Introduction

Sacral Thrust, Compression, and Distraction

Sacral Iliac Joint Exam

Research Review for the Development of a Movement Cluster

Does Sacroiliac Joint (SIJ) Dysfunction Contribute to Low Back Pain

Sacral Iliac Joint Motion

Testing

Special Tests: Sacroiliac Joint (SIJ)

ProCert

PACE

AUSPHYSIO

TPTA

NYPT

Special Tests: Sacroiliac Joint

<h2>Special Tests Covered in this Course</h2>
<ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Sacral Thrust Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Compression Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Distraction Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/thigh-thrust-test-sacroiliac-joint" target="_blank" rel="noopener">Thigh Thrust Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-gaenslens-test" target="_blank" rel="noopener">Gaenslen&apos;s Test</a></li>
 </ul>
 </li>
 <li>Additional Pain Provocation Tests (not included in <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>):
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-mennells-test" target="_blank" rel="noopener">Mennel&apos;s Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/hip-special-test-faber-patricks-test" target="_blank" rel="noopener">FABER (Patrick&apos;s) Test</a></li>
 </ul>
 </li>
 <li>Additional Pain Provocation Cluster
 <ul>
 <li>Van der Wurff et al.</li>
 </ul>
 </li>
 <li>Motion <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Stork/Gillet Test</a></li>
 <li>Brookbush/Grieve Cluster
 <ul>
 <li>Appendix: Research Review on SIJ Movement Assessment</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
Sacroiliac joint dysfunction (a.k.a. SIJD, SI joint dysfunction, SI joint syndrome, SI joint pain) may result from <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>, acute injury, or trauma, and is often mistaken for lower back pain or develops concurrently with lower back pain. Due to controversy regarding the amount of motion that occurs at the SI joint, and the relative strength of the ligaments and <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> that <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> these joints, conservative treatment options are often dismissed. It is common that patients and clients will not receive treatment for symptoms until they are complaining of chronic pain; for example, <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (e.g. &quot;patient complains of pinched nerve&quot;), ligament (e.g. pain with forward bending), or <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> (e.g. continuous dull ache) inflammation. Most often, clinical movement professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are the safest and most effective option for pain relief (e.g. manual therapy, certain modalities, and corrective exercise).
<h3>Special Note on SIJ Special Tests:</h3>
Most palpation, motion, and position <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> for the sacroiliac joint (SIJ) have questionable <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>. However, research has demonstrated that <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> and accurate for diagnosing the sacroiliac joint as a source of pain (4, 5, 22, 23). It is worth noting that SIJ pain provocation tests are more <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> than <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> (4 - 21), indicating a positive result carries more weight than a negative result. In summary, a positive result using <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II</a> is strongly indicative that pain is originating from SIJ dysfunction.
A review of&#xA0; SIJ movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> research is included in this course. The intent of the review is the suggestion of a possible cluster for identifying dysfunctional/altered motion. The research has demonstrated that the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> when confined to a narrow set of findings (24), and one <a id="observational-study" data-tip="1400" target="_blank" href="/glossary-term/observational-study" class="glossary">observational study</a> by Grieve et al. (70) demonstrated good <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> from a grouping of findings. Additional refinements to the Grieve et. al grouping can be made based on additional research and may imply a useful SIJ movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> cluster.
<h3>Brookbush Institute Recommendation:</h3>
The<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<a href="https://brookbushinstitute.com/" target="_blank" rel="noopener" style="letter-spacing: 0px;">Brookbush Institute</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">recommends that all clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are aware of <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a>. However, in practice, pain provocation has little utility for improving clinical decision-making and refining intervention selection.<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> In practice, the <a href="https://brookbushinstitute.com/" target="_blank" rel="noopener" style="letter-spacing: 0px;">Brookbush Institute</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">recommends <a id="evidence-based-practice" data-tip="1538" target="_blank" href="/glossary-term/evidence-based-practice" class="glossary">evidence-based</a> modifications to the Grieve et al. cluster to determine the less and more <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">mobile</a> sides, and to treat the SIJ according to their relative stiffness (mobilize/manipulate the stiff side, glute activation on the more <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">mobile</a> side).&#xA0;<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">
<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">Brookbush/Grieve (70) Recommended Cluster:
<h4>Assess:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat </a><a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> (OHSA): Stiff SIJ on the side opposite of an <a href="https://brookbushinstitute.com/courses/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">asymmetrical shift with &quot;heel rise&quot;</a>
 <ul>
 <li>&quot;Top tier exam&quot; used to identify asymmetry and imply further SIJ assessment</li>
 </ul>
 </li>
 <li><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Pelvic Tilt: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> tilted innominate correlated with stiffer side</li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a>: Less motion on the stiffer side</li>
 <li><a href="https://brookbushinstitute.com/courses/lower-body-goniometry" target="_blank" rel="noopener">Hip Rotation Range of Motion</a>: Less motion on the stiffer side</li>
</ul>
<h4>Treat:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/joint-mobilization-lumbar-spine-and-sacroiliac-joint" target="_blank" rel="noopener">Mobilize</a> or <a href="https://brookbushinstitute.com/courses/joint-manipulation-lumbar-spine-sacroiliac-joint-and-pubic-symphysis" target="_blank" rel="noopener">Manipulate</a>: <a id="hypomobility" data-tip="1676" target="_blank" href="/glossary-term/hypomobility" class="glossary">Hypomobile</a> SIJ (Side)</li>
 <li><a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" rel="noopener">Glute Activation</a>: <a id="hypermobility" data-tip="1679" target="_blank" href="/glossary-term/hypermobility" class="glossary">Hypermobile</a> SIJ (Side)</li>
</ul>

