European Spine Journal

, Volume 24, Issue 3, pp 521–527 | Cite as

Referred pain location depends on the affected section of the sacroiliac joint

  • Daisuke KurosawaEmail author
  • Eiichi Murakami
  • Toshimi Aizawa
Original Article



Pain referred from the sacroiliac joint (SIJ) may originate in the joint’s posterior ligamentous region. The site of referred pain may depend on which SIJ section is affected. This study aimed to determine the exact origin of pain referred from four SIJ sections.


The study included 50 patients with SIJ dysfunction, confirmed by more than 70 % pain relief after periarticular injection of local anesthetic into the SIJ. The posterior SIJ was divided into four sections—upper, middle, lower, and other (cranial portion of the ilium outside the SIJ)—designated sections 1, 2, 3, and 0, respectively. We then inserted a needle into the periarticular SIJ under fluoroscopy. After the patient identified the area(s) in which the needle insertion produced referred pain, we injected a mixture of 2 % lidocaine and contrast medium into the corresponding SIJ section.


Referred pain from SIJ section 0 was mainly located in the upper buttock along the iliac crest; pain from section 1, around the posterosuperior iliac spine; pain from section 2, in the middle buttock area; pain from section 3, in the lower buttock. In all, 22 (44.0 %) patients complained of groin pain, which was slightly relieved by lidocaine injection into SIJ sections 1 and 0.


Dysfunctional upper sections of the SIJ are associated with pain in the upper buttock and lower sections with pain in the lower buttock. Groin pain might be referred from the upper SIJ sections.


Sacroiliac joint Dysfunction Periarticular injection Referred pain Groin pain 



The authors would like to acknowledge Dr. Atsushi Takahashi for his contribution to the paper.

Conflict of interest

None declared. We attest that the authors have not received and will not receive benefits for personal or professional use from any commercial party related directly or indirectly to the subject of this article.


  1. 1.
    Bernard TN, Classidy JD (1997) The sacroiliac joint syndrome. Pathophysiology, diagnosis and management. In: Frymoyer JW (ed) The adult spine: principles and practice. Lippincott-Raven Publishers, Philadelphia, pp 2343–2363Google Scholar
  2. 2.
    Vleeming A, Mooney V, Stoeckart R (2007) Movement, stability and lumbopelvic pain. Churchill Livingstone, Edinburgh, London, New york, Oxford, Philadelphia, St Luis, Sydney, TorontoGoogle Scholar
  3. 3.
    Eichenseer PH, Sybert DR, Cotton JR (2011) A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine 36:E1446–E1452CrossRefPubMedGoogle Scholar
  4. 4.
    Dreyfuss P, Michaelsen M, Pauza K et al (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 21:2594–2602CrossRefPubMedGoogle Scholar
  5. 5.
    Maigne JY, Aivaliklis A, Pfefer F (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 21:1889–1892CrossRefPubMedGoogle Scholar
  6. 6.
    Broadhurst NA, Bond MJ (1998) Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spinal Disord 11:341–345CrossRefPubMedGoogle Scholar
  7. 7.
    Jonathan NS, David WP (2009) How often is low back pain not coming from the back? Spine 34:E27–E32CrossRefGoogle Scholar
  8. 8.
    Maigne JY, Planchon CA (2005) Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks. Eur Spine J 14:654–658CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Liliang PC, Lu K, Liang CL (2011) Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med 12:565–570CrossRefPubMedGoogle Scholar
  10. 10.
    Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37CrossRefPubMedGoogle Scholar
  11. 11.
    Vleeming A, Albert HB, Ostgaard HS et al (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 17:794–819CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Murakami E, Tanaka Y, Aizawa T et al (2007) Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci 12:274–280CrossRefPubMedGoogle Scholar
  13. 13.
    Borowsky CD, Fagen G (2008) Sources of sacroiliac region pain: insights gained from a study comparing standard intra-articular injection with a technique combining intra- and peri-articular injection. Arch Phys Med Rehabil 89:2048–2056CrossRefPubMedGoogle Scholar
  14. 14.
    Luukkainen RK, Wennerstrand PV, Kautiainen HH et al (2002) Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol 20:31–37Google Scholar
  15. 15.
    Kanno H, Murakami E (2007) Comparison of low back pain sites identified by patient’s finger versus hand: prospective randomized controlled clinical trial. J Orthop Sci 12:254–259CrossRefPubMedGoogle Scholar
  16. 16.
    Hackett GS (1958) Ligament and tendon relaxation (skeletal disability) treated by prolotherapy (fibro-osseous proliferation). Charles C Thomas publisher LTD, SpringfieldGoogle Scholar
  17. 17.
    Sakamoto N, Yamashita T, Takebayashi T et al (2001) An electrophysiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues. Spine 26:E468–E471CrossRefPubMedGoogle Scholar
  18. 18.
    Fukui S, Nosaka S (2002) Pain patterns originating from the sacroiliac joints. J Anesth 16:245–247CrossRefPubMedGoogle Scholar
  19. 19.
    Slipman CW, Jackson HB, Lipetz JS et al (2000) Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 81:334–338CrossRefPubMedGoogle Scholar
  20. 20.
    Palsson TS, Graven-Nielsen T (2012) Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. Pain 153:2233–2240CrossRefPubMedGoogle Scholar
  21. 21.
    Feinstein B, Langton JNK, Jameson RM et al (1954) Experiments on pain referred from deep somatic tissues. J Bone Jt Surg 36A:981–997Google Scholar
  22. 22.
    Hakata S, Sumita K, Katada S (2005) Wirksamkeit der AK-Hakata-Methode bei der Behanderung der akuten Lumbago. Manuelle Med 43:19–23CrossRefGoogle Scholar
  23. 23.
    Kurosawa D (2011) Report from Japan—Japanese medical society of arthrokinematic approach and the AKA-Hakata method in manual medicine. Int Musculoskelet Med 33:85–86CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Daisuke Kurosawa
    • 1
    Email author
  • Eiichi Murakami
    • 1
  • Toshimi Aizawa
    • 2
  1. 1.Low Back Pain and Sacroiliac Joint CenterSendai Shakaihoken HospitalSendaiJapan
  2. 2.Department of Orthopaedic SurgeryTohoku University School of MedicineSendaiJapan

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