A Better Way To Assess The SI Joint
In this episode of the Unreal Results podcast, I dive deep into SI joint assessment. I talk about the gold standard of SI joint mobility tests, the March Test / Gillet's Test, and why the "limitations" around the test exist. I further talk about the intricate connection of the viscera and nervous system to the SI joint and why we as healthcare practitioners need to have a holistic approach when assessing the SI joint.
Resources Mentioned In This Episode:
Episode 6: The Mysterious, Misunderstood, and Mistreated SI Joint
Results Cheat Code- The Missing Link FREE mini-course
Sign Up For LTAP in Washington D.C. (June 15-16)
Sign Up For LTAP in San Diego (Nov 2-3)
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole-body approach to care, however, it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
, and welcome to another episode of the Unreal Results podcast. Uh, here we are again, another week, another pod. Um, I think I talked about it last week, but you know, the doors opened to the next two in person courses. Uh, there's one, uh, in person LTAP level one courses. There's one in, uh, Washington DC, June 15th and 16th.
It already has nine people enrolled. Um, usually my target is about 20 to 24. Um, sometimes I can go a little higher depending on the space. Um, I have to double check, uh, the space size though. So have the assumption that full is 20 people. And so almost 50 percent full already. So if you want If you want in, in the next in person course, I would enroll now, sooner than later.
Then the other one this year will be November 2nd and 3rd in San Diego. So, yeah, two more options to get in, in the in person course. With that said, the next online course is starting the end of April, which means that I'm opening the doors to the results cheat code. Um, this week and likely the day this podcast drops.
So make sure that you, uh, check that out in the show notes. So I know Joe will link that for me. Uh, both the, um, results cheat code course as well as the LTAP in Washington and the LTAP course in San Diego. So this, this year, The results cheat code. I'm changing it up just a little bit. So, um, with the change up, it's still going to be pretty much the results cheat code.
So don't worry if you've already taken the results cheat code or you bought the results cheat code online course version, still going to have the same information. It's going to be a little less though, because as I've found, um, less is more when it comes to teaching. And so, um, sometimes when I give less in a mini course like this, um, we can actually get more out of it.
And so, that's what we're going to be doing this, this round. It's going to be the results cheat code, the missing link. Um, so a little bit different. And, um, I wanted to talk about it today. So typically in, in, in the LTAP, we still will. The first test of the LTAP, the Locator Test Assessment Protocol, is an SI joint mobility Test and that's what the results sheet code is.
Um, it's all about that first test of the LTAP. It's like a taster to the LTAP level one course. Within that test, I usually look at multiple, well two, but you could do more. Um, SI joint mobility tests. Using a breath hold. Breath hold. to determine where the body is protecting. So I have a whole entire episode about the SI joint and sort of alluding to this relationship of why the SI joint is so important, right?
The core, one of the core beliefs of the LTAP, core belief of the results sheet code is that the SI joint moves. It needs to move for good movement patterns and function of the body, and that it is affected or influenced by everything in the body, the viscera, the central nervous system, the peripheral nervous system, and the musculoskeletal system, as well as it's in an area of the body that sort of creates or links our locomotion.
Like it's what makes us like really human, to be honest, is the SI joint. So, um. That episode is called, uh, the Mysterious Misunderstood something Si Joint. I don't know, Joe will link it in the show notes. Um, but um, I talk about these core beliefs and like share the anatomy and all the things. So I don't want this episode to necessarily be a repeat of that, though.
Of course it will be a little bit. But basically, and where, where this actually really shines actually, I think is. In the misunderstoodness of the joint, in the mysteriousness of the joint, is the fact that SI joint pain, or SI joint dysfunction, is so common on people, but yet the solutions aren't that clear.
And also the assessments aren't that clear. And this is probably the number one pushback from the evidence based practice trolls I get on the interwebs are on my content when I talk about this test, but one of the tests that I use and I teach within the LTAP, in the results cheat code, is the March test, also called Gillet's test, or Gillet's, depending on how you pronounce it, G I L L E T T.
Or maybe 1T, I don't know. I'm not, I'm not the greatest speller in the world. Anyways, um, I think if you're in the world of physical therapy or athletic training, um, you probably have heard people shit on this test because, um, once upon a time, I think even as far back in the 80s or 90s, I'm not sure, I'd have to double check the article, but, but there was an article that basically said, or showed, but, that this was not a reliable or valid test.
And, um, so a lot of times when I say that I use this as a test to sort of, I describe this test as a traffic cop, this test, as well as the other SI joint mobility test sort of is like directing us to like, is there a production pattern of the viscera or central nervous system, or is it perhaps in the peripheral nervous system or musculoskeletal system itself.
which may include the joint itself. I don't want to discount that sometimes the joint mobility of the SI joint is because of the SI joint, but that's very, very few times that is. So, um, so this test gets a bad rap because it, a couple articles saying that it was unreliable. And if you actually read the studies, um, if you read the studies, both that was presenting it, but then also prove that it was unreliable.
