Is The Stork Test For The SIJ Useful Or Relevant?

stork testPlease note…in this article, I will give away yet another clinical “secret” that has contributed to my successful treatment of SIJ conditions…this post is mainly for therapists today but patients can get a lot out of it as well.

Ah, the stork test. It goes by a few names – the Gillet test and one leg standing test are some of them. This test has been used by therapists for many years and I have been personally using it for 15 years. in this blogpost, I will explain what the Stork test is, how I use it and still stay true to the intent of the original test and the interpretation from neuroscience.

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Back Injury – A Physio’s Experience

10519510_10152801588837889_6239433146789197033_nAs a Physio, I know what to do when I get an injury…theoretically… You see, we are taught how to listen and assess and work out what is wrong. We tell the patient what we have found, what we think is wrong and what needs to be done to make things better. We do our “manual magic”, we give appropriate advice and whatever things the patient needs to do at home.

What they don’t necessarily teach you is what it is like to be a patient. Even if I saw someone daily, it is still only 30-60mins in 24 hrs…I think too many physios and other health professionals need to think about that more.

I realised this quite a while ago when I had injuries. I have always been quite active so with that comes increased risk of injuries and I have had my fair share. What I want to write for you today is what happened when I strained my back quite badly and how I dealt with the issue. I will discuss what I was thinking and throw some commentary into why I chose what I did and how I made my decisions.

This is post is all about ME, NOT YOU. This is NOT what you should do. You should get assessed for any problems you have. This is about informing you what I was thinking and how I think as a patient and a physio.

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Are your pelvic floor exercises making you weaker?

Purpose – to challenge your thinking and beliefs…and those of your therapist!
Method – questions and answers, haven’t had a chance to look at the research
Summary – my beliefs were challenged…I hope yours are!

***i will add pictures and formatting to this post when I get home 🙂 ***

Do your kegals!
Switch on your core by using your pelvic floor!
Do more pelvic floor to increase your core stability!
A strong pelvic floor will help your back pain!

We have heard it all before…but do you (and your therapist) understand what the implications are?

These are my musings about the hysteria about pelvic floor exercises and how it affects your back pain and performance. I have not read about this mentioned anywhere in the past so if you find resources, please let me know. The closest I have found is Taryn Hallam from WHTA in Sydney…brilliant woman.

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SIJ Movement and Beliefs – Challenging your beliefs about “old theories”

OK, so most patients tell me that their SIJs are too loose, that their ligaments are overworked and lax and that their joint subluxes all the time.

As a clinician, I believe everything that my patients tell me is happening to them but I don’t always believe the beliefs about *why* it is happening to them. That is fair enough. I believe that they are going through their pain/dysfunction, I believe they are genuine about it (there is the occasional person that exaggerates things but they also ask questions like “so, will you have to tell the insurance company about that?”, “will this affect my payout?”, etc…), and I believe that they want to get better.

So, how do I (and any clinician worth their salt) determine what is actually going?

For statements about their ligaments and joint subluxations, you have to test them!

Now the beauty of seeing a patient in person is that I can tell how they got their beliefs, whether it was from Google or the clinician or if they are just using their own words to describe what they are feeling.

If you believe your joints are too loose, then test yourself lying flat on the floor…preferably concrete or tiles (you will see why in a minute).

1. Have someone test you. A therapist preferably
2. Have that someone put wedges or coins or small pieces of 3mm wood or whatever you want under your ASIS on the “anteriorly rotated side” until they believe you are “lined up straight”. Note the height off the floor that you “need” to make yourself “level”
3. If that amount is more than 8mm (and most people will need more than that), you either have an SIJ that moves outside a normal range of motion (possible) or there is another explanation for it (also possible). A recent review (2008 – full text article here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565072/) found 7 studies that looked at how much the SIJ moved and found the MOST amount of movement being 8mm.
4. OK, let’s assume a few things now…I DO NOT ADVOCATE THIS…this is just an interesting thought experiment…
a. assume that X-Rays are safe and don’t contain ionizing radiation
b. assume that your doctor will agree to this
c. assume you are happy to accept the results
5. The experiment would then be to take an X-Ray at a set distance with you on the bed lying prone. Have your “therapist” (whoever is with you) check that the results are the same as before. You would then take the X-Rays. Then, without moving (or as little as possible), add the amount needed under the ASIS and retake the X-Ray. (The reason why you had to test on the concrete floor is that the X-Ray beds I have seen are flat and hard – if there is a small cushion/mattress on it, have them take it off…if this were a proper experiment, ethical (it is unethical to XRay you like I am suggesting without the whole experiment undergoing ethical review etc)