<h3>For an Introduction to Special Tests</h3>
<ul>
 <li>For an introduction to Special Tests including definitions of <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> terminology, what special tests measure, <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> (<a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a>, <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, etc.), how we chose the tests in each special <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> course lessons, and best practice recommendations:</li>
 <li><a href="https://brookbushinstitute.com/article/special-tests-introduction" target="_blank" rel="noopener">Special Tests: Introduction</a></li>
</ul>

<h3>Courses covering Special Tests for the Lumbo Pelvic Hip Complex</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/special-tests-sacroiliac-joint" target="_blank" rel="noopener">Special Tests: Sacroiliac Joint (SIJ)</a></li>
 <li><a href="https://brookbushinstitute.com/courses/special-tests-hip-joint">Special Tests: Hip Joint</a></li>
 <li><a href="https://brookbushinstitute.com/courses/special-tests-lower-body-neurodynamic-tests">Special Tests: Lower Body Neurodynamic Tests</a></li>
</ul>

Course Description: Special Tests: Sacroiliac Joint

For an introduction to Special Tests including definitions of <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> terminology, what special tests measure, how we chose the tests in these lessons, and best use, check out:
<ul>
 <li><a href="https://brookbushinstitute.com/article/special-tests-introduction" target="_blank" rel="noopener">Special Tests: Introduction</a></li>
</ul>
<h2>Special Tests Covered in this Lesson:</h2>
<ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Sacral Thrust Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Compression Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">Distraction Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/thigh-thrust-test-sacroiliac-joint" target="_blank" rel="noopener">Thigh Thrust Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-gaenslens-test" target="_blank" rel="noopener">Gaenslen&apos;s Test</a></li>
 </ul>
 </li>
 <li>Additional Pain Provocation Tests (not included in <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>):
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-mennells-test" target="_blank" rel="noopener">Mennel&apos;s Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/hip-special-test-faber-patricks-test" target="_blank" rel="noopener">FABER (Patrick&apos;s) Test</a></li>
 </ul>
 </li>
 <li>Additional Pain Provocation Cluster
 <ul>
 <li>Van der Wurff et al.</li>
 </ul>
 </li>
 <li>Motion <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Stork/Gillet Test</a></li>
 <li>Brookbush/Grieve Cluster
 <ul>
 <li>Appendix: Research Review on SIJ Movement Assessment</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<h3>Special Note on SIJ Special Tests:</h3>
Most palpation, motion, and position <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> for the sacroiliac joint (SIJ) have questionable <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>. However, research has demonstrated that <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> and accurate for diagnosing the sacroiliac joint as a source of pain (4, 5, 22, 23). It is worth noting that SIJ pain provocation tests are more <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> than <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> (4 - 21), indicating a positive result carries more weight than a negative result. In summary, a positive result using <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II</a> is strongly indicative that pain is originating from SIJ dysfunction.
A review of&#xA0; SIJ movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> research is included in this course. The intent of the review is the suggestion of a possible cluster for identifying dysfunctional/altered motion. The research has demonstrated that the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> when confined to a narrow set of findings (24), and one <a id="observational-study" data-tip="1400" target="_blank" href="/glossary-term/observational-study" class="glossary">observational study</a> by Grieve et al. (70) demonstrated good <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> from a grouping of findings. Additional refinements to the Grieve et. al grouping can be made based on additional research and may imply a useful SIJ movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> cluster.
<h3>Brookbush Institute Recommendation:</h3>
The<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<a href="https://brookbushinstitute.com/" target="_blank" rel="noopener" style="letter-spacing: 0px;">Brookbush Institute</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">recommends that all clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) are aware of <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett&apos;s Cluster II: Sacroiliac Joint Pain Test-item Cluster</a>. However, in practice, pain provocation has little utility for improving clinical decision-making and refining intervention selection.<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> In practice, the <a href="https://brookbushinstitute.com/" target="_blank" rel="noopener" style="letter-spacing: 0px;">Brookbush Institute</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">&#xA0;<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">recommends <a id="evidence-based-practice" data-tip="1538" target="_blank" href="/glossary-term/evidence-based-practice" class="glossary">evidence-based</a> modifications to the Grieve et al. cluster to determine the less and more <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">mobile</a> sides, and to treat the SIJ according to their relative stiffness (mobilize/manipulate the stiff side, glute activation on the more <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">mobile</a> side).&#xA0;
<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">Brookbush/Grieve (70) Recommended Cluster:
<h4>Assess:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat </a><a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> (OHSA): Stiff SIJ on the side opposite of an <a href="https://brookbushinstitute.com/courses/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">asymmetrical shift with &quot;heel rise&quot;</a>
 <ul>
 <li>&quot;Top tier exam&quot; used to identify asymmetry and imply further SIJ assessment</li>
 </ul>
 </li>
 <li><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Pelvic Tilt: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> tilted innominate correlated with stiffer side</li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a>: Less motion on the stiffer side</li>
 <li><a href="https://brookbushinstitute.com/courses/lower-body-goniometry" target="_blank" rel="noopener">Hip Rotation Range of Motion</a>: Less motion on the stiffer side</li>
</ul>
<h4>Treat:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/joint-mobilization-lumbar-spine-and-sacroiliac-joint" target="_blank" rel="noopener">Mobilize</a> or <a href="https://brookbushinstitute.com/courses/joint-manipulation-lumbar-spine-sacroiliac-joint-and-pubic-symphysis" target="_blank" rel="noopener">Manipulate</a>: <a id="hypomobility" data-tip="1676" target="_blank" href="/glossary-term/hypomobility" class="glossary">Hypomobile</a> SIJ (Side)</li>
 <li><a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" rel="noopener">Glute Activation</a>: <a id="hypermobility" data-tip="1679" target="_blank" href="/glossary-term/hypermobility" class="glossary">Hypermobile</a> SIJ (Side)</li>
</ul>

