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Sacroiliac Joint Special Test: Gaenslen's Test

Learn how to assess the Sacroiliac Joint with Gaenslen's Test, a special test that evaluates the ligaments related to the structures of the joint. This video demonstrates how to perform the test and interpret results.

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00:04 - 00:07This is Brent of the Brookbush Institute in this video we're going over another
00:07 - 00:11special or orthopedic tests for sacroiliac joint pain, the Gaenslen's
00:11 - 00:14test. I'm going to have my friend Melissa step out, she's going to help me demonstrate
00:14 - 00:20this test. Now if you can remember that this is Thomas test with a thrust you're
00:20 - 00:24more than halfway there, now we just have to remember what are the concordance
00:24 - 00:27signs were looking for and what are some of the contraindications. The way I like
00:27 - 00:31to set this test up is I'm going to have Melissa turn around, she's going to put her
00:31 - 00:36tailbone right at the edge of the table, I'm going to have her pick this leg up the
00:36 - 00:40leg closest to me and hold it close to her chest, and then I can just have her
00:40 - 00:44roll back onto the table and she's in good position. Now most textbooks show
00:44 - 00:49the opposite, they show this leg the leg that's up being furthest from you. I
00:49 - 00:53actually find that really awkward and I don't think it affects the test one way
00:53 - 00:59or another. So this leg is going to be up, I'm now going to make sure that she's a
00:59 - 01:03little posteriorly tilted, I want her lumbar spine almost flat so that when I
01:03 - 01:07start applying pressure for these thrusts I'm not like putting pressure
01:07 - 01:13into her lumbar spine, like I'm not just thrusting and jostling her around while
01:13 - 01:17she's in this really really extended position that could give me some
01:17 - 01:20false symptoms, and give her some low back pain instead of the sacroiliac
01:20 - 01:25joint pain we're looking for. Now the test itself is pushing to end range
01:25 - 01:30flexion, pushing to end range extension. At this point I usually ask my patient
01:30 - 01:34how does this feel? This feels fine I apply a little overpressure, does this
01:34 - 01:42feel fine? It's okay. Before I do the actual test itself, which is five to six
01:42 - 01:50vigorous thrusts. All right so we're going to get here, how did that feel? That
01:50 - 01:55was pain. Alright so this is a pretty jarring test
01:55 - 02:01it's not a fun test to go through. Make sure you do kind of settle in
02:01 - 02:05there, you put them in position. Make sure that that's not provoking any pain
02:05 - 02:09that's not flaring them up, give them a little overpressure first and then do
02:09 - 02:12your thrusts. The last thing you want to do is thrust on somebody who's really
02:12 - 02:17really irritable that's going to make it really hard for you to follow up with
02:17 - 02:20any sort of physical therapy treatment. Now the way textbooks have
02:20 - 02:27this is this way, which is okay right this is we can still do the test in this
02:27 - 02:30position and you guys can experiment with this yourselves, I just find it very
02:30 - 02:35very awkward to be this way. How does this feel? Fine, if I add a little
02:35 - 02:43overpressure you're okay? Right and now the test itself is how's that? Fine, okay.
02:43 - 02:47So you said it hurt when I had your left leg up and it didn't hurt when I had
02:47 - 02:50your right leg up. Now textbooks don't make it very clear
02:50 - 02:56on which side should be up for which side of the sacrum you're feeling pain
02:56 - 03:02on, and honestly it probably doesn't matter all that much for this test
03:02 - 03:06remember we're just looking for a positive or a negative. So
03:06 - 03:11she's positive with her
03:11 - 03:17left leg up, negative with her right leg up I would just make note of that. We can
03:17 - 03:20start thinking through the biomechanics as we're going through our interventions,
03:20 - 03:23but the only thing that we're really concerned about when it comes to this
03:23 - 03:30test is am I going to make change on this particular test. So she's positive
03:30 - 03:34with left leg up can I make that negative. You can go ahead and stand up
03:34 - 03:38for a second. Now I do have to admit this is not one of my favorite tests and I
03:38 - 03:44think you can probably already figure out why. It's a fairly rough test
03:44 - 03:50in a fairly rough position. So you know this is a hip flexor stretch. If
03:50 - 03:55somebody has any sort of psoas pathology like a psoas strain, adductor
03:55 - 04:03strain this test isn't going to work out very well. If somebody has L2 to L4 nerve
04:03 - 04:08root pathology, femoral nerve involvement this is not going to work out very well.
04:08 - 04:14If somebody has lumbar spine issues just getting into this position might not
04:14 - 04:19work out very well, and as you can imagine any hip pathology, labral issues,
04:19 - 04:24even sometimes a very flared up impingement this isn't going to work out
04:24 - 04:31very well. So it's a kind of good test if used in a cluster and that's what it
04:31 - 04:35really comes down to. This is a more sensitive test
04:35 - 04:38than some of our other SI joint tests which I told you we're specific but not
04:38 - 04:43sensitive, and it does get used in the couple of clusters that we're going to
04:43 - 04:50use routinely for sacroiliac joint pain, right the test by itself I would never
04:50 - 04:55use. This is not a test that by itself I would ever use as a screen, or as a
04:55 - 05:00positive negative test, or a diagnostic test, it's only going to be used as part
05:00 - 05:03of these clusters which we're going to teach in future videos. So let's go
05:03 - 05:07through this one more time. I'm going to have Melissa go ahead and get into this
05:07 - 05:10position where she's going to put her tailbone down at the very edge of the
05:10 - 05:15table. I personally prefer that she lifts up the leg that is closest to me I find
05:15 - 05:19that I get better leverage and I have better control that way. Once she's in
05:19 - 05:23this position it's a lot more comfortable for her to roll back too.
05:23 - 05:27I'm going to make sure that I have her just posteriorly tilted a little
05:27 - 05:32bit so that I don't get hurt anteriorly tilted and and give her any lumbar spine
05:32 - 05:38pain. Now just a practical aspect, books will tell you to thrust five or
05:38 - 05:43six times, let's start by getting to end range first asking our patient does that
05:43 - 05:47provoke any of your symptoms. We want to make sure we're safe. For all you
05:47 - 05:51know they have a hip pathology that they don't know about right, so are we safe.
05:51 - 05:55Add a little overpressure, are we still safe, how does that feel? Good now go
05:55 - 06:02ahead and do your five or six thrusts, how does that feel? That's pain and
06:02 - 06:09where is that pain, in your complaint area which was right over her her sacroiliac
06:09 - 06:13joint, right over her PSIS. Alright go ahead and stand up. So there you guys
06:13 - 06:19have it the Gaenslen's test. A little bit more sensitive than specific, we're
06:19 - 06:24going to use it inside of our testing clusters, but guys just in the back of
06:24 - 06:28your hand use your logic, use your reasoning, use your common sense. If
06:28 - 06:34somebody has a history of L2, L4, nerve root adhesion, and if somebody has an adductor
06:34 - 06:41strain, somebody has a labral tear in their hip, skip this one. Just just find a
06:41 - 06:45different test to use, even if you did the clusters without this test
06:45 - 06:50they still work out pretty well. If you have any other questions please leave
06:50 - 06:55them in the comments box below, I look forward to hearing from you.

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