The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
A Prospective Study of Centralization of Lumbar and Referred Pain: A Predictor of Symptomatic Discs and Anular Competence
Study Design . The presence or absence of rapidly central izing , peripheralizing , or abolishing low  back and radiating pain , as identified during a McKenzie mechanical lumbar assessment of patients with chronic lumbar pain , was compared prospect ively with discographic pain provocation and anular competency . Objectives . To evaluate any relation between the responses of central ization and peripheralization with discographic findings . Summary of Background Data . Central ization of referred pain has been reported as a very common occurrence during McKenzie assessment and treatment . Patients whose pain central izes have been shown to achieve superior treatment outcomes . A dynamic internal disc model has been hypothesized as an underlying mechanism for central ization that has not been studied previously . Methods . Patients with chronically disabling low back pain who were referred for discography underwent preliminary blinded McKenzie clinical assessment and were categorized into three groups by their pain response . Patterns , or lack thereof , of pain response were then compared with blinded discographic pain provocation and anular findings . Results . During the McKenzie assessment , the referred pain of 50 % central ized with 74 % having positive discograms , of which 91 % had an intact anulus . The pain of 25 % peripheralized only ( would not central ize ) ; 69 % of these had positive discograms , but only 54 % had an intact anulus . The distal pain of 25 % did not respond at all , and only 12.5 % of these had positive discograms . Conclusion . The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain ( P < 0.001 ) as well as competent from an incompetent anulus ( P < 0.042 ) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .