Jul 2026· International Journal of Drug Delivery Technology· Vol 16· 0 citations· 24 references
TL;DR
There isn't a single clinical test that can accurately identify SIJ dysfunction on its own and it is necessary to conduct additional high-quality diagnostic accuracy investigations using defined reference standards.
Abstract
Background: Sacroiliac joint dysfunction is the one of the commonest conditions which leads to low back
pain. However, due to its complex anatomy and biomechanics its diagnosis is quite difficult. Previous
literature although recommended some clinical diagnostic tests but there accuracy is still unclear. Therefore,
the aim of present review was to identify the most reliable clinical diagnostic test tool in order to assess
sacroiliac joint dysfunction.
Methodology: Three databases (PubMed, Cochrane library and PEDRO) was used to search the relevant
articles. Various keywords related to sacroiliac joint dysfunctions and clinical/pain provocation test was used
by using Boolean operators (AND/OR). The full text articles were taken from inception to till 2026. The
included studies methodological quality was checked on the basis of QADAS-2 risk of bias tool.
Results: Eleven studies satisfied the requirements for inclusion. The most often studied tests were those that
provoked pain, such as the thigh thrust, compression, distraction, FABER, and Gaenslen tests. With
sensitivity ranging from 53% to 88% and specificity ranging from 16% to 81%, individual tests showed
inconsistent diagnostic accuracy. With sensitivity ranging from 85% to 91% and specificity ranging from
76% to 82%, clusters of three or more positive provocation tests consistently showed improved diagnostic
accuracy. Motion palpation tests demonstrated higher variability and less diagnostic value. The majority of
the examined studies showed a low-to-moderate risk
Conclusion: There isn't a single clinical test that can accurately identify SIJ dysfunction on its own. Pain
provocation test clusters offer the best diagnostic precision and ought to be used in standard clinical
evaluation. It is necessary to conduct additional high-quality diagnostic accuracy investigations using defined
reference standards.
ABSTRACT Introduction: The lumbar roll and modified SIMS are two common manipulation techniques used in clinical practice for sacroiliac joint dysfunction (SIJD), a common cause of low back and pelvic pain. However, there hasn’t been clear evidence of these methods’ relative clinical efficacy in recent literature. Methods: This review was registered in PROSPERO (Reg. No. CRD420251253094) and adhered to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were found through a search of PubMed, Scopus, Web of Science, CINAHL, PEDro, Cochrane Library, and Google Scholar (first 200 results). Randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD using imaging-assisted criteria or validated provocation tests were all considered eligible. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were carried out independently by two reviewers. Results: Nine of the 1,264 records that were found satisfied the requirements for inclusion. The number of participants in the sample varied from 30 to 90. Following manipulation, the majority of trials reported significant short-term reductions in pain (VAS/NPRS) and disability (ODI/functional measures), with lumbar roll and modified SIMS demonstrating similar clinical benefit. Improvements in pelvic alignment and mobility have been documented in several studies. There were a few transient adverse events, and no significant complications were noted. Conclusion: Although more high-quality trials are required to confirm long-term efficacy and ideal treatment protocols, lumbar roll and modified SIMS manipulation techniques consistently show short-term clinical benefits for SIJD. However, due to the absence of direct head-to-head comparisons and reliance on indirect classification of techniques, these findings should be interpreted as exploratory rather than definitive.
Farooq Islam, Umair Ahmed, C. McCarthy et al.· Archives of Physiotherapy· 0 citations
Background/Objectives: Iliopsoas-related groin pain (IRGP) occurs in native hips and following hip surgery. However, diagnosis is challenging due to symptom overlap with other hip pathologies and limited imaging accuracy. Treatment ranges from conservative management to surgery. This systematic review evaluates the diagnostic accuracy of clinical tests and the effectiveness of conservative and surgical treatments for IRGP. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO. A comprehensive search of PubMed, Embase, and Web of Science was performed from database inception to 13 March 2026. Diagnostic accuracy studies evaluating clinical tests for IRGP against reference standards and therapeutic intervention studies assessing treatment effectiveness in individuals with IRGP were included. Risk of bias was assessed using QUADAS-3 for diagnostic studies and the MINORS tool for treatment studies. Due to heterogeneity in populations, interventions, outcomes, and study design, a narrative synthesis was performed. Results: Three diagnostic accuracy studies and 71 treatment studies were included. All three diagnostic studies used an image-guided injection as reference standard and were at high risk of bias. The hip–external rotation–flexion–ceiling (HEC) test showed the highest diagnostic accuracy (sensitivity 94%, specificity 88%), together with resisted seated hip flexion. However, all three diagnostic studies were at high risk of bias, so these estimates should be regarded as preliminary. Supine provocation tests showed high sensitivity but poor specificity. Conservative management achieved high success rates in idiopathic and athletic populations (77–100%) but lower and more variable effectiveness after total hip arthroplasty (THA) (16–50%). Image-guided injections produced short-term improvement in 50–70% of patients, with limited long-term effectiveness in mechanically driven cases after THA. In native hips, four matched comparative cohort studies indicated that arthroscopic iliopsoas release provided no clear benefit beyond treatment of concomitant intra-articular pathology and was associated with measurable iliopsoas atrophy and loss of hip flexion strength. After THA, both iliopsoas tenotomy and acetabular component revision improved pain and function, with outcomes strongly dependent on implant position and patient selection. Methodological quality of the treatment studies was generally low to moderate (MINORS 5–14/16 for non-comparative and 14–21/24 for comparative studies), while all three diagnostic studies were at high risk of bias on QUADAS-3. Conclusions: Current evidence highlights substantial diagnostic and therapeutic uncertainty in IRGP. Clinical tests lack sufficient standalone accuracy and should at least include the HEC test and resisted seated hip flexion. Treatment outcomes depend strongly on the underlying etiology, and the lack of an accurate diagnostic reference standard further complicates their interpretation. High-quality diagnostic studies and comparative intervention trials are needed to support evidence-based clinical pathways. Registration: PROSPERO CRD42025644593.