<h3>Stork Test (a.k.a. Gillet&apos;s Test or One-legged Stand Test)</h3>
<iframe src="https://player.vimeo.com/video/249003087" frameborder="0" allowfullscreen="allowfullscreen"></iframe>
<ol>
 <li>The patient starts in a standing position with feet shoulder-width apart.</li>
 <li>The clinician places one finger on the PSIS, and one finger on the sacrum close to it.
 <ul>
 <li>Various texts suggest different landmarks on the sacrum including the sacral <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a>, S2 spinous process, and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> angle (ILA). It is likely more important to be consistent with your palpation.</li>
 </ul>
 </li>
 <li>The examiner then asks the patient to flex the hip on the side being palpated, knee to hip height, like a high march.</li>
 <li>The examiner monitors the motion of the PSIS relative to the sacrum.</li>
 <li>The same is then done on the other side.</li>
 <li>Ideally, the pelvis as a whole would not tilt <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> or <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>, and no rotation would occur. Normal pelvic motion during marching may include a small amount of <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tilting on the side of hip flexion relative to a stationary sacrum.</li>
 <li>A positive <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> for SIJ stiffness is elevation, no motion, or less motion than the opposite side.</li>
</ol>
<table>
 <tbody>
 <tr>
 <td>Test for:</td>
 <td>SIJ Stiffness (1-3, 24)</td>
 </tr>
 <tr>
 <td>Action:</td>
 <td>Examination of SIJ motion during marching.</td>
 </tr>
 <tr>
 <td>Statistics:</td>
 <td>The reliability of this test is good; however, there is no valid data currently (1-3, 23).</td>
 </tr>
 <tr>
 <td>Best use:</td>
 <td>
 The Brookbush Institute recommends using the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> as part of a cluster to determine the presence of asymmetrical stiffness, with the intent of informing best practice. (See Appendix below for more information)
 Brookbush/Grieve Cluster
 Assess:
 <ul>
 <li><a href="https://brookbushinstitute.com/article/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat </a><a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> (OHSA): Stiff SIJ on opposite side of the shift</li>
 <li><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Pelvic Tilt: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> tilt correlated with stiffer side</li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a>: Less motion on the stiffer side</li>
 <li><a href="https://brookbushinstitute.com/article/lower-body-goniometry" target="_blank" rel="noopener">Hip Rotation Range of Motion</a>: Less motion on the stiffer side</li>
 </ul>
 Treat:
 <ul>
 <li><a href="https://brookbushinstitute.com/article/joint-manipulation-lumbar-spine-sacroiliac-joint-and-pubic-symphysis" target="_blank" rel="noopener">Mobilize/Manipulate</a> Stiff SIJ</li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-maximus-activation" target="_blank" rel="noopener">Glute Activation</a> <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">Mobile</a> Side</li>
 </ul>
 </td>
 </tr>
 </tbody>
</table>
<h3>Appendix: Research Review for the Development of a Movement Cluster</h3>
<h4>Summary</h4>
The focus should be placed on addressing stiffness and asymmetry and not sacral position and range of motion.
<ul>
 <li>SIJ injection provides strong evidence that SIJ dysfunction contributes significantly to 15 &#x2013; 30% of low back pain cases.</li>
 <li>The SIJ are capable of approximately 1.6 - 6&#xB0; of rotation, and 0.1 - 2.0 mm of translation.</li>
 <li>It may be reasonable to conclude that SIJ motion is as difficult to palpate as lumbar facet motion; however, well within the limits of fingertip <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>.</li>
 <li>Asymmetrical stiffness likely alters motion and results in dysfunction and pain; it is unlikely that dysfunction is the result of a change in total ROM.</li>
 <li>Imaging may be <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> but not <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a>, subjective examination lacks <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, and palpation of sacral position lacks <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a>.</li>
 <li>Clustering pain provocation exams increases <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a>, as demonstrated by the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett Cluster II</a></li>
 <li>The Gillet <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> when constrained to 2 or 3 possible outcomes (More stiff on right, More stiff on left, Even)</li>
 <li>Grieve et al. demonstrated <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> and <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> when the Gillet <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> was combined with hip ROM asymmetry and palpation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> ligament of the pubic symphysis.</li>
 <li>Manipulation results in improved SIJ symmetry, hip ROM symmetry, gait symmetry, pain and disability.</li>
</ul>

Sacroiliac Joint Motion (SIJ) Exam

<h3>Summary:</h3>
<h4>Focus should be placed on addressing stiffness and asymmetry and not sacral position and range of motion.</h4>
<ul>
 <li>SIJ injection provides strong evidence that SIJ dysfunction contributes significantly to 15 &#x2013; 30% of low back pain cases.</li>
 <li>The SIJ are capable of approximately 1.6 - 6&#xB0; of rotation, and 0.1 - 2.0 mm of translation.</li>
 <li>It may be reasonable to conclude that SIJ motion is as difficult to palpate as lumbar facet motion; however, well within the limits of fingertip <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>.</li>
 <li>Asymmetrical stiffness likely alters motion and results in dysfunction and pain; it is unlikely that dysfunction is the result of a change in total ROM.</li>
 <li>Imaging may be <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> but not <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a>, subjective examination lacks <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, and palpation of sacral position lacks <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a>.</li>
 <li>Clustering pain provocation exams increases <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a>, as demonstrated by the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett Cluster II</a></li>
 <li>The Gillet <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> is <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> when constrained to 2 or 3 possible outcomes (More stiff on right, More stiff on left, Even)</li>
 <li>Grieve et al. demonstrated <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> and <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> when the Gillet <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> was combined with hip ROM asymmetry and palpation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> ligament of the pubic symphysis.</li>
 <li>Manipulation results in improved SIJ symmetry, hip ROM symmetry, gait symmetry, pain and disability.</li>
</ul>

