Things to know about Sacroiliac Joint Pain

BackgroundThe purpose of this study was to examine the association of sacroiliac joint (SIJ) dysfunction and pain with overuse and acute lower limb and pelvic girdle injuries of Iranian basketball players.MethodsIn this cross-sectional study, basketball-related injury data were collected during 2019–2020 from 204 basketball players of the Iranian league using the online Information Retrospective Injury Questionnaire. A researcher then performed ten clinical tests to assess SIJ dysfunction and pain (five tests for dysfunction and five tests for pain). Data analysis was performed by logistic regression at the confidence interval of 95%.ResultsWithin our sample (n = 204), injury rates were calculated across sub-groups of athletes that had only SIJ pain (n = 19), only SIJ dysfunction (n = 67), both SIJ pain and dysfunction (n = 15) or no SIJ complaints (n = 103). Across these groups, a total of 464 injuries were reported. SIJ pain group reported 80 injuries (17.2%), SIJ dysfunction group reported 210 injuries (45.2%), both SIJ pain and dysfunction group reported 58 injuries (12.5%, and the no SIJ pain or SIJ dysfunction group reported 116 injuries (25.0%). Participants with SIJ pain were more likely to report previous pelvic girdle injuries (overuse: odds ratio (OR): 0.017; 95% CI: 0.005–0.56; p < 0.001 and acute: OR: 0.197; 95%CI: 0.101–0.384; p < 0.001) and also lower limb injuries (overuse: OR: 0.179, 95%CI: 0.082–0.392, p < 0.001). Participants with SIJ dysfunction only were likely to report acute pelvic girdle injuries (OR: 0.165; 95%CI: 0.070–0.387; p < 0.001) and acute lower limb injuries (OR: 0.165; 95%CI: 0.030–0.184; p < 0.001).ConclusionThe presence of SIJ dysfunction and pain is associated with a history of acute and overuse injuries in the pelvic girdle and lower limb. Thus, SIJ dysfunction and pain should be specifically evaluated and addressed when designing rehabilitation programs for sports-related injuries.

Sacroiliac joint (SIJ) dysfunction is once again garnering attention as a treatable diagnosis for the millions of individuals suffering from acute and chronic low back pain. Theoretically, excessive or restricted motion at the SIJ can alter the mechanics of the spine and pelvis causing pain. Often the clinician's history and physical examination are nonspecific in the evaluation of low back pain and a high index of suspicion is required to consider SIJ dysfunction as the cause for the patient's symptoms. Multiple physical examination maneuvers exist to detect SIJ dysfunction, but none are individually sensitive or specific enough to diagnose SIJ dysfunction alone. The clinician should learn 3 to 5 tests that can easily be performed and replicated for the evaluation of SIJ dysfunction and use them consistently in patients presenting with low back pain. Sacroiliac joint anesthetic blocks using computed tomography (CT) or fluoroscopic-guided injection are considered the gold standards for diagnosing SIJ dysfunction as the cause for nonspecific low back pain. Imaging studies and laboratory evaluations are generally unnecessary for the diagnosis of SIJ dysfunction unless specific elements of the history and physical suggest alternate etiologies. Interventions to treat the pain of SIJ dysfunction include nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, corticosteroid injections, osteopathic manipulation, radiofrequency denervation, SIJ belts, and surgery. While there are few high-level evidence studies evaluating and comparing these treatments in individuals with SIJ pain, patients may respond to one, or a combination of these treatments.

