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