Like many aspects of diagnostic testing and most in musculoskeletal physiotherapy very few tests are definitive taken in isolation and the current trend is to use clinical prediction rules which group a number of tests in order to confirm or refute positivity. This allows the examiner to conclude with greater confidence when a group of tests are positive even in the presence of some non-positive tests.

Assessment of sacroiliac dysfunction – Foundations.

1. Active straight leg raise test.

2. Pain provocation test.

3. Kinetic tests.

4. Positional assessment.

5. Leg-length tests.

6. Passive movement assessment.

In previous posts I have discussed the role of positional assessment and Leg length testing in relation to mechanical assessment of the pelvic girdle. Today we will focus our discussion on the kinetic tests as they have been formally described. Several renowned authors have written on this topic over the years the most notable being Philip Greenman (an osteopath), Diane Lee (Canadian physiotherapist), Richard DonTingy (US physiotherapist) and Howard Turner (Australian Physiotherapist)  referred to above who has been conducting courses in the British Isles and internationally for the last 15 years on this topic.

Kinetic Tests

Forward Flexion in standing / sitting.

Hip Extension in standing.

Hip Flexion in standing (Stork / Fowler / Guillet Test).

Lateral Flexion in standin.

Rotation in standing / sitting.

When interpreting Kinetic tests it is important to recognize that the evidence of dysfunction does not infer a mechanism of pathology.

The pathology may lie in the articular system, the myofascial system.

The pathology may be local to the pelvic girdle and sacroiliac joint.

The pathology may be secondary to lumbar spine or general postural alignment characteristics

The interpretation of “positivity” is based on the extent of variance from expected norms and the number of positive tests.

The selection of legitimate targets for intervention is based on the degree of deviation on the kinetic tests rather than the side of dominant pain.

Those of you who treat the sacroiliac joint dysfunction frequently are well aware of the propensity of this joint to demonstrate alternating sides of symptoms which can sometimes leave a therapist “chasing pain” rather than identifying primary underlying mechanisms.

1. Forward Flexion in standing

Therapist : palpates inferior aspect of PSIS inferiorly

Patient : flexes forward to end of range.

Normal : PS IS move symmetrically bilaterally

Dysfunction: asymmetrical movement of PS I S. which may be early or late in the movement pattern or the PS I S. moves more Cephalad on flexion

2. Hip extension in standing

Therapist: palpates the idiom and sacrum on one sacroiliac joint.

Patient : extends the hip.

Normal: the PS I S raises cephalad relative to the sacrum

Dysfunction: PS I S. and sacrum move together

3. Hip Flexion in standing (Stork / Gillet / Fowler tests)

Therapist: palpates Ilium and sacrum of one SI joint

Patient: flexes they hit to 90° flexion.

Normal: PS I S. drops caudad relative to sacrum

Dysfunction: increased or decreased movement of Ilium relative to sacrum

4. Rotation in standing

Therapist: palpates Ilium and adjacent sacral segment.

Patient: rotates their torso.

Normal: sacrum lifts relative to PS I S.

Dysfunction: increased or decreased movement of sacrum relative to ilium

PS : the trunk  should rotate to the side of the tested S.i. joint.

5. Lateral flexion in standing

Therapist: palpates Ilium and sacrum of one SI joint.

Patient: performs lateral flexion.

Normal: PSIS drops and sacrum lifts on the side to which lateral flexion occurs

Dysfunction: increased or decreased movement of Ilium relative to sacrum

Clinical Thoughts?

1. Why does the Ilium move cephalad in standing flexion?
2. Why does the ilium move inferiorly relative to the sacrum in Gillet test?
3. How does the coupling of motion occur between Lumbar spine, Sacrum and Ilium in trunk rotation?
4. How do the pelvic biomechanics in lateral flexion occur ie how is the coupled motion achieved?

Enjoy the clinical challenge.

David

© David for PhysioDigest - an educational resource for the musculoskeletal rehabilitation community, 2010. | Permalink | One comment | Add to del.icio.us
Post tags: Anatomical terms of location, Conditions and Diseases, Diane Lee, Health, Howard Turner, Kinetic tests, Lumbar vertebrae, pelvic girdle dysfunction, pelvis, Philip Greenman, Physical therapy, Richard DonTingy, sacroiliac, Sacroiliac joint, Sacrum, SI Dysfunction

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