SIJ Symptoms, Provocation Tests, the ASLR and Minding Our Words

Hypertonic saline studies from 2012 and 2014 showed SIJ pain can also be felt in the low back in over 30% of subjects. SIJ pain is often aggravated by single leg loading, so bilateral exercises may be an easier starting point than lunges or step ups. A cluster of pain provocation tests suggests the SIJ complex is a source of symptoms, as summarized by Laslett in 2005, but not why it hurts. The active straight leg raise assesses load transfer through perceived difficulty on a six-point scale. When pain-free volunteers had hypertonic saline injected into the long dorsal ligament, provocation tests became positive, the leg raise felt harder and trunk muscle activity shifted to a more global pattern, all without any change in joint mobility. Thorvaldur stresses minding your words: explanations based on instability or slipped joints can feed fear avoidance and raise disability. The part suggests asking what earlier clinicians said and using validated questionnaires, or their questions, to identify cognitive and emotional factors.