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Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain

PK Levangie, DSc, PT, is Associate Professor, Physical Therapy Program, Sacred Heart University, Fairfield, Conn. This research was completed in partial fulfillment of the requirements for her Doctor of Science degree in epidemiology at Boston University's School of Public Health, Boston, Mass. Address all correspondence to Dr Levangie at 9 Cot Hill Rd, Bedford, MA 01730-1218 (USA) (levangiep{at}aol.com)

Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. Results. Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). Conclusion and Discussion. The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted.

Key Words: Low back pain • Odds ratio • Sacroiliac joint • Tests and measurements

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