Sacroiliac Joint Special Test: Stork (Gillet) Test

The Stork (Gillet) Test is a special test used to assess for sacroiliac joint (SIJ) dysfunction. This test requires the patient to stand on one leg with their opposite heel on the same side hips. The patient is then asked to flex the hip, bringing the knee up as close as possible to their chest and then holding the position for up to 20 seconds. During this test, the clinician will observe for any uneven shifting of the weighted leg, which

Transcript

00:00:0400:00:07
This is Brent of the Brookbush Institute
00:00:0400:00:07
and in this video we're doing the
00:00:0700:00:12
Gillet or Stork test. Now this is a sacroiliac joint dysfunction test and it
00:00:1200:00:18
is a palpatory test, which we know means reliability could be questionable. But of all
00:00:1800:00:22
the of the sacroiliac joint tests this one is definitely one of the better ones,
00:00:2200:00:26
that I'm going to show you a couple tips that will hopefully increase your
00:00:2600:00:29
reliability. I'm going to have my friend Melissa come out she's going to help me
00:00:2900:00:34
demonstrate. Now what we're going to do in this test is try to determine whether
00:00:3400:00:39
her sacroiliac joint is moving, and if you just think about it that way all
00:00:3900:00:44
we're doing is testing to make sure that both sacroiliac joints are moving and
00:00:4400:00:50
moving equally. I think we could get reliability up a little higher than what
00:00:5000:00:54
the research has said. So how we're going to do that is I'm going to have Melissa face
00:00:5400:00:59
away from me, take a step back for me would you. Now you do have
00:00:5900:01:02
to be a little careful with the clothing situation here, obviously if somebody's
00:01:0200:01:07
in jeans your palpation is going to be far less accurate than if somebody is in
00:01:0700:01:12
gym clothes. As much as I possibly can I try to get my patients and clients to be
00:01:1200:01:17
wearing you know tank tops and yoga pants, and like gym shorts or basketball
00:01:1700:01:21
shorts so that I'm not trying to palpate through anything really dense or thick,
00:01:2100:01:27
So what I'm going to find here is I'm going to find her PSIS. If you
00:01:2700:01:30
don't have a lot of practice finding somebody's PSIS you can start by
00:01:3000:01:37
finding the top of their iliac crest, and just reaching around until you find the
00:01:3700:01:44
little notches and realize her posterior superior iliac spine are much closer
00:01:4400:01:49
together than her ASIS are, your ASIS or like this, your PSIS are much closer to
00:01:4900:01:54
your lumbar spine. Usually your PSIS are also just superior and lateral to those
00:01:5400:01:58
two little dimples you'll see back here when somebody like bends over and their
00:01:5800:02:01
pants creep down a little bit, you know where those dimples are if
00:02:0100:02:05
you go just kind of in that area just superior and lateral usually the PSIS
00:02:0500:02:10
are in there. Once I find her PSIS and I'm really sure about it I'm then going to
00:02:1000:02:17
take one finger and put it there, and the other finger I'm either going to find S2 so
00:02:1700:02:21
the spine of the sacrum, or I could find the sacral base and then
00:02:2100:02:26
on the side I'm palpating I'm going to have Melissa just go ahead and
00:02:2600:02:30
lift that leg up to like 90 degrees of hip flexion. So I'm going to have
00:02:3000:02:34
her do that for me a few times, can you do that like you know a few times. Nice
00:02:3400:02:39
and slow and one of a couple of things will happen, either I'll feel no motion,
00:02:3900:02:48
I'll feel like her sacrum moves superior rather than inferior, so if she's lifting
00:02:4800:02:51
this leg you guys can think about your biomechanics a little bit here, her
00:02:5100:02:58
pelvis should kind of come down this way. If instead I feel like she tilts up this
00:02:5800:03:04
way and I don't feel a lot of motion between the PSIS and the sacral base or
00:03:0400:03:10
sacral spine, then I know that that sides not moving particularly well. I'm then
00:03:1000:03:16
going to test that against other side, so I'm going to go ahead and find PSIS, find
00:03:1600:03:20
sacral base, we'll find S2, whatever I'm comfortable with and then I'm going to go
00:03:2000:03:25
ahead and have her March on that side, and I feel a little bit of motion. I can
00:03:2500:03:31
feel her PSIS dropping down into my thumb on this side. All right
00:03:3100:03:39
and since my client has no idea what I'm doing, if I'm not sure I'm going to go back
00:03:3900:03:43
to the other side. Let me try that again, go ahead and do that again.
00:03:4300:03:48
Good left leg yeah and I feel like I'm this side, I don't feel any
00:03:4800:03:52
motion in her sacral base and I feel like her whole pelvis when she lifts up
00:03:5200:03:58
this leg like tilts this way, alright so they don't feel equal. I do this side so