Sacroiliac joint (SIJ) manipulation is a controversial topic, primarily due to false notions regarding SIJ motion and SIJ <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. Several studies have used injection to demonstrate that SIJ dysfunction contributes to low back pain. In a study by Fortin et al. on asymptomatic individuals, injection into the SIJ immediately revealed an area of buttock hyperesthesia extending approximately 10 cm caudally and 3 cm laterally from the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (Fortin area) (25). In a follow-up study, 16 patients were selected whose pain most closely matched the &quot;Fortin area&quot;, of these patients 10 benefited from therapeutic injection (26). Van der Wurff et al. mapped the area and intensity of chronic low back pain patients and then compared responders and non-responders to double diagnostic SIJ injection. The findings suggest that there were no significant differences in area; however, the intensity of <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> areas did differ; with 100% of SIJ injection responders exhibiting more intense pain in the &quot;Fortin area&quot; and only 10% of SIJ injection responders with more intense pain at the ischial tuberosity (27). Maigne et al. demonstrated that nearly 20% of individuals with low back pain and diagnosed SIJ dysfunction, experienced at least temporary relief from fluoroscopic guided SIJ anesthetic block (28). Slipman et al. demonstrated that fluoroscopic guided injections effectively reduced pain, disability, and increased time at work during a 2-year follow-up of patients diagnosed with SIJ dysfunction (29). Soneji et al. demonstrated no significant difference between ultrasound-guided and fluoroscopy guided SIJ injections, with both resulting in a significant reduction from baseline mean pain scores, as well as improvements in physical functioning, discomfort, opioid utilization, and patient satisfaction (30). Although more research is needed to aid in refining <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> and injection interventions, the effect of SIJ injection on low back pain provides strong evidence that SIJ dysfunction is a significant contributor to low back pain.