In recent years, researchers have delved into the relationship between the anatomy and biomechanics of sacroiliac joint (SIJ) pain and dysfunction in endurance runners to elucidate the connection between lower back pain and the SIJ. However, the majority of SIJ pain and dysfunction cases are diagnosed and managed through a traditional athlete-clinician arrangement, where the athlete must attend regular in-person clinical appointments with various allied health professionals. Wearable sensors (wearables) are increasingly serving as a clinical diagnostic tool to monitor an athlete's day-to-day activities remotely, thus eliminating the necessity for in-person appointments. Nevertheless, the extent to which wearables are used in a remote setting to manage SIJ dysfunction in endurance runners remains uncertain. This study aims to conduct a systematic review of the literature to enhance our understanding regarding the use of wearables in both in-person and remote settings for biomechanical-based rehabilitation in SIJ dysfunction among endurance runners. In addressing this issue, the overarching goal was to explore how wearables can contribute to the clinical diagnosis (before, during, and after) of SIJ dysfunction. Three online databases, including PubMed, Scopus, and Google Scholar, were searched using various combinations of keywords. Initially, a total of 4097 articles were identified. After removing duplicates and screening articles based on inclusion and exclusion criteria, 45 articles were analyzed. Subsequently, 21 articles were included in this study. The quality of the investigation was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) evidence-based minimum set of items for reporting in systematic reviews. Among the 21 studies included in this review, more than half of the investigations were literature reviews focusing on wearable sensors in the diagnosis and treatment of SIJ pain, wearable movement sensors for rehabilitation, or a combination of both for SIJ gait analysis in an intelligent health care setting. As many as 4 (19%) studies were case reports, and only 1 study could be classified as fully experimental. One paper was classified as being at the "pre" stage of SIJ dysfunction, while 6 (29%) were identified as being at the "at" stage of classification. Significantly fewer studies attempted to capture or classify actual SIJ injuries, and no study directly addressed the injury recovery stage. SIJ dysfunction remains underdiagnosed and undertreated in endurance runners. Moreover, there is a lack of clear diagnostic or treatment pathways using wearables remotely, despite the availability of validated technology. Further research of higher quality is recommended to investigate SIJ dysfunction in endurance runners and explore the use of wearables for rehabilitation in remote settings.

Introduction The threshold percent pain relief required to diagnose sacroiliac joint (SIJ) dysfunction during a diagnostic SIJ block (SIJB) is not known. Although there is no gold standard, one reference standard is response to definitive treatment. Methods Subgroup analysis of 320 subjects in two prospective trials of SIJ fusion: INSITE (NCT01681004) a randomized trial versus nonsurgical management (NSM) and SIFI (NCT01640353), a singlearm study. All participants were diagnosed with SIJ dysfunction via history (buttocks/leg pain and a positive Fortin finger test), at least 3 positive provocative physical examination signs, and a standardized diagnostic SIJB using fluoroscopically guided injection of local anesthetics in the target joint with a reduction of at least 50% in pain at 30 or 60 minutes after SIJB. The degree of improvement in VAS SIJ pain and Oswestry Disability Index (ODI) scores, expressed as absolute or percentage improvement from baseline, was correlated with the average acute improvement in SIJ pain during the SIJB, calculated as per Cohen et al. Results The average pain reduction during the first hour after SIJB was 79.3%. Pain reduction during block was unrelated to standard demographic predictors. Six months after SIJ fusion, the mean VAS SIJ pain reduction was 50.9 (28.6) points and the mean ODI reduction was 24.6 (20.5) points. SIJ pain and ODI reductions at 12 months in the SIJ fusion group were 50.8 (29.2) and 25.8 (20.5) points, respectively. There was little correlation in 6 or 12month improvements in SIJ pain or ODI with average reduction in pain during SIJB. In the SIJF group, the proportion of subjects achieving meaningful reductions in SIJ pain and ODI scores did not vary by average response during SIJB ( p = 0.8407 and 0.3069, respectively for 6 month changes, and p = 0.6368 and 0.5913). Similarly, response during SIJB did not predict the proportion of patients with followup pain scores &lt; 30 or ODI &lt; 20. Conclusions. In this study of &gt; 300 patients with carefully diagnosed with SIJ dysfunction, the degree of improvement in acute pain during an SIJB did not predict 6month improvements in VAS SIJ pain or ODI score. Based on our study, a 50% acute pain reduction threshold during SIJB was resulted in excellent postsurgical results. The use of overly stringent selection criteria for determining which patients should undergo SIJF may serve to withhold a beneficial procedure from a substantial number of patients with SIJ dysfunction.

Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard' lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis. The purpose of this study was to examine the reliability of clinical examination and provocation tests used in the diagnosis of SIJD. Retrospective analysis of prospectively collected data. Outpatient physical medicine and rehabilitation clinic. One hundred and seventeen patients presenting with lumbar and/or leg pain and diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated. Positivity in 3 out of 6 provocation tests was adopted as the criterion. 75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45 years. A higher level of females was determined in ender distribution. SIJD was determined on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen test. The same patients were assessed by the same clinician at 2 different times. In these data, the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of 0.92. Agreement between different observers was not evaluated, and also no comparison was performed with SI joint injection, regarded as a widely used diagnostic technique. The anatomical position of the SI joint and the lack of a diagnostic 'gold standard' make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain provocation tests is a reliable method, and these tests can be used instead of unnecessary invasive diagnostic SI joint procedures. Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain pattern.

