Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark.
School of Physiotherapy, The University of Notre Dame, Fremantle, Australia.
Phys Ther. 2019 Nov 25;99(11):1511-1519. doi: 10.1093/ptj/pzz108.
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
骶髂关节（SIJ）通常被认为与下腰痛有关，因为它位于下腰痛的位置。然而，确定疼痛的原因可能具有挑战性，特别是在没有特定原因（如妊娠、疾病或创伤）的情况下，此时可能需要借助手动临床检查来确定 SIJ 是否是症状的来源。非特异性 SIJ 相关疼痛通常被认为与 SIJ（s）的运动问题有关，这种诊断传统上是通过对 SIJ 复合体的运动进行手动评估得出的。治疗选择通常包括患者教育、手法治疗和运动。尽管管理的某些方面与指南一致，但本文认为，这些诊断和治疗所基于的假设存在问题，特别是如果它们强化了无益的病理解剖学信念。本文回顾了关于 SIJ 运动功能障碍的临床检测和诊断的证据。特别是，它质疑了继续评估运动功能障碍的做法，尽管越来越多的证据削弱了这种诊断的生物学合理性以及基于这些诊断的后续治疗模式。鼓励临床医生将他们的评估方法和解释模型与当代科学相结合，以降低他们的诊断和干预选择对临床结果产生负面影响的风险。
