Incidence of SIJ Lesions

Harris & Murray [1] stated that 20 of 37 athletes studied had a chronic stress lesion of the sacroiliac joint, and 13 of these also were unstable at the symphysis pubis, showing an association between the two areas. Further, they state that 58% of footballers and 100% of other athletes who were referred for symptoms of groin or lower abdominal pain had radiographic evidence of symphysis pubis abnormalities. Of these athletes, 34% of the footballers and 63% of the other athletes had instability at the symphysis pubis. Interestingly, the higher the athletic level, the more common were the lesions.

Davis & Lentle [2], using 99m stannous pyrophosphate bone scanning with quantitative sacroiliac scintigraphy found that 44% of women with low back pain had sacroiliitis, of which 36% were unilateral and 64% were bilateral. Ninety percent of those women with abnormal scans had normal x-rays.

Schwarzer et al. [3], studied patients with pain below the level of L5, using diagnostic blocks, and found that in 13% to 30% of patients with non-specific low back pain, the sacroiliac joint was the main cause of the pain. Further, 9% to 21% of people studied had both leakage of fluid through anterior capsular tears and pain relief from the block. They concluded that “the sacroiliac joint is a significant cause of low back pain in patients with chronic low back pain and warrants further study.” Additionally, they found that groin pain was the only pain symptom that distinguished patients with sacroiliac joint dysfunction from other forms of low back pain.

Bernard & Kirkaldy-Willis [4] found that, in a study of 1293 patients, the sacroiliac joint was the primary cause of low back pain in 22.5% of patients. Also, he mentions findings of coexisting lesions occurring in 33% of the patients with combinations of sacroiliac joint dysfunctions and any of the following: facet joint syndrome, lateral and/or central spinal stenosis, spondylolisthesis, muscle trigger points, or herniated nucleus pulposus.

Shaw [5] stated “In our study of 1,000 consecutive patients with low back pain, 98% had a mechanical dysfunction of the sacroiliac joint as a major cause of their LBP.”

Mierau [6] found that the sacroiliac joints were reported to be a common cause of low back pain in school children.

In a study of 368 new patients, Sembrano [7] found that up to 25% of low back pain was found to be coming from the hip or sacroiliac joints.

In a review of the literature, Cohen [8] estimates the prevalence of sacroiliac joint pain to be between 15% to 25% of low back pain patients.

DeJarnette [9] found 8 out of 10 will have symptomatic weightbearing sacroiliac instability. He states that “No individual reaching the age of puberty escapes some damage to this weightbearing sacroiliac joint”.

When one considers that an estimated 80% of the population will experience back pain sometime in their lives, as suggested by Berquist-Ullman [10] Kelsey [11] and Panjabi [12], with mostly temporary resolution, serious consideration should be given to this simple biomechanical approach, because it offers a unifying way to tie the entire musculoskeletal system together, based on innate movement through nutation and counternutation patterns.

Since the ridge and groove, or other degenerative changes, occur in almost every specimen over 50 years of age, [8, 13-29], the Serola Theory suggests that it is reasonable to assume that the sacroiliac joint nutation lesion is a pervasive part of the human condition and may be a major factor in many musculoskeletal dysfunctions.

In my own clinical experience, I found that almost every person who came into my clinic for back or hip pain had some degree of sacroiliac dysfunction, whether alone or in combination with another lesion.

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