The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. If symptoms exist above L5 and the patient has >3/5 positive SIJ provocation tests, I treat the lumbar spine and the SI joint. Gunaydin I, Pereira PL, Fritz J, Konig C, Kotter I. Riddle DL, Freburger JK. Hide glossary Glossary. Dreyfuss P, Dryer S, Griffin J, Hoffman J, Walsh N. Positive sacroiliac screening tests in asymptomatic adults. Tests for SIJ dysfunction generally have poor inter-examiner reliability. eCollection 2022. Careers. The Childs JD, Fritz JM, Flynn TW, et al. (Reproduction of buttock pain), Pt prone. The means were compared using the Mann-Whitney test, and Kruskal-Wallis and nonparametric trend tests were performed for the variables age and education. This has been used to discredit the procedure as well as the clinical tests predictive of the diagnostic injection outcome85. van Wingerden JP, Vleeming A, Buyruk HM, Raissadat K. Stabilization of the sacroiliac joint. As yet, there is no better gold standard available than a double, fluoroscopy guided sacroiliac nerve block, so despite its recorded flaws, it remains the best option for diagnosing sacroiliac joint pain at present. A non-mechanical mechanism is responsible for the patients' SIJ pain. Cibulka MT, Koldehoff R. Clinical usefulness of a cluster of sacroiliac joint tests in patients with and without low back pain. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. Intertester reliability for selected clinical tests of the sacroiliac joint. The likelihood ratio for a positive test (three or more SIJ tests provoke the patient's familiar pain) is 4.16 so the probability of SIJ pain more than doubles from 26% to 59%. Mechanical diagnosis and therapy approach to assessment and treatment of derangement of the sacro-iliac joint. Unilateral back pain presenting below spinal level L5 with referred pain to the buttock and thigh may be indicative of low back pain originating from the SI joint. A number of studies have addressed the problem of poor reliability of individual palpation SIJ tests by assessing groups or clusters of tests with some success2932. These All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Rosenberg JM, Quint TJ, de Rosayro AM. This indicates that individual tests are often false-positive, supporting a long-held belief that SIJ-generated pain can only be entertained as a possible diagnosis when multiple tests are positive. Overall, the rule of thumb is 2/4 positive tests are needed to diagnose a symptomatic SI joint. official website and that any information you provide is encrypted Clustering individually unreliable tests may improve reliability but still lacks face validity. Freburger JK, Riddle DL. Simopoulos TT, Manchikanti L, Singh V, Gupta S, Hameed H, Diwan S, Cohen SP. Distraction test meest specifieke test van Cluster Laslett th staat aan aangedane zijde 3-6 thrust opbouwende druk Sens 60 Spec 81 LR+ 3.2 LR- 0.49 3. Int J Environ Res Public Health. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); In this FREE video series by Vestibular Rehab SpecialistFIRAT KESGIN. Bethesda, MD 20894, Web Policies While such a cohort will still contain some cases with pain arising from structures other than the internal contents of the SIJ, it seems highly likely that if there are effective treatment methods for SIJ pain, differences in outcomes between treatments will be identified. Reliability of McKenzie classification of patients with cervical or lumbar pain. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. De cluster van Laslett bestaat uit vier testen. Sensitivity is the proportion of patients with the disease in question who have positive tests. A few may need surgical fusion. The .gov means its official. Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y. Objective To assess the diagnostic test accuracy of pain provocation tests for the sacroiliac joint. Furthermore, if all 5 tests are negative, you can likely look at structures other that the SI joint. This regimen of tests was also chosen in a similar study by Laslett (2003). A study of clinical predictors of lumbar discogenic pain as determined by provocation discography. The pain-provocation SIJ tests are reliable if performed in a highly standardized manner, using sufficient force to stress the SIJ. Le 5e test mentionn dans la littrature est le test de Gaenslen. SI Joint Special Tests | Cluster of Laslett 848 views Jan 12, 2022 In this video, we explore the Cluster of Laslett, a test item cluster used in the diagnosis of SI joint dysfunction.. Positive Outcome: The diagnosis of a painful SIJ is given for 3 or more positive tests out of 5 The SIJ as source of nociception is rejected if less than 3 tests are positive There are other interventions not available to physical therapists that may have value in the treatment of persistent SIJ pain. FOIA Sturesson B, Uden A, Vleeming A. The first unit was the census tracts. 