They don't actually use that many subjects, number one. And number two, they test them with a certain amount of time in between. So to me, this actually supports what I see clinically and how I use the test is that SI joint hypomobility. which is commonly referred to as SI joint dysfunction, is
not so black and white. It's not always a structural hypomobility, or just something that is joint related. SI joint hypomobility, 75 to 80 percent of the time, is actually a strategic hypomobility. What does strategic hypomobility mean? It means that the body, the brain, the nervous system, basically, is choosing to limit mobility around the joint for a reason.
So you can do movement or you can do manual therapy and the outcomes may be that it gets the SI joint to move and it may be that it doesn't. And so you This is why, inherently, I think the assessment is so not reliable. Well, one of the reasons why it's not reliable because we're looking at a joint that is heavily influenced by a lot of other factors.
Jean Pierre Barral from the Barral Institute. That's he, he, I didn't know this actually. So I've been learning from them for 12 years now, no, 11 years now. And, um, I didn't know until this past year I attended a class, Then they said it, uh, that Jean Pierre says 75 percent of the time, um, SI joint hypomobility or SI joint issues are visceral or central nervous system related.
And I was like, wow, that really matches up with what I see clinically. And I'd say of those 20 to 25 percent of the time when it's not, it's It's usually related to the joints of the lower extremity on the same side and more of a peripheral nervous system. reflective strategic hypomobility than the SI joint itself, I'd say of 100 percent of the time.
So 75 percent of it is as visceral and central nervous system protection pattern influenced, right? It's a witness to this. Um, I'd say 15 to 20 percent of the time it's then peripheral nervous system influenced or a witness to that same side, lower extremity. And 10%, 5 to 10 percent of
the time, it's the SI joint itself. So very little is it the SI joint itself. So, um, so it makes sense when you're doing a reliability study, especially when you're looking at the same joint in a, at a different time that you're going to get different results. Because let's say theoretically, let's say the person in that study They were tested in the morning and then they're supposed to come back four hours later to get tested again.
I think they did it Certain amount of hours later and then they did it days later. So either scenario hours later or days later We're, we might present to something completely different. I see this in my athletes all the time. And what happens is like, maybe they go to lunch and eat a food that their gut doesn't tolerate very well.
Then their gut goes into this protective pattern around the visceral organ and it changes the mobility. Right? That protective pattern is expressed in the SI joint. One of them or both of them. And so, literally four hours later, this person could have a different SI joint. mobility experience in their joints.
And, um, especially four days later, anything can happen, right? So, um, inherently joints like that, that are, there are very much correlated to being witnesses for the viscera and for the nervous system, it's hard to sort of nail down a true mobility test of their, of their structure. So.
This too, um, the other reason why it's not reliable, perhaps a reason why it's not reliable, the test was tested on like graduate level students, right? Graduate level practitioners, not seasoned practitioners. And I gotta say, after teaching for the majority of my career, All right. So I've been an athletic trainer now for 22 years and probably 18 of those years I've been teaching other professionals, physical therapists, athletic trainers, strength coaches, massage therapists, chiropractors, like all of the different professionals that touch people's bodies and the palpation skills, the level of good palpation, understanding The anatomical topography is subpar and that's probably being generous to be honest.
And um, so this test relies upon very good palpation skills and not only very good palpation skills in terms of knowing the anatomy, seeing it, feeling it, but then feeling movement and like understanding how touch is. We're asking a lot of very unseasoned professionals. And even, to be honest, seasoned professionals get this wrong on a regular basis.
So that's one thing, um, as well, is why it's like, I wouldn't doubt that it's not reliable in most, most clinicians, but this is why we have to do better. Period. I find that the March test is very helpful for me. And then this past year, like I said, um, I took a new class at the Barral Institute, um, was manual articular of the spine and pelvis.
And we went over the Gillet's test in a new way. And it was just even more highlighted on, wow, people don't palpating. So, um, and this, we break it down when I do in person courses. The in person LTAP is great for this. And the in person mastermind I do with my alumni is like so great because I can watch them palpate things and I can see what's happening.
So, you know, when it comes to the March test, traditionally the March test, like the most basic form of Gillet's test, one finger is on the PSIS and then one finger is on L4, L5 or S1. And you're assessing when the leg goes up into flexion. Does the innominate bone posteriorly rotate? And if that happens, what would you see between my fingers?
Is this finger would move down or away from this finger. That's a normal mobility test. Now, if it stays the same, that's hypomobile. If it sort of does something other, anything other than away or apart, that is a abnormal test or a indication of hypomobility. So how we do it in the results sheet code and the LTAP is we also test it with a breath hold.
Now with the breath hold, if you go from it doesn't move to all of a sudden it moves, that's indicative to a visceral and central nervous system influence strategically creating a hypomobility. When we do a little gentle breath hold, we're increasing the pressure enough within all the cavities of our viscera to improve the proprioception, proprioceptive information from them to our brain, to our insular cortex.
