The Controversy Of The Gillet SI Joint Test
This week on the Unreal Results podcast, I talk about one of my favorite topics - the Gillet SI joint test. Gillet’s test or sometimes known as the March test or Stork test, is typically known for having poor reliability based on previous research. If you’ve been following along for some time, you probably know that said research likes to get thrown around by the EBP police when I make posts on social media. But the often overlooked part of these research studies is that they have lots of flaws and limitations. Make sure you tune into this episode as I break down why the studies on the Gillet test aren’t the best and why I think the SI joint is innately difficult to assess with only one test.
Resources Mentioned In This Episode
Episode 6: The Mysterious, Misunderstood, and Mistreated SI Joint
Episode 10: EBP Police
Episode 54: A Better Way To Assess The SI Joint
Get on the Online LTAP™ Level 1 Waitlist HERE
Research Studies Mentioned
- Intertester Reliability for Selected Clinical Tests of the Sacroiliac Joint
- Inter- and Intra-Examiner Reliability of Palpation for Sacroiliac Joint Dysfunction
- Inter-Examiner and Intra-Examiner Agreement for Assessing Sacroiliac Anatomical Landmarks Using Palpation and Observation: Pilot Study
- Inter-Examiner and Intra-Examiner Reliability of the Standing Flexion Test
- Reliability of Motion Palpation Procedures to Detect Sacroiliac Joint Fixations
- Intraexaminer and Interexaminer Reliability of the Gillet Test
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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.
Hello, hello, welcome back to an Where are we? Sheesh! Uh, welcome back to another episode of the Unreal Results podcast. Where are we? I'm home in San Diego this weekend. It was, uh, Labor Day weekend. I was celebrating my niece's 14th birthday. Can't believe she's 14. Uh, for those of you following along and you're like, Wait, I thought her niece was four.
Yes, I have a 14 year old niece and a 4 year old niece. They are sisters. Um, they are 10 years apart. You can take that as whatever you want to know, but yes, my sister's kids are very spaced out. I have another niece, technically, um, my brother in law's daughter from his first marriage. She's in her mid twenties.
So they are all 10 years apart. I've got to hang out with actually all three of them this weekend or this last five days, um, which was great. Uh, the 14 year old, she's a freshman in high school this year. It's just like a whole vibe, right? Um, I will say that the thing she had going on in middle school, whatever that was, it seems to be getting better already with just within a week of high school.
So I'm happy about that. Um, we went to Six Flags on Sunday, um, which when I was a kid, that was called Marine World Africa USA in Vallejo, California. Uh, it was fun. It was, I drove. seven 14 year olds and chaperoned seven 14 year olds. Uh, it was really fun. Um, I was happy that Sophie, my niece, still wanted to sit by me on rides, um, which made me, my heart really happy.
Uh, she seemed to have a great time. All the kids seemed to have a great time. And honestly, there wasn't really a ton of drama, which I was like, whoo, anticipating that there could have been, so. Super stoked about that. But with that said, yeah, I am a little tired from the walking. It wasn't quite like a day at Disneyland walking, but it was still like 12, 000 steps.
Um, and I don't think it's as much even the steps cause you know, there are days I go on a walk and I walk 12, 000 steps, but it was just the amount of hours on my feet. Uh, so. Yeah, I was tired. Came home yesterday and uh, was gonna record the podcast but I was just like too tired and so I rested instead. I finished my book I was reading which um, I read All the Light We Cannot See by Anthony Doerr.
It was so good. It was funny though because the first 300 pages I was like, I don't know why everybody thinks this is the greatest book ever because it hasn't been and it was like good enough to keep me engaged because usually I will put a book down if I don't love it, especially that far into it. But it was engaging enough to keep me there, just not like, make me like want to like not to put it down.
And then at page 300, it got so good. And then yeah, the last like 220 pages, I could barely put it down. 100 percent one of my, I would say it's probably my top 10 favorite books to be honest, which is funny that it took that kind of turn. Um,
I mean some of you might've seen there's a Netflix like mini series or TV or movie or something like on it too. And, um, so it's about World War II and specifically like the use of radio in, um, that era. And so there's, there's a little sciencey aspect to it, which I love. Um, and he had a quote towards the end of the book that I was like, Oh my gosh, this is what I keep telling people.