1999;79:1043-1057, Cleland J. Orthopaedic clinical examination: an evidence-based approach for physical therapists. Incidence of sacroiliac joint dysfunction and low back pain in fit college students [published erratum appears in. Vous pouvez augmenter la spcificit lorsque les symptmes du patient ne se centralisent pas comme le dcrit McKenzie. Most of these treatment methods are based explicitly or implicitly on the presumption that some biomechanical malfunction or dysfunction causes either the SIJ or other tissues to provoke the pain of which the patient complains. Laslett M, Williams M. The reliability of selected pain provocation tests for sacro-iliac joint pathology. If about 30% of patients with low back pain have pain of SIJ origin, and an individual patient has three or more positive provocation SIJ tests, there is a 59% chance that this patient will have SIJ pain. When 3 of 5 tests (distraction, thigh thrust, Gaenslen, sacral thrust, compression) are positive, it indicates SIJ dysfunction. Interactive Content (Direct Video Demonstration, PubMed articles), Statistical Values for all Special Tests from the latest research, Currently on Version 5.0 Free lifetime updates. eCollection 2022. The Laslett cluster of SIJ pain provocation tests has the strongest evidence for noninvasive clinical testing. In: Vleeming A, Mooney V, Snijders CJ, Dormann TA, Stoeckart R, editors. Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment. intervertebral discs, sacroiliac joints, facet joints, bone . The Cluster of Laslett originally describes 6 provocative tests. Gaenslen's Test ( Gaenslen's maneuver) is one of the five provocation tests that can be used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and Sacroiliac joint (SIJ). If the same SIJCPR were applied to a cohort of women with pregnancy-related PGP, this proportion would likely be much higher. [4] This study provided justification for its choice of the same five tests used by van der Wurff (2006)[6] based on the inter-rater reliability reported by Laslett and Williams (1994),[10] with all tests having a kappa value of 0.52-0.88, showing fair to excellent reliability. DonTigny RL. Laslett, M. (2008) Evidence-based diagnosis and treatment of the painful sacroiliac joint. Clinically, if symptoms exist above L5, I treat the lumbar spine first. The optimal technique of injection was established in 199248 and is described in the current edition of the practice guidelines issued by the International Spine Intervention Society42. These tests have been examined for intra- and inter-examiner reliability in studies of varying quality. Van der Wurff et al (2006)[6] based their injections procedure on the published literature,[11] and adopted the standards set by the International Spinal Injection Society in order to measure the success of injections. For convenience, we may refer to this as the SIJCPR. None of the SIJ tests used were found to be predictive of the outcome of the manipulation. (Reproduction of pain), Pt supine with both legs extended. Le stockage ou l'accs technique qui est utilis exclusivement des fins statistiques. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. Post a Question. As these techniques are pain provocation techniques, be careful and start gently first. Adv Orthop. A review by Berthelot (2006) also concluded that joint injections are unreliable for diagnosing sacroiliac joint pain;[7] however, this study did not show clarity in the description of the methods used to search and screen each paper, and so the possibility of bias within the literature chosen increases, thereby raising questions as to the validity of this conclusion. will also be available for a limited time. Reprinted with permission19. 2009 Apr;14(2):213-21. doi: 10.1016/j.math.2008.02.004. If the SIJCPR of three or more positive provocation SIJ tests and the absence of centralization are applied, the diagnostic performance is improved because the false positive rate is decreased with proportionate improvement in specificity from 78% to 87%. Note: A vertically directed force is applied to the iliac crest directed towards the floor, i.e., transversely across the pelvis, compressing the SIJs. The compression test (testing right and left SIJ). Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis. Laslett M, McDonald B, Tropp H, Aprill CN, Oberg B. In addition, injectate may spread from a successful intra-articular injection to adjacent structures including the dorsal sacral foramina, the L5 spinal nerve and lumbosacral plexus84. Omdat de Thigh Thrust test en de Distraction test de hoogste individuele mate van validiteit hebben, lijken deze testen een hoge prioriteit te hebben. special test for si joint dysfunctionmaximum intensity projection algorithm 5th January 2023 . After the McKenzie evaluation, patients with discogenic pain was ruled out. When all 6 SIJ provocation tests do not reproduce symptoms, SIJ pathology can be ruled-out. Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Gupta et al. Sometimes just a single pressure is enough. Note: The pelvis is stressed with a torsion force by a superior/posterior force applied to the right knee and a posteriorly directed force applied to the left knee. Laslett M, Oberg B, Aprill CN, McDonald B. With this background information and despite an abundance of evidence indicating that no clinical picture is able to characterize pain of SIJ origin3,10,40,109, a study was initiated to investigate the diagnostic accuracy of pain-provocation SIJ tests. The results of the two studies are strikingly similar55 despite the use of a slightly different mix of SIJ tests in each study. