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