Palpation of the sacroiliac joint: An anatomical and sensory challenge

BackgroundThe sacroiliac joint (SIJ) is identified as one of many possible sources of non-specific low back pain and may be a target for diagnostic palpation. Putative diagnostic palpation of joint motion, tissue texture changes and pain form a routine aspect of practice in manual healthcare. However, the tactile tradition of diagnostic palpation is beset with anatomical and sensory confounding that may establish an upper ceiling for sensitivity and specificity. For illustrative purposes, this is highlighted by a review of the anatomy of the sacroiliac joint (SIJ). Increasing critical awareness of the inherent limitations in the tactile tradition of diagnostic palpation may lead to the development of a standardised and technologically based approach.Aims and objectivesTo highlight anatomical and sensory difficulties that may be associated with the use of diagnostic palpation. To promote wider critical consideration for the continuing role of diagnostic palpation as a tactile tradition in manual healthcare and to speculate that a technological answer may provide a more reliable and valid alternative.DiscussionReviewing the anatomy of the sacroiliac region demonstrates why diagnostic palpation of the SIJ may be more difficult than may be commonly perceived. Furthermore, the somatosensory basis of diagnostic palpation is a confounding variable that may not be possible to circumvent. In an era in which evidence for clinical practice is sought, it is timely that specific elements of this distinctive diagnostic tradition in manual healthcare be critically examined. It is speculated that the development of a technological solution may provide an alternative.ConclusionReview of the relevant anatomy helps enhance critical thinking about the use of palpation in manual healthcare practice. The diagnostic examination of the SIJ by palpation appears to be an accepted investigative approach of manual healthcare but is confounded by anatomical and sensory variables. Illustrative of systematic and possibly insurmountable anatomical and sensory confounding, the continued use of non-standardised, manual diagnostic palpation as a basis for manipulative intervention is questionable. There is a need to develop a sophisticated, technologically based alternative that offers a reliable multimodal input, standardization of findings and comparative indexing of such findings to a reference data-base. Therein lies an opportunity for a pan-disciplinary lingua-franca in diagnostic palpation.