And, um, He says it so much more poetically, like, leave it to a Pulitzer Prize winning author, right? So that book did win the Pulitzer Prize. I think it came out in 19 er, 18 uh, 2017. But anyways, uh, he wrote, We all come into existence as a single cell, smaller than a speck of dust. Much smaller. Divide.
Multiply. Add. And subtract. Matter changes hands. Atoms flow in and out. Molecules pivot. Proteins stitch together. Mitochondria send out their oxidative dictates. We begin as a microscopic electrical swarm. The lungs. The brain. The heart. Forty weeks later, six trillion cells get crushed in the vice of our mother's birth canal and we howl.
Then the world starts in on us. I mean, did that give you chills? Like, I'm like, that is Wow. This book, actually, and I think it was the connection to some of the sciencey stuff in it, uh, reminded me of one of my other all time favorite books, The Signature of All Things by Elizabeth Gilbert, and I think, too, just the writing style was, like, so poetic.
Like, I just really loved it. Like, there is such a difference between writing, and then telling a story, and then like, painting a picture, and making you feel like you're there, like, jeez, I am like, constantly in awe of really anybody creative, because like, you know, like, people who create videos and movies and stuff, like, they have that same way to like, evoke feeling, and evoke like, just this like, profound feeling, and I'm just like, wow, amazed.
But anyways, you guys. This is not turning into a book podcast. Uh, it's just, it's on my mind and that quote was great. And actually there was more sciencey quotes that I'll be sharing. Um, Maybe not on the podcast, but definitely on Instagram from that book because like I said, I was good but today's podcast is inspired by what's coming up on the calendar and that is um, the Next cohort of the online l tap level one course.
It's going to be I think october 7th is the date it starts So i'll be opening up the doors to the public a couple like A, a week or two before that. And, um, actually the day this pod podcast drops, it will be opened to the people on the wait list. So if you're not on the wait list, it's still, you can still join it, I believe.
Um, I'll make sure Joe links it in the show notes so my loyal followers can still have access to the wait list sale because the wait list presale is the biggest discount I offer. And, um, you save up to 400 on the whole bundle. And also you have first priority to the 2025 in person courses. So dates and locations will be announced to the waitlist only.
Today for the next four days and then it'll be a secret for a few more weeks And then i'll let the world know once it's open to the public. So make sure you're on the wait list and um I would love to see you there so with that said every time I do an online cohort of the LTAP I offer a like free week long experience In a mini online course that sort of starts to teach you this new lens of view and teaches you the first test of the LTAP level one, or sorry, of the LTAP.
So the first test of the LTAP is a SI joint mobility test. And you might, if you've been listening to the podcast for a while, you might've heard, and I did a whole episode on the SI joint. It's actually the most downloaded episode. I think it's over like a thousand downloads, which for me is a lot. The whole podcast itself, you know, I don't know, this episode is like 70 something, you know, the whole podcast itself, I've had 30, 000 downloads.
So like over a thousand have been just this one podcast about the SI joint. It's like called the mysterious misunderstood SI joint. And, um,
So the reason why I'm recording another podcast on it is, well, one of the reasons is like, once is never, you can never hear this enough to really understand, because like that podcast said, like, It is a very misunderstood joint. It's a misunderstood joint assessment. And, therefore, a lot of people are like, Why are you using it?
And part of the reason why it's misunderstood, and part of the reason why I feel like I need to, like, champion the use of it is because, um, a lot of people, and read by people, I mean, clinicians, clinicians, Who sometimes see what I am teaching on Instagram, which is like first of all like Instagram you're trying to teach something in You know between 30 and 90 seconds and then people some people come at you and are like this This is not correct.
And I'm like, no shit. Can you teach this in 90 seconds? So right now, since I'm ramping up to that free course to try to get people exposed to the LTAP and potentially interested in joining the LTAP level one course, I have some of my old posts on ads, on ads to specifically physical therapists and athletic trainers.
Now, first of all, I know that what I teach, Though technically is for everyone, like all clinicians, it is also not for everyone. I 100 fully, 100 percent fully understand that the world of which we are clinicians in has a certain model certain way of practicing that when you're taught it in school or in some con ed courses, you think it is 100 percent fact.
