0:04 This is Brent of the Brookbush Institute and in this video we're doing the 0:07 Gillet or Stork test. Now this is a sacroiliac joint dysfunction test and it 0:12 is a palpatory test, which we know means reliability could be questionable. But of all 0:18 the of the sacroiliac joint tests this one is definitely one of the better ones, 0:22 that I'm going to show you a couple tips that will hopefully increase your 0:26 reliability. I'm going to have my friend Melissa come out she's going to help me 0:29 demonstrate. Now what we're going to do in this test is try to determine whether 0:34 her sacroiliac joint is moving, and if you just think about it that way all 0:39 we're doing is testing to make sure that both sacroiliac joints are moving and 0:44 moving equally. I think we could get reliability up a little higher than what 0:50 the research has said. So how we're going to do that is I'm going to have Melissa face 0:54 away from me, take a step back for me would you. Now you do have 0:59 to be a little careful with the clothing situation here, obviously if somebody's 1:02 in jeans your palpation is going to be far less accurate than if somebody is in 1:07 gym clothes. As much as I possibly can I try to get my patients and clients to be 1:12 wearing you know tank tops and yoga pants, and like gym shorts or basketball 1:17 shorts so that I'm not trying to palpate through anything really dense or thick, 1:21 So what I'm going to find here is I'm going to find her PSIS. If you 1:27 don't have a lot of practice finding somebody's PSIS you can start by 1:30 finding the top of their iliac crest, and just reaching around until you find the 1:37 little notches and realize her posterior superior iliac spine are much closer 1:44 together than her ASIS are, your ASIS or like this, your PSIS are much closer to 1:49 your lumbar spine. Usually your PSIS are also just superior and lateral to those 1:54 two little dimples you'll see back here when somebody like bends over and their 1:58 pants creep down a little bit, you know where those dimples are if 2:01 you go just kind of in that area just superior and lateral usually the PSIS 2:05 are in there. Once I find her PSIS and I'm really sure about it I'm then going to 2:10 take one finger and put it there, and the other finger I'm either going to find S2 so 2:17 the spine of the sacrum, or I could find the sacral base and then 2:21 on the side I'm palpating I'm going to have Melissa just go ahead and 2:26 lift that leg up to like 90 degrees of hip flexion. So I'm going to have 2:30 her do that for me a few times, can you do that like you know a few times. Nice 2:34 and slow and one of a couple of things will happen, either I'll feel no motion, 2:39 I'll feel like her sacrum moves superior rather than inferior, so if she's lifting 2:48 this leg you guys can think about your biomechanics a little bit here, her 2:51 pelvis should kind of come down this way. If instead I feel like she tilts up this 2:58 way and I don't feel a lot of motion between the PSIS and the sacral base or 3:04 sacral spine, then I know that that sides not moving particularly well. I'm then 3:10 going to test that against other side, so I'm going to go ahead and find PSIS, find 3:16 sacral base, we'll find S2, whatever I'm comfortable with and then I'm going to go 3:20 ahead and have her March on that side, and I feel a little bit of motion. I can 3:25 feel her PSIS dropping down into my thumb on this side. All right 3:31 and since my client has no idea what I'm doing, if I'm not sure I'm going to go back 3:39 to the other side. Let me try that again, go ahead and do that again. 3:43 Good left leg yeah and I feel like I'm this side, I don't feel any 3:48 motion in her sacral base and I feel like her whole pelvis when she lifts up 3:52 this leg like tilts this way, alright so they don't feel equal. I do this side so 3:58 this side no motion, this side tilts up, this side I'm going to do it again, this side 4:03 PSIS definitely drops down and I can feel like motion between PSIS and 4:08 sacrum. I feel like my fingers are doing this a little bit, like this thumbs 4:12 moving forward. One more time, one more time good. So as you keep doing this 4:21 and you start to get a little bit of a internal frame of reference with all of 4:26 the patients that you've seen of what this test is supposed to feel like, I 4:29 think you'll notice that when I said I felt motion on this side 4:33 but this side tended to be a little stiffer and her pelvis tended to hike up 4:38 as she went into hip flexion, you would agree with me that this side 4:42 sounds stiffer and this side sounds like it's moving better. That's all I'm going to 4:48 pull from this exam actually. So I would go ahead and mark down that she 4:53 has a positive Gillet test or a positive Stork test on her left side on 4:58 her stiff side, which from a clinical decision-making perspective what 5:03 intervention would I do? Maybe I think she's going to use some sacroiliac joint 5:08 mobilizations on her left side. Or if I think she's really hypermobile on her 5:13 right side maybe I'm thinking oh man I need to give her some some glute 5:16 activation because I know my glute max is one of my primary stabilizers of the 5:19 SI joint. So let me go ahead and have you turn back this way. So 5:27 just to give you an idea I'm going to step around front, just to give you guys an 5:30 idea of where my thumbs were. So I had fingers here at PSIS and one 5:36 here like at her sacral base, or you could even go on spine of the scapula. As 5:41 she lifts this leg what I'm looking for is does this move down this way, and am I 5:48 feeling some motion between my two fingers this way. The common signs that 5:54 you'll feel with stiffness is you won't feel as much motion between your fingers, 5:59 you'll feel like they move together and this hip as she goes into hip flexion 6:02 will go up, maybe just a little bit. So that's that doesn't feel 6:09 like a lot of motion and I feel like she's going up all right; and then I 6:12 would go to the other side and as soon as she went into hip flexion, 6:16 I would go oh oh yeah yeah I feel some some play back and forth between my 6:22 fingers. I don't feel like they're necessarily moving together and usually 6:27 if she has good motor control on this side and good mobility you won't 6:32 feel the the pelvis hiked up, in fact the PSIS on this side because she's going 6:36 into a posterior pelvic tilt will actually drop down. So that's it, 6:42 that is the Gillet test that is the Stork test. I think a lot of people try to get 6:45 way too complicated with this test and be like well I felt the sacrum, go anterior and I 6:50 felt the sacrum rotate this way. Leave all that alone, the more 6:55 complicated the test gets the more reliability starts dropping; and I 7:00 know there's some expert palpators out there and I know there's people 7:03 out there with better patient skills than me, but we still have to think how 7:08 can we make this as reliable as possible. I think if you just compare signs, 7:13 you look for which side is stiffer that's your positive side, and for the 7:19 record guys sacroiliac joint dysfunction is almost always asymmetrical. Another 7:25 sign that you might think in the back of your head that's a little weird is if 7:28 you feel like both sides are stiff, something is probably wrong and you 7:31 should probably retest that. But if you just look for the stiffer side and then 7:37 if we add another layer on top of that, usually the stiffer side is one with no 7:44 motion between your two points that your palpating, your fingers move together and 7:49 that side tends to hike up. The side with more motion you get more play between 7:55 your two fingers they don't tend to move together, and your PSIs moves down. 8:00 So this would be the mobile side the side that goes up and your fingers move 8:04 together, that would be the positive side. Again I wouldn't go any further than 8:08 that, the only reason I'm going to use the stork test is to try to figure out 8:11 which side do I need to mobilize and which side do I need to stabilize. Thank 8:16 you Melissa. I hope you guys enjoyed this test.
