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Low back pain: Sacroiliac joint pain may be myth

BMJ 2004; 329 doi: (Published 22 July 2004) Cite this as: BMJ 2004;329:232

Rapid Response:

Sacroiliac joint pain: is it a myth?

I read with interest the review article by by Speed on Low back pain
and the subsequent response from Bamji 1. I find Bamji’s statement not
supported by evidence. His assertion is based on some observations-none of
them supported by reference.

Injections into the sacroiliac joint (SIJ) under fluoroscopic control
have proved that the joint is a source of low back pain 2. SIJ is an
important link in weight transmission to the lower limb. The SIJ surface
is oriented parallel to the line of weight transmission. So, weight
bearing results in significant amount of shear stress. The SIJ may be a
very rigid joint, but there is movement on physiological loading,
increased under larger loading, in both symptomatic and asymptomatic
joints 3.

Sacroiliac pain have so far been attributed to joint hypermobility.
It appears increasingly clear that we should think in terms of joint
dysfunction due to instability from abnormal motor unit recruitment. There
is growing evidence that patients presenting with low back pain of
“sacroiliac origin” have altered pattern of motor unit recruitment4. The
causative relationship is still unclear.

Exercise related stress reaction of SIJ is a known cause of low back
pain 5. I find no evidence to support his observation that most cases of
sacroiliac strain are injuries of the gluteal region.

Our understanding of the role of SIJ in low back pain is still
evolving. There are many aspects where we need more research until we have
definitive knowledge. Contributing unsubstantiated statements may help to
increase the myth rather than dispel it.


1. Bamji AN. Sacroiliac joint pain may be myth. BMJ 2004;329:232.

2. Maigne J, Aivaliklis A, Pfefer F. Results of sacroiliac joint
double block and value of sacroiliac pain provocation tests in 54 patients
with low back pain. Spine 1996;21:1889-92.

3. Struesson B, Selvik G, Uden ALF. Movements of the sacroiliac
joints: a roentgen stereophotogrammetric analysis.Spine.1989;14(2):162-5.

4. Hungerford B, Gilleard W, Hodges P. Evidence of altered
lumbopelvic muscle recruitment in the presence of sacroiliac joint pain.
Spine. 2003;28(14): 1593-1600.

5. Marymont JV, Lynch MA, Henning CE. Exercise related stress
reaction of the sacroiliac joint. An unusual cause of low back pain in
athletes. American Journal of Sports Medicine. 1986;14(4):320-3.

Competing interests:
None declared

Competing interests: No competing interests

25 July 2004
Munier Hossain
Orthopaedic Registrar
Bangor Hospital , Gwynedd LL57 2PW