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 .
Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.
Previous research indicates that physical examination can not diagnose sacroiliac joint ( SIJ ) pathology . Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability . This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations , in relation to an accepted criterion st and ard . In a blinded criterion-related validity design , 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ .  The tests were evaluated singly and in various combinations ( composites ) for diagnostic power . All patients with a positive response to diagnostic injection reported pain with at least one SIJ test . Sensitivity and specificity for three or more of six positive SIJ tests were 94 % and 78 % , respectively . Receiver operator characteristic curves and areas under the curve were constructed for various composites . The greatest area under the curve for any two of the best four tests was 0.842 . In conclusion , composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ . Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections . When all six provocation tests do not provoke familiar pain , the SIJ can be ruled out as a source of current LBP
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 .