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain: A predictor of symptomatic discs and annular competence. (Reproduction of pain). Sacroiliac joint pain: Anatomy, biomechanics, diagnosis, and treatment. [7] There is now thought that the gold standard of SIJ nerve block may not be the most appropriate[8] and so the IASP diagnostic criteria for SIJ pain no longer as valid as it once was. official website and that any information you provide is encrypted Arch Phys Med Rehabil. The Cluster of Laslett originally describes 6 provocative tests. Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint Laslett M. http://araw.mede.uic.edu/cgi-bin/testcalc.pl. This was not the case for van der Wurff et al (2006),[6] where all subject received both long and short term injections, thereby eliminating this possibility. Agreement between diagnoses reached by clinical examination and available reference standards: A prospective study of 216 patients with lumbopelvic pain. Prior to any examination, the probability of a given disorder being present is its prevalence. SIJ Cluster Laslett: These tests should be performed in the described order. Likelihood ratios are summary statistics derived from sensitivity and specificity values. Le Cluster de Laslett est un outil utilis dans l'valuation de la lombalgie. There is evidence that exercises not specifically aimed at improving lumbopelvic stability are no more effective than other commonly used treatments95,96. Cohen SP, Abdi S. Lateral branch blocks as a treatment for sacroiliac joint pain: A pilot study. Eventually, Laslett proposes an algorithm comprising 4 provocative tests to identify the SI joint as the source of pain as the other two tests didnt have additional diagnostic value. . Literature Search Seven electronic databas. Ferrante FM, King LF, Roche EA, et al. about navigating our updated article layout. Test results are captured in a file with the file name that you specify. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Some 54% of women with pregnancy-related PGP satisfy the SIJCPR91. sharing sensitive information, make sure youre on a federal A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. However, there is a single case report of a patient satisfying the SIJCPR who responded to exercises specifically targeted to an observed directional preference112. Cluster of Laslett Execution: Perform the Thigh Thrust and Distraction Test If both are positive: Diagnosis of SIJ Pain Continue if 0 or 1 tests are positive Perform the Compression Test: 2 tests positive? Treatment based on a presumed SIJ source of pain still begs the question of why does it hurt? An explanation may be that the SIJ is a source of pain for one of two reasons: Inflammatory processes such as those found in ankylosing spondylitis87,88 are known to affect the SIJ. Cibulka et al32 reported a sensitivity of 82% and specificity of 88% for three of four palpation-based tests (standing flexion, PSIS position in sitting, supine long sitting, and prone knee flexion). The optimal rule was to perform the distraction, compression, thigh thrust and sacral thrust tests but stopping when there are 2 positives. Three pathways between the sacro-iliac joint and neural structures. Additionally, in patients presumed to have an SIJ source of pain, Sturesson16 found no difference in range of motion between the symptomatic and asymptomatic sides. La douleur de l'articulation sacro-iliaque peut alors tre exclue ou du moins peu probable. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. A recent study confirmed that three or more pain provocation SIJ tests have modest predictive power in relation to controlled comparative SIJ blocks. The practical value of this data is as follows. For example, a test with a positive likelihood ratio of 10 indicates that a positive test result is 10 times more likely in patients with the disease in question than in those known to be free of that disease. . . Man Ther. Overall, the rule of thumb is that two out of four positive tests are needed to diagnose a symptomatic SI-joint. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. But how do we decide which one to use? Waldron T, Rogers J. . Furthermore, the Visual Analog scale and Cluster of Laslett will determine whether an asymmetric load can provoke pain in the lumbar region or cause a blockage in the SI joint. The evidence in favor of these interventions is limited106. Le Cluster de Laslett dcrit l'origine 6 tests provocateurs. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. Design Systematic review of diagnostic test accuracy. Patients satisfying these criteria have a high probability that SIJ pain will be confirmed by diagnostic injection of local anesthetic. followers, 275k Researchers should be aware that intra-articular SIJ pain is not a homogeneous subgroup of the low back pain population. Spine 1995;20:31-7. This clinical reasoning process may be considered a clinical prediction rule for the identification of a subset of patients most likely to have pain of SIJ origin. While back pain patients will have structural and biomechanical aberrations, focusing on these aspects is fraught with problems associated with the reliability and validity of test procedures. Rapidly Reversible Low Back Pain: An Evidence-Based Pathway to Widespread Recoveries and Savings. But as a manual therapist, it is hard to give up on a hard-won skill, and from time to time SIJ manipulation was attempted when he was convinced that the SIJ was a source of pain. One of five possible interpretations of the above results