00:03:5800:04:03
this side no motion, this side tilts up, this side I'm going to do it again, this side
00:04:0300:04:08
PSIS definitely drops down and I can feel like motion between PSIS and
00:04:0800:04:12
sacrum. I feel like my fingers are doing this a little bit, like this thumbs
00:04:1200:04:21
moving forward. One more time, one more time good. So as you keep doing this
00:04:2100:04:26
and you start to get a little bit of a internal frame of reference with all of
00:04:2600:04:29
the patients that you've seen of what this test is supposed to feel like, I
00:04:2900:04:33
think you'll notice that when I said I felt motion on this side
00:04:3300:04:38
but this side tended to be a little stiffer and her pelvis tended to hike up
00:04:3800:04:42
as she went into hip flexion, you would agree with me that this side
00:04:4200:04:48
sounds stiffer and this side sounds like it's moving better. That's all I'm going to
00:04:4800:04:53
pull from this exam actually. So I would go ahead and mark down that she
00:04:5300:04:58
has a positive Gillet test or a positive Stork test on her left side on
00:04:5800:05:03
her stiff side, which from a clinical decision-making perspective what
00:05:0300:05:08
intervention would I do? Maybe I think she's going to use some sacroiliac joint
00:05:0800:05:13
mobilizations on her left side. Or if I think she's really hypermobile on her
00:05:1300:05:16
right side maybe I'm thinking oh man I need to give her some some glute
00:05:1600:05:19
activation because I know my glute max is one of my primary stabilizers of the
00:05:1900:05:27
SI joint. So let me go ahead and have you turn back this way. So
00:05:2700:05:30
just to give you an idea I'm going to step around front, just to give you guys an
00:05:3000:05:36
idea of where my thumbs were. So I had fingers here at PSIS and one
00:05:3600:05:41
here like at her sacral base, or you could even go on spine of the scapula. As
00:05:4100:05:48
she lifts this leg what I'm looking for is does this move down this way, and am I
00:05:4800:05:54
feeling some motion between my two fingers this way. The common signs that
00:05:5400:05:59
you'll feel with stiffness is you won't feel as much motion between your fingers,
00:05:5900:06:02
you'll feel like they move together and this hip as she goes into hip flexion
00:06:0200:06:09
will go up, maybe just a little bit. So that's that doesn't feel
00:06:0900:06:12
like a lot of motion and I feel like she's going up all right; and then I
00:06:1200:06:16
would go to the other side and as soon as she went into hip flexion,
00:06:1600:06:22
I would go oh oh yeah yeah I feel some some play back and forth between my
00:06:2200:06:27
fingers. I don't feel like they're necessarily moving together and usually
00:06:2700:06:32
if she has good motor control on this side and good mobility you won't
00:06:3200:06:36
feel the the pelvis hiked up, in fact the PSIS on this side because she's going
00:06:3600:06:42
into a posterior pelvic tilt will actually drop down. So that's it,
00:06:4200:06:45
that is the Gillet test that is the Stork test. I think a lot of people try to get
00:06:4500:06:50
way too complicated with this test and be like well I felt the sacrum, go anterior and I
00:06:5000:06:55
felt the sacrum rotate this way. Leave all that alone, the more
00:06:5500:07:00
complicated the test gets the more reliability starts dropping; and I
00:07:0000:07:03
know there's some expert palpators out there and I know there's people
00:07:0300:07:08
out there with better patient skills than me, but we still have to think how
00:07:0800:07:13
can we make this as reliable as possible. I think if you just compare signs,
00:07:1300:07:19
you look for which side is stiffer that's your positive side, and for the
00:07:1900:07:25
record guys sacroiliac joint dysfunction is almost always asymmetrical. Another
00:07:2500:07:28
sign that you might think in the back of your head that's a little weird is if
00:07:2800:07:31
you feel like both sides are stiff, something is probably wrong and you
00:07:3100:07:37
should probably retest that. But if you just look for the stiffer side and then
00:07:3700:07:44
if we add another layer on top of that, usually the stiffer side is one with no
00:07:4400:07:49
motion between your two points that your palpating, your fingers move together and
00:07:4900:07:55
that side tends to hike up. The side with more motion you get more play between
00:07:5500:08:00
your two fingers they don't tend to move together, and your PSIs moves down.
00:08:0000:08:04
So this would be the mobile side the side that goes up and your fingers move
00:08:0400:08:08
together, that would be the positive side. Again I wouldn't go any further than
00:08:0800:08:11
that, the only reason I'm going to use the stork test is to try to figure out
00:08:1100:08:16
which side do I need to mobilize and which side do I need to stabilize. Thank