And you also might be very held on to the fact that you are an expert in the body. You are an expert in exercise. You are an expert in human movement. And so, I know when I come at you with a new model, a model that sort of inherently tells you that the model you are previously or currently using may have some holes in it, may have some things wrong about it.
When your ego is attached to that, it feels uncomfortable. It makes you feel some sort of way. And then your instant response is to go on the defense and be like, you don't know what you're talking about. And specifically for the SI joint mobility tests, people who are like, I'm smarter than you are like instantly, Anna, why are you using that assessment test?
It has been shown to be not reliable, both intra rater and intra rater, intra and inter rater reliability has been shown to be unreliable. So why are you even using that as an assessment test? And as I often tell people when I'm teaching this in the courses, like, yes, I know I actually don't live under a rock.
I'm very intelligent. I also went to school. I also can reread research and do, even though I'm like shit on all the evidence based medicine trolls, like I actually do read research. I actually am interested in research. In fact, I go to like, I go to the research Congress every three years. And it is an actual, like, scientific research conference.
Like it's a conference where like all they're doing is presenting their research, which for those of you who've gone to like a physical therapy conference or a, you know, the NATA annual symposium, like that's like the free comm, right, the free communications when students get stand up there and like, here's my study that I did to get my degree.
Here's the methods and here's the statistical analysis. And this is what the results say. And this is what I recommend. That's the boring part of those symposiums. Like, I'm just telling you, like, I, I enjoy that. And I think there's value in it. And I want to continue to champion people who do research because it helps to.
Like it's part of the scientific process and so it's not like I don't know that the gold standard SI joint mobility test, which is the Gillet's test or the March test or also called the Stork test. It's not like I don't know that research papers have shown it to be unreliable. However, when you look at it in a, this new model.
of understanding how the body works. Not as just a body as in the orthopedic musculoskeletal system, but the body as an entire organism. It makes sense, and actually you would expect these research papers to show that it's unreliable. And this also means that just because it's unreliable from an inter rater and intra rater reliability test doesn't mean it's not giving us reliable and valuable information for our patient's body.
So let's, let's do this episode, right? I, like, I don't want to teach the whole, like, The whole course, right? That's like, if you're interested in how I teach this and, and like the nuances of it and like to learn it differently and use it in your practice, like come to the free course. The doors open next week and I'll be shouting it from the rooftops on all my socials, on my email list, on the podcast.
So, you know, next week the link will be available. Formally it was called the results cheat code. I think I'm changing the name this year. Last round I called it results cheat code the missing link. I think it will probably be just the missing link this time, but I'm not a hundred percent sure, but no, it's my free course coming up.
Join that and we can go in deep, right? We'll have two 90 minute calls that I can talk about it. Plus like all the access to me that week. You want to pick my brain. So today's episode, I just want to talk about the one, two, three, four, the four journal articles that showed that the Gillet's test was not reliable.
I want to talk about those, those articles and those articles. Yeah. Those research articles. I want to discuss them a little bit because even without, so even now let's step back into the old, Well, I call it the old model, but the current model that the physical therapy and athletic training world operates on is biomechanical orthopedic model of seeing whole body movement Pain injury, etc.
When we're operating under that current model and we're looking at these research articles There is also some significant red flags When you really understand how to read the research, actually, you don't even have to really understand to read the research. You just have to read it with some, a common sense brain, but you read these articles and you're like, they're not actually very strong.
They're not strong. Um, what's the word I'm looking for? They're not strong research projects. I don't even know. I don't know. My brain is not working, but so let's talk about them. So there's four studies. The most recent, I believe. I, I am sure somebody will tell me I'm wrong. I think, well, there was one in 2020, but when you actually look at that one, 'cause the title talks about the reliability, but when you look at the title of that article from 2020, it's actually looking at the reliability of diagnosing a painful SI joint.
So using these tests to diano, diagnose a painful SI joint, and that's not what we're talking about. We're talking about diagnosing or assessing, finding out if a joint is hypomobile, is it, if it's. if it's not moving or not. So the most recent study to look at just true mobility of the SI joint, so the ability for the ilium to move on the sacrum or vice versa the sacrum to move on the ilium for movement to occur between the sacrum and the ilium or between L4, L5 and the ilium between L4, L5 and the sacrum, right?