is possible: On the basis that provocation SIJ tests have been shown to be both reliable and valid predictors of SIJ pain, item 1 is at least partially false. When both the prevalence of the disorder and the results of a test are known, likelihood ratios permit calculation of the change in odds and probability of a disorder being present or absent80. The centralization phenomenon is a common clinical observation when low back patients are examined using the standardized test movements and sustained postures first described by McKenzie59. The site is secure. The key tests (distraction, compression, thigh thrust, Gaenslen's, and sacral thrust) have been described in detail in previous publications19,5052 and are reproduced in Figures Figures115. Heuft-Dorenbosch L, Weijers R, Landewe R, S van der Linden, D van der Heijde. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. However, the literature concerning pelvic girdle pain (PGP) associated with pregnancy offers some good-quality information in this regard. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Because a significant proportion of back patients with discogenic pain can be identified using the McKenzie system of evaluation to determine the presence of the centralization phenomenon, the following SIJCPR can be easily applied to the great majority of back pain patients: Low back pain patients satisfying this SIJCPR have a probability of SIJ pain exceeding 70% and in those with pregnancy-related PGP, the probability is close to 90%. Study with Quizlet and memorize flashcards containing terms like Laslett cluster, Thigh thrust, Gaenslen's test and more. Man Ther 2009;14:213-21. Movement, Stability and Lumbopelvic Pain: Integration of Research and Therapy. The excavation of test trenches at Sites 15/1, 16/29 and 16/15 (Site 15/1: 2 m wide and 5.2 m deep, bedrock reached; Site 16/29: 1 m wide and 2.4 m deep, bedrock not reached; Site 16/15: 2 m wide and 2.1 m deep, bedrock reached) (Fig. This experience was later strengthened during research when it became apparent that in cases with confirmed SIJ pain, the patient commonly reported no change or aggravation after manipulation. Joint Bone Spine 2006;73:17-23. Tests that stress the SIJ in order to provoke familiar pain have acceptable inter-examiner reliability and have clinically useful validity against an acceptable reference standard. A large number of clinical tests have been proposed to assess movement or asymmetry of the SIJ. None of the SIJ tests evaluated has any value in identifying the SIJ lesion believed to be treatable by the manipulation. Inter-and intra-examiner reliability of palpation for sacroiliac joint dysfunction. Mark Laslett, the author of the cluster proposes a diagnostic algorithm to evaluate the outcomes of each individual test. This rises to 77% if the McKenzie method of assessment does not yield the centralization phenomenon. The control arm of the study should be subjected to a sequence of any two of a number of treatments excluding those used in the treatment arm. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Nous utilisons des cookies pour optimiser notre site web et notre service. Before Sachez que les pousses ne sont pas des pousses de thrapie manuelle. Fagan's nomogram from data derived from Laslett et al52, N=34. These individuals generally have a physical therapy, chiropractic, osteopathic, or manual medicine background. A test with high specificity and low sensitivity is useful in making the diagnosis, but a large proportion of cases positive to the reference standard will have negative tests; i.e., there is a high false negative rate33,34. This hypothesis is fragile indeed, since the means by which such dysfunctions are identified rest upon a flimsy evidential base, disputed by published data showing tests for SIJ dysfunction to be unreliable and invalid. In a second paper, the data were analyzed in more detail against a single block reference standard to report on the diagnostic accuracy of composites of pain provocation SIJ tests. A reference standard for SIJ dysfunction is not readily available, so validity of the tests for this disorder is unknown. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. 2006 Jan;87(1):10-4. doi: 10.1016/j.apmr.2005.09.023. Start with T10 and then go down (inferior angle of scapula is T6/7) b. Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Man Ther. 2022 Oct 1;17(6):1156-1169. doi: 10.26603/001c.38168. Part I: Asymptomatic volunteers. Pelvic pain in Maigne's syndromea multi-segmental . Careers. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. followers. Schwarzer AC, Aprill C, Bogduk N. The sacroiliac joint in chronic low back pain. Centralization of pain is not achieved during a McKenzie evaluation of repeated movements/sustained positions. Diagnostic des douleurs de l'articulation sacro-iliaque : validit des tests de provocation individuels et des composites de tests. To illustrate and test my ideas about cooperation and discord, however, I focus first on the area where common interests are greatest and where the benefits of international cooperation may be easiest to realize. Dar G, Peleg S, Masharawi Y, Steinberg N, Rothschild BM, Hershkovitz I. Dar G, Khamis S, Peleg S, et al. A goal of this paper is to steer future research into areas with the greatest potential. You can increase the specificity