0:04 This is Brent of the Brookbush Institute in this video we're going over another 0:07 special or orthopedic tests for sacroiliac joint pain, the Gaenslen's 0:11 test. I'm going to have my friend Melissa step out, she's going to help me demonstrate 0:14 this test. Now if you can remember that this is Thomas test with a thrust you're 0:20 more than halfway there, now we just have to remember what are the concordance 0:24 signs were looking for and what are some of the contraindications. The way I like 0:27 to set this test up is I'm going to have Melissa turn around, she's going to put her 0:31 tailbone right at the edge of the table, I'm going to have her pick this leg up the 0:36 leg closest to me and hold it close to her chest, and then I can just have her 0:40 roll back onto the table and she's in good position. Now most textbooks show 0:44 the opposite, they show this leg the leg that's up being furthest from you. I 0:49 actually find that really awkward and I don't think it affects the test one way 0:53 or another. So this leg is going to be up, I'm now going to make sure that she's a 0:59 little posteriorly tilted, I want her lumbar spine almost flat so that when I 1:03 start applying pressure for these thrusts I'm not like putting pressure 1:07 into her lumbar spine, like I'm not just thrusting and jostling her around while 1:13 she's in this really really extended position that could give me some 1:17 false symptoms, and give her some low back pain instead of the sacroiliac 1:20 joint pain we're looking for. Now the test itself is pushing to end range 1:25 flexion, pushing to end range extension. At this point I usually ask my patient 1:30 how does this feel? This feels fine I apply a little overpressure, does this 1:34 feel fine? It's okay. Before I do the actual test itself, which is five to six 1:42 vigorous thrusts. All right so we're going to get here, how did that feel? That 1:50 was pain. Alright so this is a pretty jarring test 1:55 it's not a fun test to go through. Make sure you do kind of settle in 2:01 there, you put them in position. Make sure that that's not provoking any pain 2:05 that's not flaring them up, give them a little overpressure first and then do 2:09 your thrusts. The last thing you want to do is thrust on somebody who's really 2:12 really irritable that's going to make it really hard for you to follow up with 2:17 any sort of physical therapy treatment. Now the way textbooks have 2:20 this is this way, which is okay right this is we can still do the test in this 2:27 position and you guys can experiment with this yourselves, I just find it very 2:30 very awkward to be this way. How does this feel? Fine, if I add a little 2:35 overpressure you're okay? Right and now the test itself is how's that? Fine, okay. 2:43 So you said it hurt when I had your left leg up and it didn't hurt when I had 2:47 your right leg up. Now textbooks don't make it very clear 2:50 on which side should be up for which side of the sacrum you're feeling pain 2:56 on, and honestly it probably doesn't matter all that much for this test 3:02 remember we're just looking for a positive or a negative. So 3:06 she's positive with her 3:11 left leg up, negative with her right leg up I would just make note of that. We can 3:17 start thinking through the biomechanics as we're going through our interventions, 3:20 but the only thing that we're really concerned about when it comes to this 3:23 test is am I going to make change on this particular test. So she's positive 3:30 with left leg up can I make that negative. You can go ahead and stand up 3:34 for a second. Now I do have to admit this is not one of my favorite tests and I 3:38 think you can probably already figure out why. It's a fairly rough test 3:44 in a fairly rough position. So you know this is a hip flexor stretch. If 3:50 somebody has any sort of psoas pathology like a psoas strain, adductor 3:55 strain this test isn't going to work out very well. If somebody has L2 to L4 nerve 4:03 root pathology, femoral nerve involvement this is not going to work out very well. 4:08 If somebody has lumbar spine issues just getting into this position might not 4:14 work out very well, and as you can imagine any hip pathology, labral issues, 4:19 even sometimes a very flared up impingement this isn't going to work out 4:24 very well. So it's a kind of good test if used in a cluster and that's what it 4:31 really comes down to. This is a more sensitive test 4:35 than some of our other SI joint tests which I told you we're specific but not 4:38 sensitive, and it does get used in the couple of clusters that we're going to 4:43 use routinely for sacroiliac joint pain, right the test by itself I would never 4:50 use. This is not a test that by itself I would ever use as a screen, or as a 4:55 positive negative test, or a diagnostic test, it's only going to be used as part 5:00 of these clusters which we're going to teach in future videos. So let's go 5:03 through this one more time. I'm going to have Melissa go ahead and get into this 5:07 position where she's going to put her tailbone down at the very edge of the 5:10 table. I personally prefer that she lifts up the leg that is closest to me I find 5:15 that I get better leverage and I have better control that way. Once she's in 5:19 this position it's a lot more comfortable for her to roll back too. 5:23 I'm going to make sure that I have her just posteriorly tilted a little 5:27 bit so that I don't get hurt anteriorly tilted and and give her any lumbar spine 5:32 pain. Now just a practical aspect, books will tell you to thrust five or 5:38 six times, let's start by getting to end range first asking our patient does that 5:43 provoke any of your symptoms. We want to make sure we're safe. For all you 5:47 know they have a hip pathology that they don't know about right, so are we safe. 5:51 Add a little overpressure, are we still safe, how does that feel? Good now go 5:55 ahead and do your five or six thrusts, how does that feel? That's pain and 6:02 where is that pain, in your complaint area which was right over her her sacroiliac 6:09 joint, right over her PSIS. Alright go ahead and stand up. So there you guys 6:13 have it the Gaenslen's test. A little bit more sensitive than specific, we're 6:19 going to use it inside of our testing clusters, but guys just in the back of 6:24 your hand use your logic, use your reasoning, use your common sense. If 6:28 somebody has a history of L2, L4, nerve root adhesion, and if somebody has an adductor 6:34 strain, somebody has a labral tear in their hip, skip this one. Just just find a 6:41 different test to use, even if you did the clusters without this test 6:45 they still work out pretty well. If you have any other questions please leave 6:50 them in the comments box below, I look forward to hearing from you.
