00:00:0400:00:07
This is Brent of the Brookbush Institute
00:00:0400:00:07
in this video we're going over another
00:00:0700:00:11
special or orthopedic tests for sacroiliac joint pain, the Gaenslen's
00:00:1100:00:14
test. I'm going to have my friend Melissa step out, she's going to help me demonstrate
00:00:1400:00:20
this test. Now if you can remember that this is Thomas test with a thrust you're
00:00:2000:00:24
more than halfway there, now we just have to remember what are the concordance
00:00:2400:00:27
signs were looking for and what are some of the contraindications. The way I like
00:00:2700:00:31
to set this test up is I'm going to have Melissa turn around, she's going to put her
00:00:3100:00:36
tailbone right at the edge of the table, I'm going to have her pick this leg up the
00:00:3600:00:40
leg closest to me and hold it close to her chest, and then I can just have her
00:00:4000:00:44
roll back onto the table and she's in good position. Now most textbooks show
00:00:4400:00:49
the opposite, they show this leg the leg that's up being furthest from you. I
00:00:4900:00:53
actually find that really awkward and I don't think it affects the test one way
00:00:5300:00:59
or another. So this leg is going to be up, I'm now going to make sure that she's a
00:00:5900:01:03
little posteriorly tilted, I want her lumbar spine almost flat so that when I
00:01:0300:01:07
start applying pressure for these thrusts I'm not like putting pressure
00:01:0700:01:13
into her lumbar spine, like I'm not just thrusting and jostling her around while
00:01:1300:01:17
she's in this really really extended position that could give me some
00:01:1700:01:20
false symptoms, and give her some low back pain instead of the sacroiliac
00:01:2000:01:25
joint pain we're looking for. Now the test itself is pushing to end range
00:01:2500:01:30
flexion, pushing to end range extension. At this point I usually ask my patient
00:01:3000:01:34
how does this feel? This feels fine I apply a little overpressure, does this
00:01:3400:01:42
feel fine? It's okay. Before I do the actual test itself, which is five to six
00:01:4200:01:50
vigorous thrusts. All right so we're going to get here, how did that feel? That
00:01:5000:01:55
was pain. Alright so this is a pretty jarring test
00:01:5500:02:01
it's not a fun test to go through. Make sure you do kind of settle in
00:02:0100:02:05
there, you put them in position. Make sure that that's not provoking any pain
00:02:0500:02:09
that's not flaring them up, give them a little overpressure first and then do
00:02:0900:02:12
your thrusts. The last thing you want to do is thrust on somebody who's really
00:02:1200:02:17
really irritable that's going to make it really hard for you to follow up with
00:02:1700:02:20
any sort of physical therapy treatment. Now the way textbooks have
00:02:2000:02:27
this is this way, which is okay right this is we can still do the test in this
00:02:2700:02:30
position and you guys can experiment with this yourselves, I just find it very
00:02:3000:02:35
very awkward to be this way. How does this feel? Fine, if I add a little
00:02:3500:02:43
overpressure you're okay? Right and now the test itself is how's that? Fine, okay.
00:02:4300:02:47
So you said it hurt when I had your left leg up and it didn't hurt when I had
00:02:4700:02:50
your right leg up. Now textbooks don't make it very clear
00:02:5000:02:56
on which side should be up for which side of the sacrum you're feeling pain
00:02:5600:03:02
on, and honestly it probably doesn't matter all that much for this test
00:03:0200:03:06
remember we're just looking for a positive or a negative. So
00:03:0600:03:11
she's positive with her
00:03:1100:03:17
left leg up, negative with her right leg up I would just make note of that. We can
00:03:1700:03:20
start thinking through the biomechanics as we're going through our interventions,
00:03:2000:03:23
but the only thing that we're really concerned about when it comes to this
00:03:2300:03:30
test is am I going to make change on this particular test. So she's positive
00:03:3000:03:34
with left leg up can I make that negative. You can go ahead and stand up
00:03:3400:03:38
for a second. Now I do have to admit this is not one of my favorite tests and I
00:03:3800:03:44
think you can probably already figure out why. It's a fairly rough test
00:03:4400:03:50
in a fairly rough position. So you know this is a hip flexor stretch. If
00:03:5000:03:55
somebody has any sort of psoas pathology like a psoas strain, adductor
00:03:5500:04:03
strain this test isn't going to work out very well. If somebody has L2 to L4 nerve
00:04:0300:04:08
root pathology, femoral nerve involvement this is not going to work out very well.
00:04:0800:04:14
If somebody has lumbar spine issues just getting into this position might not
00:04:1400:04:19
work out very well, and as you can imagine any hip pathology, labral issues,
00:04:1900:04:24
even sometimes a very flared up impingement this isn't going to work out
00:04:2400:04:31
very well. So it's a kind of good test if used in a cluster and that's what it
00:04:3100:04:35
really comes down to. This is a more sensitive test
00:04:3500:04:38
than some of our other SI joint tests which I told you we're specific but not
00:04:3800:04:43
sensitive, and it does get used in the couple of clusters that we're going to
00:04:4300:04:50
use routinely for sacroiliac joint pain, right the test by itself I would never
00:04:5000:04:55
use. This is not a test that by itself I would ever use as a screen, or as a
00:04:5500:05:00
positive negative test, or a diagnostic test, it's only going to be used as part
00:05:0000:05:03
of these clusters which we're going to teach in future videos. So let's go
00:05:0300:05:07
through this one more time. I'm going to have Melissa go ahead and get into this
00:05:0700:05:10
position where she's going to put her tailbone down at the very edge of the
00:05:1000:05:15
table. I personally prefer that she lifts up the leg that is closest to me I find
00:05:1500:05:19
that I get better leverage and I have better control that way. Once she's in
00:05:1900:05:23
this position it's a lot more comfortable for her to roll back too.
00:05:2300:05:27
I'm going to make sure that I have her just posteriorly tilted a little
00:05:2700:05:32
bit so that I don't get hurt anteriorly tilted and and give her any lumbar spine
00:05:3200:05:38
pain. Now just a practical aspect, books will tell you to thrust five or
00:05:3800:05:43
six times, let's start by getting to end range first asking our patient does that
00:05:4300:05:47
provoke any of your symptoms. We want to make sure we're safe. For all you
00:05:4700:05:51
know they have a hip pathology that they don't know about right, so are we safe.
00:05:5100:05:55
Add a little overpressure, are we still safe, how does that feel? Good now go
00:05:5500:06:02
ahead and do your five or six thrusts, how does that feel? That's pain and
00:06:0200:06:09
where is that pain, in your complaint area which was right over her her sacroiliac
00:06:0900:06:13
joint, right over her PSIS. Alright go ahead and stand up. So there you guys
00:06:1300:06:19
have it the Gaenslen's test. A little bit more sensitive than specific, we're
00:06:1900:06:24
going to use it inside of our testing clusters, but guys just in the back of
00:06:2400:06:28
your hand use your logic, use your reasoning, use your common sense. If
00:06:2800:06:34
somebody has a history of L2, L4, nerve root adhesion, and if somebody has an adductor
00:06:3400:06:41
strain, somebody has a labral tear in their hip, skip this one. Just just find a
00:06:4100:06:45
different test to use, even if you did the clusters without this test
00:06:4500:06:50
they still work out pretty well. If you have any other questions please leave