Damage, trauma, or lack of strength to the sacroiliac area. Sacroiliac refers to the area comprised of the sacrum and ilium bones of the pelvis. The sacrum forms the base of the vertebral column and the posterior portion of the end of the pelvis in conjunction with the coccyx. The ilia are at each side of the pelvis located at the most upper part.

Strains to the sacroiliac area most likely evolve from abrupt, twisting motions of the trunk of the body, bending forward and pulling at the same time, or falling on one side of the buttocks. They may also be linked to sciatica, hip arthritis (see Diagnostic Code: 5009), or abnormality of the sacrum bone itself.

Sharp or aching pain in the lower back, usually appears a day after the actual injury in combination with aches and stiffness over the sacroiliac joint, and difficulty in bending forward. In addition, limited motion of the lumbosacral area, limited forward flexion, and pain are also signs. Numbness, tingling or burning sensation may also be symptoms.

A positive Gaenslen's sign and a positive pelvic compression test are suggestive of this disorder. Laseque's maneuver in contrast will help distinguish sciatica or radicular pain on affected side from disease of the hip joint. Diagnostic imaging will help rule out a fracture or pre-existing arthritis or other bony involvement. Rarely CT or MRI scans are indicated.

Initial treatment may include rest, ice, and analgesics for the pain and inflammation. Patients are educated concerning correct posture and back rehabilitation, which includes the institution of flexion and extension exercises. May sometimes need ambulatory aids if there is severe pain with weight bearing.

As with most musculoskeletal conditions, in spite of therapy, there may be varying degrees of impaired physical mobility, and limited activities of daily living (ADL).

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Evaluate under the General Rating Formula for Diseases and Injuries of the Spine for diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar spine), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine). The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.