If you have a hypermobile SIJ, you will see the changes on XRays…a movement of 8mm or more can be seen…but i bet in most people, not much changes at the joint level.

My thoughts have been changed over the years by thinking about such things and testing the clinically and trying to take the opposite position to where I stood in my beliefs. I have kept the beliefs that have withstood intellectual and scientific (research) challenge and I have changed the beliefs that have proven to be inaccurate (positional testing is the main one, the amount of SIJ motion available is the other).

Having said that, I believe that the SIJ moves and it moves in a small but significant amount. I test for it. However, I have found that other tests and research has led me to believe what i was seeing before as “positional faults” are more likely to be muscle activation patterns etc…

What do you think? Are you ready to challenge your beliefs?

Please remember that my beliefs have changed about the reasons *why* i feel what i feel. I still feel them, I just interpret them differently. I can still feel and see the old “positional faults” but if I can “fix” them without all the old techniques I used and without manipulation, then it has to beg the question “was it really stuck in the first place?”

All “systems” and “paradigms” we use in all areas of life are simply a means to describe what we see and feel and live with and experience. I refer back to science because it seeks to explain why we feel these things.

I hope you found this an interesting post…

How I work with pelvic floor physios

Thinking Girl

Who should I see about my problems?

FAQ: Who should you see if you have problems with your pelvic floor?

This is a great question. Ideally, you would see a physiotherapist who has had extensive Musculoskeletal (MSK) Physiotherapy training AND training in Women’s Health (WH) Physiotherapy. Unfortunately, there aren’t too many of these physios around. They are definitely out there but not all MSK physios know about the pelvic floor very well and not all WH Physios know about the rest of the MSK system.

Also, in my opinion, a thorough understanding of the thorax and pelvis is lacking among physiotherapists. I know for a fact that most Masters programs do not address these 2 areas very well. As an exercise (if you are a health professional), close your eyes and imagine the anatomy of the knee – most physios can picture this in good detail with bones, ligaments, cartilage and muscles all in the right place. Now do the same with the thorax…not so clear huh? Can you name all 13 joints that exist for the 4th Thoracic Ring (T3, T4, L+R 4th rib, Sternum)? I rest my case!

What I am good at…

I look at a person holistically – for a review of this, click here – and consider what regions are important to look at. For example, a patient might come in with difficulty controlling the bladder during exercise. Is it a joint, muscle, nerve, visceral or brain/beliefs problem? Is their pelvic floor strong enough? Does it relax enough? Is it on too long or too hard? Is it under pressure from other muscles or joints? Is the pelvic floor actually damaged?

All of these things are important to identify and investigate.

How I am Incomplete…

Now, the way that things work is this: If I want to be trained in Women’s Health, I have to do courses. However, whilst they would let me do the theory, it has been suggested to me that it would be highly unlikely that the other participants would allow me to do the internal examination practicals that I would need to do to learn. In theory, there are male obstetricians so male WH physios shouldn’t be a problem. In theory, it is sexist and discriminatory. In reality, I don’t mind. There are plenty of good female therapists around who I can refer to. I don’t need to be able to do internal examinations to be a good physio. I can live without the fear of being sued or charged with sexual assault!! There is enough work for everyone so let’s just share the love!!

Sharing the Love – I refer patients to good WH physios!

So, when there is a patient who looks like their primary problem is a damaged pelvic floor, I refer them to a WH physio I can trust. I will always check all the MSK systems to make sure that I have taken care of everything I need to make the WH physio’s job easier. I also write a letter explaining what I have found and what I think the potential problems may be and specific issues I would like an opinion on.

