Low back pain, pelvic girdle pain or both? Tests to rule in the Pelvis.
Pelvic girdle pain (PGP) is a frequent occurrence in patients who present with low back pain. The prevalence has been stated as 15% in regular population and even higher in athletes especially in some specific groups (ie. rowers).
Pelvic girdle pain is defined by pain experienced between the posterior iliac crest and gluteal fold, particularly in the vicinity of the sacroiliac joints (1). Patients will describe a decreased endurance capacity for standing, walking and sitting. Believed causes of PGP are pregnancy, trauma or reactive arthritis. To reach the sole diagnosis of PGP one must exclude other regions including the lumbar spine and hip.
Recent studies have demonstrated that positive findings on a combination of pain provocation tests can reliably indicate pelvic girdle pain (2). These tests include: Patrick’s Faber test, Thigh thrust, Gaenslen’s test and more. Best evidence suggests that patients with at least 3 PGP provocation tests that are positive are more likely to be regarded to have SI joint pain. See below for complete descriptions and photos of the tests.
Once a diagnosis of PGP has been established various treatment approaches can be pursued. Interventions used include: correction of muscle imbalance, mobilization/manipulation, use of sacroiliac belt, acupuncture/IMS, pool therapy and prolotherapy.
References:
Vleeming A et al. European Guidelines for the Diagnosis and Treatment of Pelvic Girdle Pain. Eur Spine J 2008; 17:794-819.
Szadek KM et al. Diagnostic Validity of Criteria for Sacroiliac Joint Pain: A Systematic Review. The Journal of Pain 2009; 10(4):354-368.
Pelvic girdle pain provocation tests:
Patrick’s Faber test
Patient supine: one leg is flexed, abducted and externally rotated so the heel rests on the opposite knee. Examiner presses gently on superior aspect of knee. If pain is felt in sacroiliac joints the test is positive.
Posterior Pelvic Pain Provocation Test/Thigh Thrust
Patient supine: hip flexed to 90 degrees on test side, light manual pressure is applied to patient’s flexed knee along the longitudinal axis of femur while pelvis is stabilized. If pain is felt deep in gluteal area the test is positive.
Gaenslen’s Test
The patient lying supine, flexes the hip/knee and draws it toward the chest and holds. Patient’s opposite side is close to edge of the bed. The examiner slowly hyperextends the thigh over the edge with gradual pressure while other leg remains flexed. Test is positive if the patient experiences pain.
Palpation of Long dorsal sacroiliac ligament (LDL)
Patient prone: test for tenderness of LDL directly under the posterior superior iliac spine.
Anterior Distraction and Posterior Compression Test
Patient supine, the medial aspect of the ASIS is palpated bilaterally with heels of the crossed hands. A slow, steady, posterolateral force is applied through the ASISs. The force is maintained for 5 seconds.