Like that, that is the true SI joint. Um, It was in 1999. In 1999, they decided to do another test because they recognized that the three tests before that, the three research articles before it, the three, um, things that everybody relied upon of interpreting the validity and the reliability of this test. I shouldn't say validity because that's not what we're arguing about.
That's a whole nother can of worms. So the reliability of the test was, um, that's why they did it, right? They were like, you know, those old articles, those old research things, like they have some flaws to them. And so we're going to do a new one and we want to like do it right or do it better. And so the old tests or the old articles I'll share was from the earliest one being from 1985.
then the next one in 1987, and then the next one in 1989. So we're going to talk about all of them. The last, the first one and the last article were both published in the same journal, which is the Journal of Manipulative and Physiological Therapeutics. Now, first of all, and you might have heard me say this on the podcast episodes I've done on evidence based practice Which I'll have Joe link those in the show notes.
But, first of all, that's the first, a little bit of red flag. The Journal of Manipulative and Physiological Therapeutics. Not throwing shit at them. Shade, not shit, but whatever, same difference. But I've literally never heard of them, except for from these studies. I will say the author of the study. The author of the study is known in the SI joint world.
Thank you. Uh, I think his first name's Peter, but his last name is Vander Wolf, Worf, Worf, ooh. I had a speech impediment as a kid and those, those letters together, like, ooh, that brings it out. W U R F, Peter, Vanderwurf tough, tough, you can even see my mouth straining to say that. Um, that, if, if you know, in the SI joint pain provocation world, world, there is a I think he is one of the researchers who put a cluster of tests together for diagnosing SI joint pain, so provocation tests.
So anyways, he's, he's like, I'm, I see that and I'm like, okay, well I know he knows what he's talking about. But also in general, like I was saying, this journal is not a well known journal. It's not a gold standard journal for physical therapy, for sports medicine, for orthopedics. It's not a well known journal for sports medicine, for orthopedics.
for medicine in general. So that in itself I don't want to say it's a red flag. It's a yellow flag. It's a, could be a great article. Don't know, but there's a reason why. And you should know if you went to grad school to did a thesis or dissertation, you should know this. There's a reason why when it's not a well known journal, the well known gold standard journals have such high requirements for the statistical analysis.
That sometimes your master's theses or your doctoral dissertations are not good enough to be published in that. Or maybe the writing sucks. I don't know. But I know that the editorial boards and the process of getting accepted in the gold standard journal article, journal publications have a higher standard that the research is held to.
So when you see research articles that are in. Unknown, not as well known professional journals, you have to sort of like take that with a grain of salt and ask like, well, why? And I don't know why. And like I said, this journal might not be that bad. I don't know, but I've never like going through school again.
School for me was like over 20 years ago now, but 20 years ago when I was doing all my research and like really diving into all the journals, like I, I don't ever, I didn't ever see this. So, um, and maybe it's more common in a different one, like a, you know, a different profession or sometimes different countries, right?
Different countries, um, have different ones. But anyways, so that's the first yellow flag is the journal it's in. But then when you continue to look into it, we'll go back to the ones from the 80s. So two of the three from the 80s used, actually, they modified Gillet's. Original test. So Gillet's original test, he was a chiropractor.
I say was, I'm assuming he's dead, but I don't know. He could be alive. I don't know when he was born or what the, whenever he first told the world about this test, I don't know how old he was. So the Gillet's test is hands against the wall. So your arms distance from the wall. And so you have some support as the patient.
Tester hands, one on. the spinous process of L4, L5, S1, 2, or 3. And then the other one on PSIS for the most part. There is a variation where we go down to the, um, ischial tuberosity or the ischial spine. We're not going to talk about that right now because the standard is L5, S1, S2,
and no, so the standard is S3 with the other hand on the PSIS. All right. So these tests, the old tests in the eighties, they did, they didn't, I didn't, they did not specify if the hands were on the wall. First of all, the hand placements were that, but the patient Gillet describes contralateral hip flexion with a bent knee up to 90 degrees.