Sacroiliac joint (SIJ) dysfunction is an underdiagnosed condition. Several published cohorts have reported favorable mid-term outcomes after SIJ fusion using titanium implants placed across the SIJ. Herein we report long-term (24-month) results from a prospective multicenter clinical trial. One hundred and seventy-two subjects at 26 US sites with SI joint dysfunction were enrolled and underwent minimally invasive SI joint fusion with triangular titanium implants. Subjects underwent structured assessments preoperatively and at 1, 3, 6, 12, 18 and 24 months postoperatively, including SIJ pain ratings (0-100 visual analog scale), Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and patient satisfaction. Adverse events were collected throughout follow-up. All participating patients underwent a high-resolution pelvic CT scan at 1 year. Mean subject age was 50.9 years and 69.8% were women. SIJ pain was present for an average of 5.1 years prior to surgical treatment. SIJ pain decreased from 79.8 at baseline to 30.4 at 12 months and remained low at 26.0 at 24 months (p<.0001 for change from baseline). ODI decreased from 55.2 at baseline to 31.5 at 12 months and remained low at 30.9 at 24 months (p<.0001 for change from baseline). Quality of life (SF-36 and EQ-5D) improvements seen at 12 months were sustained at 24 months. The proportion of subjects taking opioids for SIJ or low back pain decreased from 76.2% at baseline to 55.0% at 24 months (p <.0001). To date, 8 subjects (4.7%) have undergone one or more revision SIJ surgeries. 7 device-related adverse events occurred. CT scan at one year showed a high rate (97%) of bone adherence to at least 2 implants on both the iliac and sacral sides with modest rates of bone growth across the SIJ. In this study of patients with SIJ dysfunction, minimally invasive SI joint fusion using triangular titanium implants showed marked improvements in pain, disability and quality of life at 2 years. Imaging showed that bone apposition to implants was common but radiographic evidence of intraarticular fusion within the joint may take more than 1 year in many patients. This prospective multicenter clinical trial was approved by local or regional IRBs at each center prior to first patient enrollment. Informed consent with IRB-approved study-specific consent forms was obtained from all patients prior to participation.

(2008). Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Journal of Manual & Manipulative Therapy: Vol. 16, No. 3, pp. 153-154.

There is a relatively high incidence of sacroiliac joint (SIJ) pain and dysfunction among patients undergoing evaluation for low back pain. Low back pain is a leading cause of disability globally. SIJ dysfunction can affect people of varying age ranges, with a higher distribution in several clusters, including pregnant women and adults who have undergone lumbar or lumbosacral fusion surgery. SIJ pain or dysfunction is estimated to account for 15% to 30% of all cases of axial low back pain and is an often underrecognized and undertreated cause of chronic low back pain. This chapter will provide information on the physiologic, psychologic, and physical effects of SIJ pain and how those factors impact the personal, societal, and global burden of disability from SIJ pain. Tools for the evaluation of disability are briefly discussed.

Study Design Prospective multicenter single-arm interventional clinical trial.Objective To determine the degree of improvement in sacroiliac (SI) joint pain, disability related to SI joint pain, and quality of life in patients with SI joint dysfunction who undergo minimally invasive SI joint fusion using triangular-shaped titanium implants.Methods Subjects (n = 172) underwent minimally invasive SI joint fusion between August 2012 and January 2014 and completed structured assessments preoperatively and at 1, 3, 6, and 12 months postoperatively, including a 100-mm SI joint and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and EuroQOL-5D. Patient satisfaction with surgery was assessed at 6 and 12 months.Results Mean SI joint pain improved from 79.8 at baseline to 30.0 and 30.4 at 6 and 12 months, respectively (mean improvements of 49.9 and 49.1 points, p < 0.0001 each). Mean ODI improved from 55.2 at baseline to 32.5 and 31.4 at 6 and 12 months (improvements of 22.7 and 23.9 points, p < 0.0001 each). SF-36 physical component summary improved from 31.7 at baseline to 40.2 and 40.3 at 6 and 12 months (p < 0.0001). At 6 and 12 months, 93 and 87% of subjects, respectively, were somewhat or very satisfied and 92 and 91%, respectively, would have the procedure again.Conclusions Minimally invasive SI joint fusion resulted in improvement of pain, disability, and quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis and SI joint disruption.

