical Therapy Association 2019. All rights reserved. For permission, please email: journals.permissions@oup.com.

PY - 2019/7/29

Y1 - 2019/7/29

N2 - The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where the sacroiliac joint (SIJ) is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, where the SIJ may be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the sacroiliac joint(s); a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this perspective argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models to contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.

AB - The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where the sacroiliac joint (SIJ) is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, where the SIJ may be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the sacroiliac joint(s); a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this perspective argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models to contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.

U2 - 10.1093/ptj/pzz108

DO - 10.1093/ptj/pzz108

M3 - Journal article

JO - Physical Therapy

JF - Physical Therapy

SN - 0031-9023

ER -