Sacroiliac joint pain in the pediatric population

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  • 1 Department of Neurological Surgery, Washington University in St. Louis; and
  • | 2 St. Louis Children's Hospital, St. Louis, Missouri
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The sacroiliac (SI) joint can be a pain generator in 13%–27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms.


A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits.


Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations.


Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.

Abbreviation used in this paper:

SI = sacroiliac.

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Contributor Notes

Address correspondence to: Jeffrey R. Leonard, M.D., Department of Neurological Surgery, St. Louis Children's Hospital, One Children's Place, Suite 4 S 20, St. Louis, Missouri 63110. email:

Current address for Dr. Powers: Wake Forest Baptist Health, Winston-Salem, North Carolina.

Please include this information when citing this paper: DOI: 10.3171/2012.2.PEDS11220.

  • 1

    Bogduk N: The anatomical basis for spinal pain syndromes. J Manipulative Physiol Ther 18:603605, 1995

  • 2

    Bogduk N, The sacroiliac joint. Bogduk N: Clinical Anatomy of the Lumbar Spine and Sacrum ed 4 New York, Elsevier, 2005. 173180

  • 3

    Bowen V, & Cassidy JD: Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade. Spine (Phila Pa 1976) 6:620628, 1981

    • Search Google Scholar
    • Export Citation
  • 4

    Brolinson PG, , Kozar AJ, & Cibor G: Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep 2:4756, 2003

  • 5

    Dreyfuss P, , Cole AJ, & Pauza K: Sacroiliac joint injection techniques. Phys Med Rehabil Clin N Am 6:785813, 1995

  • 6

    Dreyfuss P, , Dreyer SJ, , Cole A, & Mayo K: Sacroiliac joint pain. J Am Acad Orthop Surg 12:255265, 2004

  • 7

    Dreyfuss P, , Michaelsen M, , Pauza K, , McLarty J, & Bogduk N: The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976) 21:25942602, 1996

    • Search Google Scholar
    • Export Citation
  • 8

    Egund N, , Olsson TH, , Schmid H, & Selvik G: Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiol Diagn (Stockh) 19:833846, 1978

    • Search Google Scholar
    • Export Citation
  • 9

    Fortin JD, , Kissling RO, , O'Connor BL, & Vilensky JA: Sacroiliac joint innervation and pain. Am J Orthop 28:687690, 1999

  • 10

    Grob KR, , Neuhuber WL, & Kissling RO: [Innervation of the sacroiliac joint of the human.]. Z Rheumatol 54:117122, 1995. (Ger)

  • 11

    Hill JJ, & Keating JL: A systematic review of the incidence and prevalence of low back pain in children. Phys Ther Rev 14:272284, 2009

  • 12

    Laslett M, , Aprill CN, , McDonald B, & Young SB: Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther 10:207218, 2005

    • Search Google Scholar
    • Export Citation
  • 13

    Maigne JY, , 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 (Phila Pa 1976) 21:18891892, 1996

    • Search Google Scholar
    • Export Citation
  • 14

    Manchikanti L, , Singh V, , Pampati V, , Damron KS, , Barnhill RC, & Beyer C, et al. : Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician 4:308316, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Newton W, , Curtis P, , Witt P, & Hobler K: Prevalence of subtypes of low back pain in a defined population. J Fam Pract 45:331335, 1997

  • 16

    Schwarzer AC, , Aprill CN, & Bogduk N: The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 20:3137, 1995

  • 17

    Slipman CW, , Jackson HB, , Lipetz JS, , Chan KT, , Lenrow D, & Vresilovic EJ: Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 81:334338, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Slipman CW, , Sterenfeld EB, , Chou LH, , Herzog R, & Vresilovic E: The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil 79:288292, 1998

    • Search Google Scholar
    • Export Citation


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