The brain has a better idea of what's going on in space and goes, Oh, okay. We don't need to. protect and lock down everything, we can grant that mobility back. And so that's when you see the mobility change. So if you do a breath hold and nothing changes, this means that something else is influencing this mobility likely down in the leg itself from, and then I talked about this in that original podcast about the SI joint from this reflexive.
connection of the peripheral nerves. So there are five peripheral nerves that innervate the SI joint. And so that is many different lines of communication from the rest of the leg can that can tell the SI joint to strategically that It needs to protect itself. That is not safe to move. So, and then, of course, if that's not the influence, then it's the joint itself.
And then that is actually when you learn about the rest of Gillet's test. Is not only do we assess these upper ligaments, right, the iliolumbar ligaments. The ligaments that go from the ilium to the lumbar spine, but now we assess the ligaments that go directly from the sacrum to the ilium and then the sacrum to the ischial spine and the sacral sacrum to the ischial tuberosity.
So we then can break down very specifically what line of ligaments. What, what specific ligament is not allowing the mobility of this joint to happen? And you would be surprised sometimes how like one little area of induration or like stiffness in the ligament can affect the entire mobility. And so that's why it's really good to get specific on which ligament, but We only need that specificity in that 10, 5 to 10 percent of the time when it's actually a truly a structural issue, you know, and what's likely we usually have a combination of a strategic and a structural.
hypomobility going on. Because over time, a strategic hypomobility can lead to that tissue induration, tissue, tissue stiffness from lack of movement through there. And then you get a structural hypomobility. So they can go together, but oftentimes you, uh, you alleviate a lot of the movement problems. You alleviate a lot of the pain when you can.
affect the strategic part first. And then, then once you affect all the strategic parts, then you can get very specific and precise to what ligament line it is in the actual SI joint ligaments itself that needs to be addressed from a manual therapy standpoint to get that joint moving fully. So, um, so This is, this is the, this is the thing.
So even though those articles came out years ago about how unreliable this test is, it is still the gold standard of being one of the main tests to look at SI joint mobility. It is still a test that is taught in most physical therapy and athletic training schools today. That doesn't mean anything too much because we know it takes like 20 years for information to sort of like get into practice, but also part of this, why it's still taught is because there hasn't been another test that has proved to be any better.
And this, again, is more evidence towards the fact that maybe it has nothing to do with the test, but the understanding of what actually influences the mobility of the SI joint. And this is where the results cheat code comes in, and this is why it's a missing link, because it is actually can be such a powerful thing for us to witness this influence of the viscera, this influence of the central nervous system, this influence of the peripheral nervous system at a joint, because it becomes a very objective thing to see this influence.
So, um, Yeah, I'm trying to think, like, is there anything else I wanted to share about that? Not really, other than, like, let's stop just, well, let's just, let's just stop being evidence based police. But then also, like, let's look at the evidence that you're using to police me, or police people, and actually, let's look at it thoughtfully, with intention, and understanding, always going back to the anatomy, and understanding, like, well, What, what are some possibilities of why this test wouldn't be reliable?
And in fact, even in the study, they talk about the level of skill of the people doing the study. It's also a very small study. Um, but I think we need to, you know, appreciate that when you can take a new lens of view like we do around here, looking at the body as a whole organism, not just the musculoskeletal system.
And we can consider the viscera when we consider the central nervous system when we consider this fundamental drive for survival and everything we do being related to safety in the nervous system and surviving, then you have to actually, then you actually have to be forced to look at joint mobility in a different way, then you could understand why something like this and a joint like this that tends to be a witness to those things, why it is inherently always going to be unreliable because it's always changing and fluctuating.
within one session of treatment, and you'll see this too. This is probably one of the coolest things of the LTAP, doing the LTAP, is you get to see just how fluid SI joint mobility really is, as you sort of peel back the layers of projection pattern. Hopefully that gives you some food for thought around this.
Um, I'll be obviously talking about it a lot more in this round of the results cheat code, the missing link. And, uh, remember that's a free mini course. So, um, I'd love for you to join if it doesn't work out for you, no big deal. It also, the results of the original results cheat code online course will, is always available for purchase on my website.
Um, and, uh, The in that course you get both SI joint mobility tests. So in this results sheet code the missing link We're just gonna dive into the March test and get really good with that You know and one of the simple things the one of the simple ways we can get really good at it is once we find Our landmarks and we've pushed really hard to find our landmarks to let up your let up on the pressure on your hands so you can feel the fine movements of the bones underneath your hands.
Part of the problem is when people palpate, they stay so much pressure that then they miss the subtle movements happening underneath their hands because all their brain can feel, all their proprioceptors in their thumbs can feel, is the pressure that they're creating. And so just getting really nuanced with that will be helpful to train our hands.
And once we can train our hands in, we'll also be able to train our eyes in that we can see this kind of movement even in virtual settings or without being hands on to, which is, you know, part of the reason I use the March test in this assessment is to make it accessible for non hands on practitioners.
So, Lots to dive into, um, hopefully it gives you some insight into this test is actually pretty darn good test. We just need to get better at doing it and dialing in our palpation skills, dialing in our anatomy skills. Dialing in our understanding of a truly whole organism lens of view and, uh, dialing in our touch skills.
So I hope you'll join me for that free mini course and, uh, if you haven't already listened to that first podcast, please do so. Have a great day. We'll see you next week.