Several exacting methods of motion analysis have been used to determine the amount of motion of the SIJ. In studies by Jacob et al. and Kissling et al., using a three-dimensional stereophotogrammetric method with intraosseous markers, transition from sitting to standing resulted in average values for rotation and translation of 1.8&#xB0;/0.7 mm for males and 1.9&#xB0;/0.9 mm for the females. Based on a couple of individual cases in the study, it was postulated that pathological sacroiliac joint <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a> may occur when values are more than 6.0&#xB0;/2 mm (31, 32). Egund et al. used roentgen stereophotogrammetry to demonstrate that during <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> motions, the sacrum moved primarily around a transverse axis about 2&#xB0;, and the distance between the two <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> iliac spines varied at most by 0.4 mm during 7 different body positions (33). In a study by Wilke et al., Schanz screws were implanted in S1 and the ilium and measured continuously with a three-dimensional <a id="goniometry" data-tip="1524" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometric</a> system. The maximum rotation angle in the sagittal plane was 1.3&#xB0; on the right and 1.6&#xB0; on the left for flexion plus extension. Extension of the hip always produced the largest motion in the sacroiliac joint (34). Cibulka et al. also demonstrated small reciprocal motions in straddle position using radiostereometric analysis that matched the amount of motion demonstrated in other studies (35). Additionally, two studies by Struesson et al. demonstrated that movement of the sacroiliac joint was small during the standing hip flexion <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> when compared to reciprocal straddle position, suggesting that standing may reduce SIJ motion due to muscular contraction or <a id="form-closure" data-tip="1452" target="_blank" href="/glossary-term/form-closure" class="glossary">form closure</a> (36, 37). These studies indicate that the SIJ are capable of approximately 1.6 - 6&#xB0; or rotation, and/or 0.1 - 2.0 mm of translation. Although the initial impression of these motions may result in jumping to a conclusion that they are small and insignificant, we must be careful not to impose a subjective value without reference.
<table>
 <tbody>
 <tr>
 <td>
 <h4>How much is 2 to 3mm?</h4>
 It is easy to see 1.6 - 6&#xB0; or rotation, or translation of 0.1 - 2.0 mm and think that the motion of the SIJ is not worth consideration; however, these motions should be considered relative to other joint motions. Kozanek et al. demonstrated that during flexion-extension movements of the trunk, the lumbar facets rotated primarily along a mediolateral axis at an average of 2&#xB0;&#x2013;6&#xB0;, and translated (<a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>) in a cranial/caudal direction an average of 2&#x2013;4 mm (38). There are very few practitioners who would argue that the motion of the lumbar facets is not palpable, and yet, the amount of motion is similar to the motion reported by studies on the SIJ. The next reasonable question to ask may be: &quot;How <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> are the receptors in the fingertips, and what is the threshold amount of motion that can be reliably palpated?&quot;. A reasonable conclusion about fingertip <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> may be made by analogy, comparing the amount of SIJ motion to studies on the height of braille letters and reading speed/comprehension by the blind. Lei et al. demonstrated that when blind adults were tested with the lowest braille heights (0.04mm), more repeated motions over words and slower reading speeds occurred; however, repeated movements and reading speed were normal at medium and high braille heights (o.18 and 0.38mm) (39). This implies that it is possible to comfortably identify the difference in braille letters when heights are 1/5 of a mm, and reading could still take place at 1/20th of an mm. These heights are between 10 and 50 times smaller than the amount of motion of the SIJ. Although palpation and <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of SIJ motion may be more difficult than palpating <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> at the shoulder or hip, it may be reasonable to conclude that SIJ motion is as difficult to palpate as lumbar facet motion, and well within the limits of fingertip <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>.
 </td>
 </tr>
 </tbody>
</table>
<h3>SIJ Dysfunction and Altered Motion</h3>
Additional motion studies have investigated how SIJ motion is altered by pain and dysfunction. Kibsg&#xE5;rd et al. demonstrated that the straight let raise <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> resulted in 0.8&#xB0; of <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> rotation and 0.3&#xB0; inward tilt of the straight leg ilium on the sacrum in patients with long-standing severe sacroiliac joint pain (40). Sturesson et al. used roentgen stereophotogrammetry to investigate SIJ motion in 25 patients with SIJ disorders, in various normal and extreme physiologic positions, demonstrating a mean ROM of 2.5&#xB0; (0.8 degree-3.9 degrees), and mean translation of 0.7 mm (0.1-1.6 mm). There was no difference between symptomatic and asymptomatic joints (41). Adhia et al. demonstrated that when SIJ-negative low back pain patients were compared to SIJ-positive low back pain patients (diagnosed using <a id="test-item-cluster" data-tip="1209" target="_blank" href="/glossary-term/test-item-cluster" class="glossary">test cluster</a>), they exhibited significantly different innominate movement patterns and trends of rotation, but not innominate ranges of motion (42). Buyruk et al. demonstrated a correlation between asymmetric stiffness and pelvic pain using a novel Doppler imaging of vibration technique (43). In another study by the same group, Damen et al. demonstrated that using the vibration imaging technique to <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> SIJ asymmetric laxity had a <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> of 65%,, <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a> of 83%, and a positive <a id="predictive-values" data-tip="1738" target="_blank" href="/glossary-term/predictive-values" class="glossary">predictive value</a> 77% for pregnancy-related pelvic pain persisting postpartum (44). The studies by Adhia et al., Buyruk et al., and Damen et al. may suggest that asymmetric stiffness is the physical phenomenon leading to changes in motion and pain, and not changes in total ROM (42, 43, 44). Adding to the &quot;asymmetry hypothesis&quot;, Cibulka et al. demonstrated that patients with low back pain without evidence of SIJ dysfunction had more hip external ROM than internal ROM bilaterally, whereas those with evidence of SIJ dysfunction had significantly more hip external ROM than internal ROM unilaterally, specifically on the side of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> innominate (45). These studies imply that determining how dysfunction affects total SIJ ROM may be the wrong <a id="hypothesis" data-tip="1446" target="_blank" href="/glossary-term/hypothesis" class="glossary">hypothesis</a> to investigate. Instead, these studies suggest that asymmetric stiffness likely alters motion during activity and is correlated with dysfunction and pain. The change in stiffness without a change in total ROM may be similar to the changes described in the Panjabi et al.&apos;s neutral zone <a id="hypothesis" data-tip="1446" target="_blank" href="/glossary-term/hypothesis" class="glossary">hypothesis</a> for the lumbar spine (46, 47). The application of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> to both the lumbar spine and SIJ also increases congruence between hypothesized spine dysfunction, suggesting that changes in motion of various segments of the spine may occur due to similar mechanisms.
<h4>Changes in Motion Following Manipulation</h4>
Studies have demonstrated some changes in pelvic motion and position post manipulation; however, based on research findings expectations should be modified. Tullberg et al. compared roentgen stereophotogrammetric analysis and position tests before and after manipulation in 12 individuals with <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> sacroiliac joint dysfunction, demonstrating that manipulation did not change the position of the sacrum in standing; however, manual sacral position tests did change from positive to normal (48). This may suggest that the effects of manipulation do not alter sacral position and that manual sacral position tests are not valid; however, these tests may still have diagnostic benefits if capable of identifying individuals who would benefit from sacral directed therapies. In an RCT by Cibulka et al., 20 patients who had sided low back pain and SIJ dysfunction were randomly assigned to control and experimental groups and pelvic tilt was measured. The experimental group was manipulated on the side of stiffness resulting in equal and opposing tilting toward normalization of both innominates during retesting (based on relative ASIS and PSIS height) (49). This may imply that while sacral position is not palpable, inomminate tilt may be palpable and used as a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of manipulation success. In a <a id="quasi-experimental-research" data-tip="1159" target="_blank" href="/glossary-term/quasi-experimental-research" class="glossary">quasi-experimental study</a> by de Toledo et al. manipulation did not result in significant changes in SIJ mobility; however, the clear trend in the data may also suggest that this study was too small to reach statistical significance (50). Conversely Mahmoud et al. demonstrated that <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> iliosacral joint manipulation increased SIJ ROM, reduced hyperlordosis of the lumbar spine, and decreased SIJ and low back pain (51). Based on these research studies, and the studies discussed below regarding treatment, manipulation should be expected to alter iliac position and not sacral position, improve asymmetry but potentially not SIJ <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a>, and reduce symptoms associated with SIJ dysfunction.
<img src="https://www.datocms-assets.com/25800/1650084909-sij-image-2.png" title="SI Joint Image">

