The Sacroiliac Joint - A New Management Paradigm

Steve Dischiavi holds credentials as a licensed physical therapist and a certified athletic trainer. He also has a manual therapy certification from the Ola Grimsby Institute and is board certified by the American Physical Therapy Association as a Sports Clinical Specialist (SCS).

The blog you’re about to read is targeted at clinicians just like myself. I was taught in PT school to evaluate the sacroiliac joint (SIJ) via a movement-based analysis. I even went on for a certification in manual therapy nearly 2 decades ago, and again was taught the movement-based approach. Well, as the song goes… “times they are a changin”….

So… if you’re a clinician who will diagnosis the SIJ as being “unstable” from movement-based testing, using tests that evaluate the positional movement of the PSIS… then you need to begin to question the approach you’re taking.

There is a contemporary conversation taking place within the field of physical therapy. If you’re like me and learned to evaluate the sacroiliac joint (SIJ) through movement-based testing, you need to be involved in this evolving conversation.

A great place to start is with a “Perspective” article published in Physical Therapy in 2019. It is titled “Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area” written by Thorvaldur Palsson, et.al.1

The narrative dives into several areas pertaining to the treatment of this mysterious region of the body. It gives the reader a thoughtful and contemplative view of the contemporary conversation surrounding the evaluation and treatment of the SIJ.

The target audience should be the clinicians who continue to evaluate the SIJ solely on movement based analysis, attempting to diagnosis the SIJ with terms related to movement dysfunction. We have all heard terms like “upslip, downslip, or sacral torsions”. The narrative addresses why this is not the best approach to diagnosing the SIJ.

The article also touches on the concepts of “pain science” and how assessing how the SIJ “moves” tells the clinician very little about why the tissues about the SIJ might be sensitized. The article scratches the surface about the patient’s pain experience and how harmful terms such as “instability” and how the SIJ “goes out” are ways that can perpetuate and even heighten the pain experience for your patients.

The Perspective article gives the reader a great introduction as to why you might consider altering your approach to the SIJ. I’ll leave you with a quote directly from the article:
“If clinical decisions are based on a construct that lacks plausibility and clinical tests lacking in validity and reliability, the entire management paradigm must be questioned.”
The next question you might be asking yourself… ok, how do I learn a new management paradigm? A great start would be to take the 4-hour introductory webinar, Sacroiliac Joint Current Concepts - Remote Course - June 26, 2021, offered by Herman and Wallace… learn the evidence-based approach to the SIJ with Steve Dischiavi, PT, DPT, MPT, SCS, ATC, COMT who has been working closely on the hip and pelvis for over 20 years!

I hope to see you at the webinar!

1. Palsson TS, Gibson W, Darlow B, et al. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther. 2019;99(11):1511-1519.