What I would like to see from WH physios…

Too often, patients get categorised into a WH physio problem or a MSK physio problem. This is an issue because it isn’t a holistic approach.

The type of WH patients I can help are those that don’t seem to be improving their bladder/bowel control, have an endurance problem, have pain…basically anyone who is not improving!

If you are a suffering from pelvic floor issues and your treatment doesn’t seem to be working, then ask your WH physio for a MSK physio referral. If you need help finding one, just ask me!

A holistic approach - is your therapist using it?

Conclusion:

Better understanding between MSK physios and WH physios needs to occur. Thankfully, the last 15 years has seen a great improvement in the communication between the 2 groups!

If you are a women’s health physio, I invite you to comment below and make sure you add your website or FB/Twitter page to your comments. That way, patients can locate you!

If you are a patient who has issues with your pelvic floor, please feel free to ask questions below about who you should see. Any good physio would be ok with you asking if a referral to a MSK or WH physio would be helpful 🙂

Remember, 1 in2 to 1 in 3 women will have pelvic floor issues in their lifetime. Let’s solve the problem, not just use panty liners!

SIJ Series – 2.What does the SIJ do?

The SIJ is a fantastic structure. It has a simple design for its simple job – to transfer load from the trunk to the legs and from the legs to the trunk.

 

It receives force from the femur via the hip joint into the innominate (a combination of the Ilium, Ischium and Pubis bones), transfers the load through the SIJ into the sacrum. From the sacrum, the load goes up through (in “normals”) the L5/S1 disc and then upwards through the vertebral bodies.

 

Here is the beauty of the design of the SIJ…the amount of load passing through the joint determines how much the joint “locks up”

You see, the SIJ moves a little (we will deal with this in a later post) – not very much but it moves enough to give you some twisting in the pelvis…but it also moves to help provide nutrition to the joint.

 

It might be easier to think about the SIJ as being able to “hold” on lightly or strongly depending on the situation.

In everyday life, you hold your knife lightly when spreading margarine but hold it quite firmly when cutting through a through a dense vegetable like a Swede…alternatively, you hold a newborn baby quite gently but if you were hanging off the edge of a cliff, how hard would you hold on?

How gentle would you be?

How hard would you hold on?

It all depends on the situation and the load.

 

In the same way, the SIJ “winds up” as little or as much as it needs to. This makes sense – you don’t want to be squeezing as hard as possible for every action. So when you lie down, the SIJ is pretty relaxed. When you hop or run, it winds up quite a bit because all your weight is on one leg and dropping from a height.

 

I love the SIJ – and the rest of the body – because of amazing facts like these…our bodies are so adaptable and the systems are so simple in design yet so complex that we can’t replicate it with the same size restraints.

 

If you are interested in learning more about the SIJ, please go to www.mypteducation.com and make contact with me about where you would like me to host a course for you.

SIJ Series – 1.What is the SIJ?

Hi – this is the first of a series of short blog posts to get you acquainted with your SIJs. Let me know what you think…

The pelvis is made up of 2 of these Innominates and a Sacrum that sits between them

Your Innominate

There are many Myths and legends about the SIJ. Some people believe that all problems come from the pelvis (which are the 2 SIJs, the pubic symphysis and the innominates (2x Ilium, Ischium and Pubis).

The Sacroiliac Joints (SIJ) are 2 of the most important joints in the body. They transfer the load from the lower limbs (your legs) to the spinal column. If they don’t do their job properly, you will start to load unevenly through your body.

 

Uneven loading in the body can lead to hip and knee joint arthritis, disc injuries in the back and pain from strained ligaments around the SIJ.

 

Research suggests that the SIJ is the *cause* of pain in 15-20% of low back cases…but just because the SIJ is sore doesn’t mean it is the main problem…

 

Do you have what might be SIJ pain? Why don’t you leave a comment and tell us about your story.

 

If you are a physiotherapist, why don’t you go to http://www.myPTeducation.com to find out where the next SIJ is being held – if you want us to come to your town/city to run one, just email Antony at antonylo@mypteducation.com or leave your comments below.

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