SIJ Motion

Several studies have investigated the <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> of imaging and medical examination for the diagnosis of SIJ dysfunction. Elegafy et al. demonstrated that computed tomography had a <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> of 57.5% and a <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a> of 69%, based on a comparison to the number of patients who tested positive using SIJ Injection (anesthetic block) (52). Slipman et al. demonstrated that of 31 patients, 19 responded to SIJ block, only 4 responders had signs of SIJ dysfunction on bone scans, and zero non-responders had signs on bone scans (53). These studies may suggest that imaging has high <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a>, but very low <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>. Additional studies using radiographs imply a correlation between SIJ dysfunction and femoral acetabular impingement syndrome (FAI). Krishnamoorthy et al. demonstrated a high percentage of SIJ abnormalities on radiographs (25.2%) in patients with FAI (54). Further, Morgan et al. demonstrated that a significant number of patients meeting strict criteria for SIJ pain had radiographic evidence of FAI or hip arthrosis (55). Arthrography may demonstrate some of the physical phenomena that may be contributing to SIJ pain. Fortin et al. demonstrated the extravasation of contrast medium during arthrogram of the SIJ, which may imply micro-damage of SIJ capsular structures and/or the potential of intra-articular fluids to aggravate adjacent neural structures (56). Schwarzer et al. demonstrated similar findings; of 13 low back pain patients (30%) who obtained relief from an anesthetic SIJ block, 9 exhibited tears of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule during arthrography (57). Dreyfuss et al. demonstrated that the combination of medical history and physical examination was also not particularly beneficial for assessing the contribution of SIJ dysfunction to low back pain (58). And, Freburger et al. demonstrated that using calipers and inclinometers for determining SIJ motion and dysfunction was unreliable in a multicenter study (59). These studies demonstrated that imaging may be <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> but lacks <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, that medical examination alone lacks <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, there appears to be a correlation between SIJ dysfunction and FAI, and arthrography may be useful in aiding in further research.
Studies have demonstrated a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> diagnosis of SIJ pain using clusters of the most effective SIJ special tests for pain provocation. A study by Laslett et al. in 1994 demonstrated that many of the pain provocation tests were <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> (60). In 2003 and 2005, Laslett et al. reported the <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> of a <a id="test-item-cluster" data-tip="1209" target="_blank" href="/glossary-term/test-item-cluster" class="glossary">test cluster</a> resulted in 94% <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> and 78% <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a>, using anesthetic SIJ block as the comparison criteria (61, 62). Further, in 2009, a meta-analysis by Szadek et al. demonstrated that the <a href="https://brookbushinstitute.com/video/thigh-thrust-test-sacroiliac-joint" target="_blank" rel="noopener">thigh thrust test</a>, the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-sacrul-thrust-compression-distraction-tests" target="_blank" rel="noopener">compression test</a>, and 3 or more positive stressing tests (as used in the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-testing-item-cluster-lasletts-cluster-ii" target="_blank" rel="noopener">Laslett Cluster</a>) demonstrated discriminating <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> for diagnosing SIJ pain (63). The Laslett Cluster is covered in detail in the course, &quot;<a href="https://brookbushinstitute.com/article/special-tests-sacroiliac-joint" target="_blank" rel="noopener">Special Tests: Sacroiliac Joint</a>&quot;. The success of the pain provocation cluster may imply that clustering exams is a potential path to <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. An interesting comparison by Soleimanifer et al. demonstrated that there was no correlation between findings of SIJ motion special tests, and SIJ pain provocation special tests. It is important to note that most or the tests used were not part of any cluster currently supported by research (Sitting flexion, Standing flexion, <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a> knee flexion, <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet test</a>, <a href="https://brookbushinstitute.com/video/hip-special-test-faber-patricks-test" target="_blank" rel="noopener">FABER</a>, <a href="https://brookbushinstitute.com/video/thigh-thrust-test-sacroiliac-joint" target="_blank" rel="noopener">Posterior shear</a>, Resisted abduction <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>) (64). However, the idea that a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> pain cluster and a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> movement cluster should demonstrate correlation is likely an important goal in the development of a movement cluster. These studies demonstrate that there is a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> approach for diagnosing SIJ pain, and that clustering exams may be a viable option for improving SIJ movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a>.
Several studies have investigated the <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> of movement <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a>. Herzog et al. demonstrated that some palpation procedures demonstrated <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, but not others; which implies that more <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> training protocols should be developed to teach motion palpation (65). Lueck et al demonstrated inter- and intra-rater <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> at a single clinic was variable for SIJ motion exams, noting that intra-rater <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> was higher than inter-rater <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> and that it was the amount of daily practice and not years of experience that affected <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> (66). Hungerford et al. demonstrated that the <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> of the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> was high when findings were reduced to a 2-point scale (PSIS remained neutral or moved <a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>) and were still moderate when a 3-point scale was used (PSIS neutral, <a id="cephalad" data-tip="1559" target="_blank" href="/glossary-term/cephalad" class="glossary">cranial</a>, or <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>) (67). Levangie et al. demonstrated that a positive <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> had a relatively high <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a> for low back pain (presumably related to SIJ <a id="hypomobility" data-tip="1673" target="_blank" href="/glossary-term/hypomobility" class="glossary">hypomobility</a>), but only weak association with PSIS height, and no correlation with standing forward flexion <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a>, sitting forward flexion <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a>, or supine-to-sit <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (68) Interestingly, Cibulka et al. demonstrated 82% <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, 88% for <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a>, 86% positive predictive and 84% for negative <a id="predictive-values" data-tip="1738" target="_blank" href="/glossary-term/predictive-values" class="glossary">predictive value</a> for a combination of many of the same tests mentioned above, including the standing flexion text, sitting posterior-superior iliac spine palpation, <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> long-sitting <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a>, <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> knee flexion <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (69). Considering the relatively high <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> of the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> and the relatively high <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> of the tests investigated by Cibulka et al., it seems likely that these <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> are testing different phenomena correlated with SIJ dysfunction. An interesting study by Grieve et al. should have inspired further research. Grieve et al. demonstrated that a <a id="test-item-cluster" data-tip="1209" target="_blank" href="/glossary-term/test-item-cluster" class="glossary">test cluster</a> including the <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> revised by the author (alternate hip and knee flexion in supported standing), passive <a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir" target="_blank" rel="noopener">hip rotation RO in </a><a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> with 90&#xB0; of hip and knee flexion, and palpation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> ligament of the symphysis pubis were <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> for identifying individuals referred by a physician who responded to SIJ manipulation in conjunction with education on living modification and a progressive walking program (70). What is interesting about this cluster is the use of the most <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> movement <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a>, a focus on identifying asymmetry, pain with palpation which research has demonstrated has high <a id="specificity" data-tip="1223" target="_blank" href="/glossary-term/specificity" class="glossary">specificity</a> for other joints and correlation with the success of the implied treatment. These concepts and many of the same <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> were used in the cluster recommended below. These studies suggest that most SIJ movement <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> are likely unreliable and inaccurate alone; however, a cluster of <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> may be more <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> and accurate. The <a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a> when constrained to 2 or 3 possible outcomes is likely the most <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> individual <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. Further, based on the studies above, it may be reasonable to conclude that a movement cluster should focus s on identifying asymmetrical stiffness and asymmetrical motion, with the intent of predicting best practice for improving stiffness and asymmetry.
<table>
 <tbody>
 <tr>
 <td>Brookbush/Grieve (70) Recommended Cluster:
 <h4>Assess:</h4>
 <ul>
 <li><a href="https://brookbushinstitute.com/article/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat </a><a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> (OHSA): Stiff SIJ on the side opposite of an <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">asymmetrical shift with &quot;heel rise&quot;</a>
 <ul>
 <li>&quot;Top tier exam&quot; used to identify asymmetry and imply further SIJ assessment</li>
 </ul>
 </li>
 <li><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Pelvic Tilt: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> tilted innominate correlated with stiffer side</li>
 <li><a href="https://brookbushinstitute.com/video/sacroiliac-joint-special-test-stork-gillet-test" target="_blank" rel="noopener">Gillet Test</a>: Less motion on the stiffer side</li>
 <li><a href="https://brookbushinstitute.com/article/lower-body-goniometry" target="_blank" rel="noopener">Hip Rotation Range of Motion</a>: Less motion on the stiffer side</li>
 </ul>
 <h4>Treat:</h4>
 <ul>
 <li><a href="https://brookbushinstitute.com/article/joint-manipulation-lumbar-spine-sacroiliac-joint-and-pubic-symphysis" target="_blank" rel="noopener">Mobilize/Manipulate</a>: Stiff SIJ Side</li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-maximus-activation" target="_blank" rel="noopener">Glute Activation</a>: <a id="mobility" data-tip="1457" target="_blank" href="/glossary-term/mobility" class="glossary">Mobile</a> SIJ Side</li>
 </ul>
 </td>
 </tr>
 </tbody>
</table>

