Chapter 1

The Significance of the SI Joint in Low Back Pain

While sacroiliac joint disorders have been well documented as a clinically significant source of low back pain, it remains one of the under-diagnosed and under-treated areas in orthopedic practice.

In this video we will present an overview of sacroiliac joint diagnostic techniques, using a multidisciplinary approach. Three key specialists, with years of experience in diagnosing painful SI joints, will be featured. While very different in their background, specialty and training, they agree on the need and the methods for identifying those patients with low back complaints attributable to SI joint problems.

The SI joint may be responsible for up to 25% of complaints related to low back pain.  That number may be even higher in long fusions that include the sacrum.


Dr. Garfin is a paid consultant and ownership interest in SI-BONE Inc.

The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For information about the risks, visit: www.si-bone.com/risks

"While sacroiliac joint dysfunction has been well documented as a clinically significant source of low back pain, it remains one of the under-diagnosed and under-treated areas in orthopedic practice.

Noted orthopedic surgeon Dr. Steven Garfin will review some important background about the SI Joint.
The SI joint may be responsible for up to 25 or 30% of complaints related to low back pain.  That number may be even higher in long fusions that include the sacrum.  

Despite the fact the literature on the SI joint goes back a long way it has truly been an under-appreciated, under-studied and under-diagnosed joint.  

The SI joint was nothing we ever paid attention to.  You learn about it in anatomy but diagnostically or therapeutically it just wasn’t an issue.

Recently there has been a summit meeting of individuals who are familiar with the SI joint and academic spine surgeons and clinically active spine surgeons such as me to talk about the SI joint.  

Meta analysis was done of available literature.  The discussions were summarized and we were able to come up with an agreement as to a consensus how to diagnose and potentially treat SI joint related problems that fortunately has been accepted for publication.

I realized that this is something I should listen to, pay attention to, and try to diagnose and try to teach my residents and fellows.

The algorithm lays out questions to ask for the history and for the physical exam.  It includes examining the hip and neurologic exam for the spine, and then there are roughly five tests for the SI joint that stress the SI joint. 

Three of them should be positive to lead or strongly lead to the diagnosis of the SI joint as a cause of pain. 

These tests are not very complicated or too sophisticated.  Most health care providers no matter what their specialty have learned them somewhere along their training.  Unless you think about the SI joint you don’t do these tests.  To add them in takes maybe five minutes maximum and it’s really sort of a thought process and a completeness of the exam and anybody can do that.

It’s critical for physicians and non-physicians, surgeons and non-surgeons to pay attention to the joint as a possible diagnosis and etiology related to low back pain."