This document presents a case study of a 30-year-old female patient complaining of sharp low back pain for 2 weeks. It reviews tests and classifications for lumbar spine issues and provides screening tests that can help determine if the source of pain is the sacroiliac joint (SIJ). These include observation, palpation, range of motion tests, and SIJ provocation tests. Treatment options discussed include lumbopelvic stabilization exercises in phases focusing first on transverse abdominis and multifidus muscles before strengthening other core muscles. The importance of different SIJ provocation tests is also ranked.

1. Low Back Pain: Is it SIJ???
Case Study
 CJ
o 30 yo F
o C/o sharpLBP for approx.2 weeks
o Runner
o No children,nospecificonset
o You notice thatshe gesturestoher painbeingright-sidedwhenshe describesittoyou
o Sometimeshaspaindownherrightlegto the knee andaroundinher groin1
o Aggravatingfactors
 Rollingoverinbed
 Sit-to-stands
 Sitting/standingforlongperiodsof time
o Relievingfactors
 Lyingdownsupine/hook-lying
o Is currentlyaPT student,soshe sitsall of the time!
 ReviewTreatmentBased ClassificationSystemforLumbarSpine2
o ManipulationGroup
 Hypomobilitywithspringtesting
 FABQ<19
 Hip IR >35˚
o StabilizationGroup
 Hypermobilitywithspringtesting
 Increasingepisodefrequency
 3+ priorepisodes
o SpecificExercise Group
 Directional preference forextension/flexion
 Centralization
 Peripheralizationinopposite direction
o Traction Group
 Peripheralizationwithoutabilitytocentralize atall
Screening
 Observationandpalpation –standing
o Lookingforasymmetries?3
o CommonCompensatoryPattern?4
o Fortin’sSignor FortinFingerTest5
o Gillet’shypomobilitytest6
o Lumbar ROM
 Centralization/peripheralization7
 What if there ispainwithall movements?8

2. o Hip ROM/MMT1
o SIJpain provocationtests(see lastpage)
 Clusterof tests9
 Orderof importance8
 Thighthrust test(P4)
 Distractiontest
 Compressiontest,FABER?
 Sacral thrusttest
 Gaenslen’s???
Now what?
 Form vs.force closure10
o Form closure – the shape of the jointandthe alignmentof the innominateskeeps
everythingtogether
o Force closure – the fascia,muscles,andligamentsholdthe jointstogether. Thisallows
for some movement
o Test– ASLR
 Poorforce closure – doesnotautomaticallybrace withabdominals
 Poorform closure – unable toperformevenwithabdominalbracingunless
utilizingSIbelt ortherapistismanuallystabilizing
 Treatment
o Lumbopelvicstabilizationtherapeuticexercise9
o Phases10
 Phase 1: isometriccontractionof transverse abdominisandmultifidus
 Phase 2: contractionof transverse abdominisandmultifiduswithactive LE
movement
 Phase 3: activatingtransverse abdominisandmultifidusduringtrunk
movement
 Lastly(notlistedasPhase 4, but probablyshouldbe),afterproperrecruitment
of transverse abdominisandmultifiduswithmovementisachieved,workon
strengtheningothercore muscles,suchasglutes,obliques,andlatissimusdorsi.
Thisshouldnotbe done earlierinordertopreventexcessivesheeringforceson
the SIJ

3. SIJ Provocation tests inorder of importance
1. Thigh Thrust (P4) 2. Distraction test
3. Compressiontest 4. Sacral thrust
5/6. Gaenslen’stest
***Remember,according to Laslett, 2/4 tests withoutGaenslen’shasnearly the same likelihoodratio
as 3/6 testswith Gaenslen’s

4. References
1. DuttonM. Dutton'sOrthopaedicExaminationEvaluationand Intervention, ThirdEdition.
McGraw-Hill Medical; 2012.
2. FritzJM, ClelandJA,ChildsJD.Subgroupingpatientswithlow backpain:Evolutionof a
classificationapproachtophysical therapy. JOrthop SportsPhysTher.2007;37(6):290-302.
3. Huijbregts P. Sacroiliac joint dysfunction:Evidence-baseddiagnosis. OrthopaedicDivision Review.
2004:18-32.
4. PopeRE. The commoncompensatory pattern:Itsorigin andrelationshipto the postural
model. Am Acad Osteopath J. 2003;14(4):19-40.
5. FortinJD, Falco FJ. The fortin finger test: An indicator of sacroiliac pain. Am J Orthop (Belle Mead
NJ). 1997;26(7):477-480.
6. Levangie PK. Fourclinical testsof sacroiliac joint dysfunction:The associationof test resultswith
innominatetorsionamongpatientswith and withoutlow back pain. PhysTher.
1999;79(11):1043-1057.
7. Laslett M, YoungSB, Aprill CN, McDonaldB. Diagnosingpainful sacroiliac joints: A validity study of
a McKenzie evaluationandsacroiliac provocationtests. AustJ Physiother. 2003;49(2):89-97.
8. Laslett M, Aprill CN, McDonaldB, YoungSB. Diagnosisof sacroiliac joint pain:Validity of individual
provocationtestsandcompositesof tests. Man Ther. 2005;10(3):207-218.
9. Laslett M. Evidence-baseddiagnosisand treatmentof the painful sacroiliac joint. J Man Manip
Ther. 2008;16(3):142-152.
10. Pool-GoudzwaardAL, Vleeming A, Stoeckart R, Snijders CJ, MensJM. Insufficient lumbopelvic
stability:A clinical, anatomicaland biomechanicalapproachto 'a-specific' low back pain. Man
Ther. 1998;3(1):12-20.