SIJ Motion Testing

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 <ul>
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 <li>Laslett's Cluster II</li>
 </ul>
 </li>
 <li>Laslett, M., Young, S. B., Aprill, C. N., &amp; McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Australian Journal of Physiotherapy, 49(2), 89-97.</li>
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 <ul>
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 <ul>
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 <li>Slipman, C. W., Lipetz, J. S., Plastaras, C. T., Jackson, H. B., Vresilovic, E. J., Lenrow, D. A., &amp; Braverman, D. L. (2001). Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. American journal of physical medicine &amp; rehabilitation, 80(6), 425-432.</li>
 <li>Soneji, N., Bhatia, A., Seib, R., Tumber, P., Dissanayake, M., &amp; Peng, P. W. (2016). Comparison of fluoroscopy and ultrasound guidance for sacroiliac joint injection in patients with chronic low back pain. Pain Practice, 16(5), 537-544.
 <ul>
 <li>Sacroiliac Joint Motion</li>
 </ul>
 </li>
 <li>Jacob, H. A. C., &amp; Kissling, R. O. (1995). The mobility of the sacroiliac joints in healthy volunteers between 20 and 50 years of age. Clinical Biomechanics, 10(7), 352-361.</li>
 <li>Kissling, R. O., &amp; Jacob, H. A. (1996). The mobility of the sacroiliac joint in healthy subjects. Bulletin (Hospital for Joint Diseases (New York, NY)), 54(3), 158-164.</li>
 <li>Egund, N., Olsson, T. H., Schmid, H., &amp; Selvik, G. (1978). Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiologica. Diagnosis, 19(5), 833-846.</li>
 <li>Wilke, H. J., Fischer, K., Jeanneret, B., Claes, L., &amp; Magerl, F. (1997). In vivo measurement of 3-dimensional movement of the iliosacral joint. Zeitschrift fur Orthopadie und ihre Grenzgebiete, 135(6), 550-556.</li>
 <li>Cibulka, M. T. (2001). Re: a radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine, 26(12), 1404-1405.</li>
 <li>Sturesson, B., Uden, A., &amp; Vleeming, A. (2000). A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine, 25(3), 364-368.</li>
 <li>Sturesson, B., Uden, A., &amp; Vleeming, A. (2000). A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine, 25(2), 214.
 <ul>
 <li>Comparison</li>
 </ul>
 </li>
 <li>Kozanek, M., Wang, S., Passias, P. G., Xia, Q., Li, G., Bono, C. M., … &amp; Li, G. (2009). Range of motion and orientation of the lumbar facet joints in vivo. Spine, 34(19), E689-E696.</li>
 <li>Lei, D., Stepien-Bernabe, N. N., Morash, V. S., &amp; MacKeben, M. (2019). Effect of modulating braille dot height on reading regressions. PloS one, 14(4), e0214799.
 <ul>
 <li>Motion and Dysfunction</li>
 </ul>
 </li>
 <li>Kibsgård, T. J., Röhrl, S. M., Røise, O., Sturesson, B., &amp; Stuge, B. (2017). Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clinical Biomechanics, 47, 40-45.</li>
 <li>Sturesson, B. E. N. G. T., Selvik, G., &amp; UdÉn, A. (1989). Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine, 14(2), 162-165.</li>
 <li>Adhia, D. B., Milosavljevic, S., Tumilty, S., &amp; Bussey, M. D. (2016). Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin. Manual therapy, 21, 100-108.</li>
 <li>Buyruk, H. M., Stam, H. J., Snijders, C. J., Laméris, J. S., Holland, W. P., &amp; Stijnen, T. H. (1999). Measurement of sacroiliac joint stiffness in peripartum pelvic pain patients with Doppler imaging of vibrations (DIV). European Journal of Obstetrics and Gynecology and Reproductive Biology, 83(2), 159-163.</li>
 <li>Damen, L., Buyruk, H. M., Güler-Uysal, F., Lotgering, F. K., Snijders, C. J., &amp; Stam, H. J. (2002). The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine, 27(24), 2820-2824.</li>
 <li>Cibulka, M. T., Sinacore, D. R., Cromer, G. S., &amp; Delitto, A. (1998). Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine, 23(9), 1009-1015.</li>
 <li>Panjabi, M. M. (1992). The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of spinal disorders, 5(4), 383-9.</li>
 <li>Panjabi, M. M. (1992). The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of spinal disorders, 5, 390-390.
 <ul>
 <li>Changes in Motion Following Manipulation:</li>
 </ul>
 </li>
 <li>Tullberg, T., Blomberg, S., Branth, B., &amp; Johnsson, R. (1998). Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 23(10), 1124-1128.</li>
