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

True sacroiliac (SI) joint pain arises for well-established pathological reasons. For example, SI joint infection is characterised by non-specific, diffuse and poorly localised pain that makes an initial clinical diagnosis difficult, even though the condition is a prima facie SI joint lesion. On the other hand, the putative sacroiliac joint pain of the ‘sacroiliac joint syndrome’ that is by definition not associated with morphological and radiological abnormality, is a symptom commonly observed in clinical practice. Such a presentation possesses a typically well-localisable pain in the region overlying the posterior sacroiliac joint. The contention is that composite SI joint pain provocation tests, whilst of arguably statistical ‘significance’, may lack clinical significance particularly in the light of anatomical research that presents an alternative patho-anatomic basis for localisable sacroiliac pain and may offer a rational basis for diagnosis and treatment.