In this lecture, we discuss the Sacroiliac Joint and pain related to the area. We discuss the anatomy and biomechanics of the structure which helps us understand why it is difficult to attribute SIJ pain to changes in joint movement (too little or too much). We focus on how clinicians should steer away from communicating clinical findings that are based on questionable assessment methods as this may cause greater harm than good. Instead, we highlight the necessity of identifying factors that may be barriers for recovery, mainly unhelpful thought processes and pain-related behavior. The main message is that we need to identify factors that may be underlying the patient’s problem and addressing these constructively. This requires an approach which builds on communication, shared decision-making and strategies that support dependency.

Learning points

• Movement in the joint complex is very difficult to detect, mainly due to the stable and robust joint structure.
• A range of clinical assessment methods can help us identifying whether the SIJ is part of the clinical problem. They cannot tell us why the problem is there
• Messaging based flawed reasoning e.g. attributing pain to changes in SIJ mobility should be avoided as this can delay/prevent recovery
• The focus should be on identifying barriers for recovery, including unhelpful thoughts and beliefs and constructively addressing these in a individually tailored management approach.