Introduction Lumbar fusion procedures for the treatment of appropriately selected cases of degenerative lumbar spine disease are rapidly increasing, with reported good overall results. However, an estimated 5 to 30% of these patients may suffer from significant persisting low back pain, despite technically successful surgery. In this setting, sacroiliac joint (SIJ) dysfunction has been postulated as possible underdiagnosed cause for these persisting symptoms. We aimed to assess the prevalence, associated risk factors and clinical impact of SIJ pain after lumbar fusion procedures. Material and Methods Retrospective observational study of consecutive patients undergoing lumbar fusion at a single center between September 2012 and January 2014. A transversal evaluation through telephone interview was conducted, investigating the presence and characteristics of residual low back pain. Numeric pain rating scale (NPRS) for low back pain and Oswestry Disability Index (ODI) were collected for each patient. General demographic and surgery related data, including gender, age, body mass index, smoking status, number of segments fused and levels of fusion (including or not S1 level) was also noted. Selected patients with residual pain suspected to be of SIJ origin underwent clinical evaluation with a battery of 6 widely accepted SIJ provocative tests (FABER, SIJ sulcus tenderness, Gaenslen's test, Yeoman's test, compression test and sacral thrust). Those with 3 or more positive tests were considered to suffer from SIJ originated pain (SIJ-pain group). Statistical analysis comparing this group with the non-SIJ pain group (patients presenting with residual pain without clinical evidence of SIJ origin) regarding the collected variables was performed using SPSS 19 software. Results From a total of 89 patients that underwent surgery in this period, 52 patients were available for interview (mean age 59 years, 36.5% male, 63.5% female). Eight patients (15.4%) were completely asymptomatic, whereas 44 patients (84.6%) reported some degree of residual pain (mean NPRS of 4.73, mean ODI of 29.81%), although most reported clinical improvement and pain decrease with surgery. It was possible to clinically evaluate a final sample of 32 patients with residual pain (mean follow-up of 22.7 months). In 15 cases (46.9%) there was evidence of SIJ originated pain, as indicated by positiveness to 3 or more SIJ provocative tests. Presence of SIJ-pain was significantly associated with higher ODI scores (Mann-Whitney U 58.5, p = 0.009), and also tended to associate with higher NPRS scores (Mann-Whitney U 80, p = 0.071). Predictors for SIJ-pain development after surgery were not found, as there were no associations between the presence of SIJ-pain and the initially retrieved demographic and surgery related data, such as age, gender, BMI, smoking status, fusion to the sacrum and number of fused segments. Conclusion In the post-lumbar fusion patient population that remains symptomatic after surgery, SIJ dysfunction and pain may account for a large proportion of cases, as illustrated by the impressively high rate of residual low back pain compatible with SIJ-pain found in this study (46.9%). Moreover, it may significantly affect functional outcome and surgery success rates, as patients in the SIJ-pain group presented worse ODI and NPRS scores than those with non-SIJ residual pain.

Sacroiliac joint (SIJ) dysfunction is a prevalent cause of chronic, unremitting lower back pain. To concurrently compare outcomes after surgical and nonsurgical treatment for chronic SIJ dysfunction. A total of 148 subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (n = 102) or nonsurgical management (n = 46). Pain, disability, and quality-of-life scores were collected at baseline and at 1, 3, 6, and 12 months. Success rates were compared using Bayesian methods. Crossover from nonsurgical to surgical care was allowed after the 6-month study visit was complete. Six-month success rates were higher in the surgical group (81.4% vs 26.1%; posterior probability of superiority > 0.9999). Clinically important (≥ 15 point) Oswestry Disability Index improvement at 6 months occurred in 73.3% of the SIJ fusion group vs 13.6% of the nonsurgical management group (P < .001). At 12 months, improvements in SIJ pain and Oswestry Disability Index were sustained in the surgical group. Subjects who crossed over had improvements in pain, disability, and quality of life similar to those in the original surgical group. Adverse events were slightly more common in the surgical group (1.3 vs 1.1 events per subject; P = .31). This Level 1 study showed that minimally invasive SIJ fusion using triangular titanium implants was more effective than nonsurgical management at 1 year in relieving pain, improving function, and improving quality of life in patients with SIJ dysfunction caused by degenerative sacroiliitis or SIJ disruptions. Pain, disability, and quality of life also improved after crossover from nonsurgical to surgical treatment.