Vandeputte Frans-Jozef, Sergooris Abner, Roose Stijn et al.· Journal of Clinical Medicine· 0 citations
Background: Sacroiliac joint (SIJ) pain is a common musculoskeletal condition among postpartum women due to hormonal, biomechanical, and physiological changes during pregnancy and childbirth. Increased ligament laxity, altered posture, weight gain, and pelvic instability may contribute to sacroiliac joint dysfunction. This condition often leads to pelvic girdle pain, low back pain, and functional limitations that affect daily activities such as walking, sitting, standing, and childcare. Objective: To determine the prevalence of sacroiliac joint pain and assess the level of disability among postpartum females in Sialkot. Materials and Methods: A descriptive cross-sectional study was conducted among 300 postpartum women aged 20-40 years from public and private hospitals in Sialkot. Non-probability convenience sampling approach was employed. Sacroiliac joint pain was assessed using clinical provocation tests including FABER, compression, and distraction tests. Pain intensity was measured using the Numerical Pain Rating Scale (NPRS), and functional disability was evaluated using the Oswestry Disability Index (ODI). Data were analyzed using SPSS version 25. Results: Clinical provocation testing demonstrated positive SIJ pain provocation in 84.0% (n=252) of acute postpartum participants, with severe functional disability observed in 46.0% (n=138). Most women reported moderate pain (74.7%), while 20.7% experienced severe pain. According to the ODI, 46% of participants had severe disability, 37.7% moderate disability, 10.7% minimal disability, and 5.7% were classified as crippled. Conclusion: Sacroiliac joint pain is highly prevalent among postpartum females and is associated with considerable functional disability. Early screening and physiotherapy-based rehabilitation may help reduce pain and improve functional outcomes. Keywords: Sacroiliac joint pain, Postpartum women, Pelvic girdle pain, Functional disability, Oswestry Disability Index.
H. Sattar, M. H. Bari, M. Munir· medRxiv· 0 citations
Background: Deep gluteal syndrome (DGS) is an increasingly recognized cause of posterior hip pain, particularly in athletes and physically act give individuals. It results from entrapment of neural structures within the deep gluteal space, frequently associated with musculotendinous imbalance, repetitive hip movements, and sport-specific biomechanical stress. Purpose: To systematically describe the musculotendinous and neural entrapment mechanisms underlying DGS, with particular focus on clinical presentation, imaging findings, and management strategies in athletes. Furthermore, a secondary aim was to evaluate the frequency and clinical relevance of DGS-related conditions reported in athletes. Methods: A systematic descriptive review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, PEDro, and the Cochrane Library were searched. Studies addressing anatomical predispositions, clinical features, imaging characteristics, and conservative or surgical treatment were included. Results: Eighty-four studies met the inclusion criteria. DGS encompasses multiple entrapment patterns involving the sciatic, pudendal, posterior femoral cutaneous and superior gluteal nerves. In athletes, repetitive hip flexion–adduction–internal rotation movements, overuse microtrauma and hypertrophic musculature appear to contribute to neural compression. Clinical diagnosis remains challenging due to symptom overlap with lumbar disorders. MRI represents the primary imaging modality, although findings may be subtle or nonspecific. Initial management is conservative, while endoscopic decompression may be indicated in refractory cases. Conclusion: There are seven clinical conditions that may cause DGS: ischiofemoral impingement, piriformis syndrome, gemelli-internal obturator syndrome, posterior femoral cutaneous nerve entrapment, superior gluteal nerve entrapment, pudendal neuropathy, and proximal hamstring syndrome. Therefore, DGS is an “umbrella term” that encompasses different pathologies resulting in very similar clinical presentations. In the athletic population, the two most frequent conditions are pudendal neuropathy and proximal hamstring syndrome.