when the patients symptoms dont centralize as described by McKenzie. This presents the possibility that subjects may have been recorded as having a negative response to the first injection and so not passed on to the next confirmatory injection, which may have shown a positive response. The clinical examination described is reliable, requires no special equipment, and is available from trained clinicians in most developed countries. Discriminant validity and relative precision for classifying patients with non-specific neck and low back pain by anatomic pain patterns. Pereira PL, Gunaydin I, Trubenbach J, et al. Study Pelvis/SIJ intro (Final Exam) flashcards. IASP's three diagnostic criteria were: Based on recent research, the IASP criteria have been superseded for a variety of reasons. Address all correspondence to Dr Mark Laslett. Est-ce que moins de 2 ou mme tous les tests sont ngatifs ? Stuge B, Veierod MB, Laerum E, Vollestad N. Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: Randomised single blind controlled trial. HHS Vulnerability Disclosure, Help Federal government websites often end in .gov or .mil. Provocation SIJ tests are more frequently positive in back pain patients than the accepted prevalence of SIJ pain58. Specifically, I explain and demonstrate the following special tests: thigh thrust, distraction, sacral thrust, and compression tests.INSTAGRAM | @thecatalystuniversity Follow me on Instagram @thecatalystuniversity for additional helpful content and for my more fun side: Pets, Workouts, Dragon Ball ZWEBSITE | https://www.thecatalystuniversity.com/SleepPhones | Need to Relax? Fortin JD, Washington WJ, Falco FJE. In chronic back pain populations, patients who have three or more positive provocation SIJ tests and whose symptoms cannot be made to centralize have a probability of having SIJ pain of 77%, and in pregnant populations with back pain, a probability of 89%. Mobile Apps For Heath Care. The diagnostic utility was as follows: These results show that when three or more pain provocation tests are found, there is a high probability that sacroiliac joint pain is present. (Reproduction of symptoms), Pt supine. The cluster includes: the Patrick Faber Test, the Gaenslen Test, CompressionDistraction Test, Anterior Shear Test, Log-Roll Test, and Distraction Test. These tests are divided into those that assess movement or position by palpation (palpation tests) and those that stress the structure to reproduce the patient's symptoms (pain provocation tests) ( Laslett and Williams, 1994 ). The authors reported. Laslett et al[4] identified the TIC for SIJ dysfunction after the McKenzie evaluation to rule out discogenic pain. The comparison of the diagnostic accuracy of 3 or more positive sacroiliac joint (SIJ) provocation tests in their study and the reported results from our study is inappropriate. It is unknown if provocation tests can reliably identify extra-articular SIJ sources of pain. Note: A vertically directed force is applied to the midline of the sacrum at the apex of the curve of the sacrum, directed anteriorly, producing a posterior shearing force at the SIJs with the sacrum nutated. Thrapie manuelle. The cluster includes: the Patrick Faber Test, the Gaenslen Test, Compression-Distraction Test, Anterior Shear Test, Log-Roll Test, and Distraction Test. Then SIJ pain can be ruled out or is at least unlikely. The first perspective proposes that the joint is malfunctioning in some manner and the word dysfunction is commonly used to encapsulate the complexity of aberrations believed to occur. doi: 10.1155/2021/6610500 Part 1: Reliability. Create. Si deux tests sont positifs maintenant, le diagnostic est probablement une articulation SI symptomatique. Although debated throughout literature, it is generally accepted that 10-25% of patients who present with mechanical low back or buttock pain will have this pain secondary to sacroiliac joint pain. He coordinates the Austrian Cluster for Tissue Regeneration since 2006, which includes 28 work groups from academia with multiple research targets and 12 spin-off groups. Le stockage ou l'accs technique est strictement ncessaire dans le but lgitime de permettre l'utilisation d'un service spcifique explicitement demand par l'abonn ou l'utilisateur, ou dans le seul but d'effectuer la transmission d'une communication sur un rseau de communications lectroniques. van der Wurff P, Hagmeijer RH, Meyne W. Clinical tests of the sacroiliac joint: A systematic methodological review. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. The positive likelihood ratio is 7.0, yielding a post-test probability of 77%. MeSH Ngaa-bi-nya-nhumi-nya (to Test First): Piloting the Feasibility of Using the Growth and Empowerment Measure with Aboriginal Pregnant Women Who Smoke. The sacral thrust test (testing right and left SIJ simultaneously). In this author's opinion, the treatments with the most potential for reductions in pain and disability are exercises aimed at improvement in lumbopelvic stability and intra-articular steroid injections. Le stockage ou l'accs technique qui est utilis exclusivement des fins statistiques anonymes. Open navigation menu. The studies reviewed are largely in agreement, concluding that a multi-test regimen is an acceptable clinical tool to make reliable predictions of sacroiliac joint pain when compared to the gold standard.