Ligamentous Injury: Sacroiliac Joint and Iliolumbar Pain

Abstract

Sacroiliac joint (SIJ) pain and iliolumbar pain are common yet underestimated causes of chronic low back pain (LBP). There are many ways in which SIJ and iliolumbar pain can present, making the diagnosis challenging. SIJ pain is usually localized to the buttocks but can also be referred to the upper or lower lumbar region, groin, abdomen, lower limb, or the foot [1, 2]. Iliolumbar pain typically presents as localized unilateral or bilateral lower lumbar pain that may radiate along the iliac crest to the groin [3, 4]. Due to the myriad of presenting symptoms, no single physical examination or historical feature can reliably elucidate SIJ or iliolumbar pain often necessitating multiple provocative physical exam maneuvers or diagnostic nerve blocks to confirm diagnosis [5]. Many therapeutic approaches focus on interventional options, but conservative management with physical therapy and NSAIDS may provide a viable option with fewer risks in the early course of treatment [5]. Referral for diagnostic or therapeutic interventions should be considered after conservative management has failed or for refractory pain.