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Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management

Peebles, Rebecca DO1; Jonas, Christopher E. DO, FAAFP2

doi: 10.1249/JSR.0000000000000410
Extremity and Joint Conditions: Section Articles

Sacroiliac joint (SIJ) dysfunction is a common cause of low back pain in the athlete, especially in sports with repetitive, asymmetric loading. Complex anatomy and broad pain referral pattern make diagnosis difficult. Identifying three or more positive physical examination maneuvers for the SIJ improves examination sensitivity and specificity. Imaging is rarely helpful in establishing the diagnosis but is often used to rule out other pathology. Conservative management with activity modification, medication, physical therapy, manipulation and bracing is first line treatment. After at least 6 weeks of conservative efforts or if pain limits the athlete’s tolerance of these measures, diagnostic and therapeutic intra-articular or periarticular injections or nerve blocks can be used. Radiofrequency ablation is recommended as the next approach for treatment. When all other options have been exhausted, surgical management can be considered. For athletes, once the underlying dysfunction is adequately addressed, gradual progression to full participation is encouraged.

This article explores the principles of diagnosis, treatment and return to play for athletes with sacroiliac joint dysfunction.

1Medical Corps Uniformed Services University of the Health Sciences, Bethesda, MD; and 2Medical Corps Uniformed Services University of the Health Sciences, Bethesda, MD

Address for correspondence: Rebecca Peebles, DO, US Air Force, Medical Corps Uniformed Services University of the Health Sciences 4301 Jones Bridge Rd, A1038 Bethesda, MD 20814-4799; E-mail:

Copyright © 2017 by the American College of Sports Medicine.