Composite sacroiliac joint pain provocation tests: A question of clinical significance

This study is aimed to investigates sacroiliac joint (SIJ) dysfunction to understand the treatment and the prevention as it is said (prevention is better than cure).Also, it is to recognize causes that increase SIJ pain, to protect and to educate people against SIJ.In addition, it is to study symptoms and treatment of SIJ dysfunction, especially treatment by physiotherapythat involve electrotherapy, exercise therapy, heat therapy, cold therapyandetc, to reduce painimprove circulation, improve muscles power, increase rang of motion, strength muscles and ligaments around the SIJ and advice patient or normal person to improve lifestyle activity where lifestyle activity or dealyroutin consider main cause thatlead to SIJ dysfunction.For this reason,wecan use the physiotherapy to the prevention against sacroiliac joint (SIJ) dysfunction. Additionally, this study performed on only one case diagnosed with sacroiliac joint (SIJ) dysfunction who observed in Tobruk\medical Center in 2018. The study showed that sacroiliac joint dysfunction has similar signs and symptoms with low back pain that make physiotherapist and ortopedics to confuse between them in the diagnosis. The SIJ dysfunction wasdiagnosed by manual examination and radiology (X-ray, Magnetic resonance imaging and omputed tomography).But sometimes, Sacroiliac joint dysfunction diagnosed as low back pain, especially in ToprukMedical Center because there is no advanceintechnology and in devices examination like therapeutic intra- articular or periticular injection or nerve blocks. For these reasons, just one case had been found in TobrukMedical Center during the study period. This study showed the SIJ dysfunction does not related to age, but it may be affected by lifestyle activity or gender where females were more commonly affected with SIJ dysfunctin. Retraction Note:This article has been retracted by the Editorial Board of TUJMS. Upon internal review using plagiarism detection software, it was found that the manuscript substantially duplicates content previously published by the same authors. The retraction is issued due to redundant publication, undeclared reuse of data and text, and a breach of publication ethics.

Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation.

Cross-sectional observational cohort study. The aim of this study was to determine the incidence and risk factors associated with the development of sacroiliac joint (SIJ) dysfunction following lumbosacral fusion. Adjacent segment degeneration to both proximal and distal areas of spinal fusion is a postoperative complication of lumbar fusion. Various studies examined supra-adjacent degeneration following lumbar fusion, but few focused on infra-adjacent degeneration. In lumbosacral fusion, fusion extends to the sacrum, placing increased stress on the SIJ. A total of 2069 sequential patients who underwent lumbosacral fusion surgery from 2008 to 2018 at a single academic medical center were retrospectively reviewed. Patients who subsequently developed SIJ dysfunction were identified. SIJ dysfunction was defined as patients who met the diagnostic criteria with physical examination and received an SIJ injection with clinical evidence of improvement. Controls, without subsequent SIJ dysfunction, were matched with cases based on levels of fusion, age, sex, and body mass index. Pre-and postoperative pelvic parameters were measured, including pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis, lumbosacral angle, L4 incidence and L5 incidence. Of 2069 patients who underwent lumbosacral fusion, 81 patients (3.9%) met criteria for SIJ dysfunction. Measurements were made for 47 of 81 patients who had SIJ dysfunction, that had both pre- and post-operative imaging. Measurements for 44 matched controls were taken. Postoperative PT was significantly lower in SIJ dysfunction patients compared to controls (20.82° ± 2.19° vs. 27.28° ± 2.30°; P < 0.05), as was L5 incidence (28.64° ± 3.38° vs. 37.11° ± 3.50°; P < 0.05). Incidence of the SIJ dysfunction after lumbosacral fusion surgery was 3.9% and these patients had a significantly lower PT and L5 incidence compared to the control group. Significantly low PT may be derived from weak hamstring muscles, predisposing a patient to SIJ dysfunction. Therefore, hamstring muscle strengthening exercise for patients with decreased PT after lumbosacral fusion may decrease the incidence of SIJ dysfunction.Level of Evidence: 3.