G. Bisciotti, A. Bisciotti, R. Zini et al.· Muscles Ligaments and Tendon...· 0 citations
Background/Objectives: Sciatica and hip osteoarthritis (OA) are common causes of lower extremity pain and functional impairment. Because both conditions may produce overlapping symptoms, distinguishing them can be challenging. Misdiagnosis may lead to inappropriate treatment, delayed intervention and unnecessary procedures. In addition, the frequent coexistence of hip and lumbar degenerative pathology, commonly referred to as hip–spine syndrome, further complicates diagnostic evaluation. This review aims to examine current diagnostic strategies used to differentiate lumbar radiculopathy from hip OA and to introduce the Athena Sign, which is presented as a preliminary, hypothesis-generating clinical observation requiring prospective validation. Methods: A narrative review of the literature was performed focusing on the pathophysiology, clinical presentation, differential diagnosis, physical examination and imaging evaluation of sciatica and hip OA. Particular emphasis was placed on clinical examination techniques and diagnostic injections used to identify the primary pain generator. Results: Both conditions share overlapping symptom patterns and inflammatory mechanisms, which may obscure the source of pain. Careful assessment of gait, hip range of motion, neurological findings and provocative maneuvers remains essential for accurate diagnosis. Imaging findings should be interpreted in conjunction with clinical examination due to the high prevalence of asymptomatic degenerative changes. The Athena Sign, observed with internal and external rotation of the hips in a prone position with the knee flexed, is associated with anterior intra-articular hip pathology and may provide an additional diagnostic indicator in patients with ambiguous hip–spine presentations. Conclusions: A systematic diagnostic approach integrating clinical examination, imaging and targeted diagnostic injections is essential for distinguishing between lumbar radiculopathy and hip OA. Recognition of dynamic clinical findings such as the Athena Sign may further improve diagnostic accuracy and guide appropriate management in patients presenting with overlapping hip and lumbar symptoms.
Evangelos I. Sakellariou, Evangelia Argyropoulou, P. Karampinas et al.· Diagnostics· 0 citations
In view of new evidence revealing a mechanical and nociceptive role of the thoracolumbar fascia (TLF), it has been suggested to be involved in low back pain. To compare characteristics of the TLF in low back pain (LBP) patients and asymptomatic controls. Two independent investigators performed a systematic literature search using PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar. Imaging studies (ultrasound/MRI) investigating the morphology and mechanics of the TLF in LBP patients and controls were included. We used robust variance estimation to pool (a) the standardized mean differences (SMD) between both groups and (b) the correlation between TLF characteristics and subjective pain ratings in LBP patients. A total of 14 trials with moderate-to-high methodological quality (5.1 ± 1.2 points on the JBI critical appraisal checklist) were identified. Relative to asymptomatic controls, the LBP patients displayed a higher thickness (SMD: 0.64, 95% CI 0.41 to 0.88, p = < .001, 12 studies), stiffness (SMD: 0.82, 95% CI 0.34 to 1.31, p = .018, 3 studies), and echogenicity (SMD 0.43, 95% CI 0.16 to 0.70, p = .02, 3 studies) of the TLF. No effect was found for fascial layers sliding (SMD: − 0.05, 95% CI − 5.82 to 5.71, p = .92, 2 studies), although both studies of this comparison found significant (opposite) difference to controls. TLF thickening correlated with higher pain ratings. The TLF of patients with LBP is thickened, stiffened and more echogenic when compared to controls, while the role of shear mobility is unclear. As we additionally found associations of TLF characteristics with pain ratings, future research addressing the predictive value of these markers is warranted. Low back pain patients display increased stiffness, thickness, and echogenicity of the lumbar fascia. Shear mobility is altered, but evidence with regard to the direction of the effect is inconsistent. Properties of the lumbar fascia could represent a new factor in diagnostics and treatment of back pain, but prospective trials are needed to investigate their causal contribution. Low back pain patients display increased stiffness, thickness, and echogenicity of the lumbar fascia. Shear mobility is altered, but evidence with regard to the direction of the effect is inconsistent. Properties of the lumbar fascia could represent a new factor in diagnostics and treatment of back pain, but prospective trials are needed to investigate their causal contribution.
Jan Wilke, Julius Debertshaeuser, F. Konrad· Sports Medicine - Open· 0 citations