 <li>Cibulka, M. T., Delitto, A., &amp; Koldehoff, R. M. (1988). Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain: an experimental study. Physical Therapy, 68(9), 1359-1363.</li>
 <li>de Toledo, D. D. F. A., Kochem, F. B., &amp; Silva, J. G. (2019). High-velocity, low-amplitude manipulation (HVLA) does not alter three-dimensional position of sacroiliac joint in healthy men: A quasi-experimental study. Journal of Bodywork and Movement Therapies.</li>
 <li>Mahmoud, Y. M., Kattabel, O. M. A., &amp; Amin, D. I. (2016). Effect of Posterior Iliosacral Joint Manipulation on Subjects With Hyperlordosis of Lumbar Spine. Isotope and Radiation Research, 48(1), 87-95.
 <ul>
 <li>Testing</li>
 </ul>
 </li>
 <li>Elgafy, H., Semaan, H. B., Ebraheim, N. A., &amp; Coombs, R. J. (2001). Computed tomography findings in patients with sacroiliac pain. Clinical orthopaedics and related research, 382, 112-118.</li>
 <li>Slipman, C. W., Sterenfeld, E. B., Chou, L. H., Herzog, R., &amp; Vresilovic, E. (1996). The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine, 21(19), 2251-2254.</li>
 <li>Krishnamoorthy, V. P., Beck, E. C., Kunze, K. N., Cancienne, J. M., Krivicich, L. M., Suppauksorn, S., … &amp; Nho, S. J. (2019). Radiographic Prevalence of Sacroiliac Joint Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome. Arthroscopy: The Journal of Arthroscopic &amp; Related Surgery, 35(9), 2598-2605.</li>
 <li>Morgan, P. M., Anderson, A. W., &amp; Swiontkowski, M. F. (2013). Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement. Hip International, 23(2), 212-217.</li>
 <li>Fortin, J. D., Vilensky, J. A., &amp; Merkel, G. J. (2003). Can the sacroiliac joint cause sciatica?. Pain physician, 6(3), 269-272.</li>
 <li>Schwarzer, A. C., Aprill, C. N., &amp; Bogduk, N. (1995). The sacroiliac joint in chronic low back pain. Spine, 20(1), 31-37.</li>
 <li>Dreyfuss, P., Michaelsen, M., Pauza, K., McLarty, J., &amp; Bogduk, N. (1996). The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine, 21(22), 2594-2602.</li>
 <li>Freburger, J. K., &amp; Riddle, D. L. (1999). Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study. Physical therapy, 79(12), 1134-1141.</li>
 <li>Laslett, M., &amp; Williams, M. (1994). The reliability of selected pain provocation tests for sacroiliac joint pathology. Spine, 19(11), 1243-1249.</li>
 <li>Laslett, M., Young, S. B., Aprill, C. N., &amp; McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Australian Journal of Physiotherapy, 49(2), 89-97.</li>
 <li>Laslett, M., Aprill, C. N., McDonald, B., &amp; Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.</li>
 <li>Szadek, K. M., van der Wurff, P., van Tulder, M. W., Zuurmond, W. W., &amp; Perez, R. S. (2009). Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of pain, 10(4), 354-368.</li>
 <li>Soleimanifar, M., Karimi, N., &amp; Arab, A. M. (2017). Association between composites of selected motion palpation and pain provocation tests for sacroiliac joint disorders. Journal of bodywork and movement therapies, 21(2), 240-245.</li>
 <li>Herzog, W., Read, L. J., Conway, P. J., Shaw, L. D., &amp; McEwen, M. C. (1989). Reliability of motion palpation procedures to detect sacroiliac joint fixations. Journal of manipulative and physiological therapeutics, 12(2), 86-92.</li>
 <li>Lueck, D. (2009). Reliability of sacroiliac joint tests in experienced and inexperienced examiners.</li>
 <li>Hungerford, B. A., Gilleard, W., Moran, M., &amp; Emmerson, C. (2007). Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork test on the support side. Physical Therapy, 87(7), 879-887.</li>
 <li>Levangie, P. K. (1999). Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Physical Therapy, 79(11), 1043-1057.</li>
 <li>Cibulka, M. T., &amp; Koldehoff, R. (1999). Clinical usefulness of a cluster of sacroiliac joint tests in patients with and without low back pain. Journal of Orthopaedic &amp; Sports Physical Therapy, 29(2), 83-92.</li>
 <li>Grieve, E. (2001). Diagnostic tests for mechanical dysfunction of the sacroiliac joints. Journal of Manual &amp; Manipulative Therapy, 9(4), 198-206.</li>
</ol>

Bibliography

© 2019 Brent Brookbush
Questions, comments, and criticisms are welcomed and encouraged

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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