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