Top 5 Fridays! 5 Ways to Reframe your Narrative Around SI Joint Pain

When patients present with non-specific SI joint or low back pain, symptoms are more likely present due to sensitivity versus any dysfunction.

Low evidence exists with our ability to perform clinical tests as very little movement actually occurs during normal activities (0.2-0.5 degrees). This raises the idea that the perception of tiny movement could be attributable to other factors such as soft tissue motion or pain-associated muscle activation as a response to nociceptive activity.

Given this challenging paradigm, here are 5 ways to manage and change the narrative around SI joint-related pain.

Narrative of SI Pain by Cameron Faller

👉Identify Patient Beliefs about their Pain - With the SI Joint being an inherently stable structure with very minimal movement, many patients still come in with the belief they are broken and damaged resulting in pain

👉Avoid Communicating Fragility Messages - Describing the pelvis as unstable or out of place not only is unsupported by the evidence but also sends messages of fear that can be linked to avoidance behavior which in turn can sustain pain and disability

👉Help Patients Make Sense of their Pain - Provide explanations that aid in patients being able to reconceptualize their pain in a way that promotes functional recovery and avoids reinforcing negative behaviors

👉Align Treatment Rationale with Explanation about Pain - When performing techniques, avoid blaming symptoms on specific tissues and keep messages consistent with education regarding pain (i.e. explain that manual is performed for improved neurophysiological mechanisms and not necessarily to mobilize the pelvis)

👉Provide Reassurance with Clear Expectations of Recovery - Reassure patients that their pelvis is inherently strong and stable, and oftentimes the road to recovery may take some time but they do not have to live with intolerable pain

Education is vital with management and clinicians should carefully consider their role in perpetuating implausible pathoanatomical diagnoses

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