I’ve been getting treatment for a disc herniation at L5-S1, now they say it’s my SI joint…?
I’ve been getting treatment for a disc herniation at L5-S1 for a year now. I’ve been through physical therapy, had three epidural steroid injections, been to a neurosurgeon, etc. I went to my pain management center yesterday for a follow up. I only saw the PA and not the doctor. She made me put my right ankle on my left leg and she pushed down on my right leg. It hurt really bad. Now she is saying that it is my SI joint and not my back. I’ve had lower back pain in the same spot with pain radiating down the back of my right leg. Now they want to do another injection but for the SI joint. Should I get it done? Will it help?
I don’t know what to believe now. Should I find another doctor?
SIJ dysfunction is very difficult to diagnosis and its very existance is heavily argued.
The test for SIJ that your PA did is called Faber’s test, or Partricks test. It is one of the tests that is used to help diagnose SIJ. However, the presense of this test being positive in isolation is a very poorly reliable method by which to diagnose SIJ dysfunction. First, because it is also positive in people who have hip pain, second because there are many false positives.
The current standard for non-invasive manual testing to help rule in SIJ dysfunction is a series of manual tests. One test being positive makes it unlikely that the disorder exists, 3 or more tests being positive makes is likely that SIJ dysfunction exists. These tests include Patricks test, but also the “squish test”, “thigh thrust”, “gapping test”, posterior shear test and ganelson’s test and/or cranial glide of the sacrum.
If Patricks test was the only test that was administered to you, then I would not go through the injeciton without more definitive diagnosis.
There are several good studies that support this and I can give you specific references if you desire, but most of the work has been done by Laslett and/or Korkenmeyer.
The good news is, if it really IS SIJ dysfunction, the vast majority are inflammatory in nature and respond well to injections…a few are mechanical and need physical therapy.
It’s very hard to find someone who is proficient at diagnosing SIJ dysfunction. I’d be skeptical about a PA giving you the recommendation unless they followed the guidelines above. To look at this further, I would see a physical therapist who is preferably Diplomaed (but someone who is certified would be OK too) in mechanical diagnosis and therapy. You can find one at www.mckenziemdt.org
The other recommendation I would have would be to see a physiatrist…a medical doctor of rehabilitation…just fine one who specializes in musculoskeletal care.
Good luck