These tests used straight leg hip flexion. Now I see why they wanted to do straight leg hip flexion, potentially. When you think about why they chose to do that, because again, this test is looking at SI joint mobility and they're trying to see like, let's see if we can get the ilium to move on the sacrum.
That's what this test is looking at more than the sacrum moving on the ilium. They're looking at the ilium moving on the sacrum. And I could imagine that when they were thinking like, let's straighten the leg, they're thinking, well, then the hamstrings If there's any hamstring tightness, it will sooner pull on the nominant and create motion at a lower range of motion than above 90.
So you don't have to restrict a certain range of motion degree. But that in itself means that when you then tell me that the March test is unreliable based on these findings, they're not even looking at the same test. And that's how research is. You're not supposed to extrapolate. You're not supposed to extrapolate period the interpretation or the way the test was done, right?
So that means those two tests for 1985 and 1987 like we can't even say that they're looking at the same thing For the sake of argument, we'll continue and say that wasn't that big of a deal And so we'll move on to tell you the next problem. The next problem with the test in my mind is The one for 1985 used 17 patients 17 That's not very many people.
That's not a very large N. For most studies to have a good chance of giving you any good information about reliability or validity, we need more than 17 people. 17 people is not very much at all. So that also makes it kind of shitty test or shitty research, um, method. And then the 1987 article used 53 students.
Better but still not great and then also let's talk about the fact that well I don't know that I didn't pull the 1985 Article today. I think I might have it. I'm not really sure but I didn't pull it So I don't know what the age for the 17 patients were but in the 1987 53 students You can assume that they're students at a college and so they're in their Early twenties, which nothing wrong.
No, no, no shame to early twenties, but also like that doesn't give us a very good example of the normal population. That's seeking physical therapy or athletic training, maybe athletic training services more so than physical therapy. The other problem, which is talked about in the 1999 article. is the omnibus score.
I don't even know what that is because I don't understand statistics, but it's one of the statistical analysis, analyses they use to determine That those tests were unreliable and it's been talked about in science since then that that That way of scoring is not the best way of scoring to figure out.
So That's actually why they're repeating this test in 1999 because they're like, you know what they use the omnibus test And we think there's a better way. We think there's a better statistical analysis to tell us if this test is reliable or not. So we're going to do it, redo it and do it again. And then the tests were 1989.
Um, I don't know why I don't have a ton of details on this, it was maybe because I saw how many patients it was, how many subjects it was, and I was like, well, that's a shitty study anyways. But, Herzog, let's see, reliability of motion palpation procedures to detect SI joint fixations, Okay, all, interesting, all four articles have been published in the same journal, the Journal of Manipulative and Physiological Therapeutics.
So this one from 1989, Herzog et al. It used 11 patients. So again, very low number of subjects. That's not great. I mean, it does not say what kind of test they used, if they used a bent knee or a straight leg like the other two. Um, I'm assuming since it was in the 80s around the same time as these other tests.
studies that they might've also used the Omnibus Score because I think the Omnibus Score must have been in the 80s the way to do this statistical analysis. Just like any science, science gets better and gives us better information. That's the same for statistics, I believe. I'm not a mathematician. I'm not a statistician, but I would assume.
So now we're to this recent 1999 study. So Um, it, I already told you, we already know that the journal we don't, I don't love, but we do know at least this is using more traditional Gillet's test, the more traditional March or Stork test. Okay, great. Now, interesting enough, they also looked at what changes with your, you know, with the thing, the hand on the spine being an L5, being an S1 or being an S3, if there is any changes.
And, uh, we actually go into that quite a bit. Well, we talked about a little bit in LTAP level one, but we really dive in, in LTAP level two on how just changing that hand placement can give us a different information too. So more on that. If you take my courses, but they did all three, which I actually liked that.
They did all three, but also the fact that they did all three is a yellow flag, knowing what I know now, which I'll talk about it as well, but knowing what I know, I'm like, well, now you're testing three different ligament directions.
So if you're testing three different things, but grouping them all together, as if they're the same, is that really going to. Is that really going to always get you the best information? I don't know. You would actually have to do an additional research project to determine if it makes a difference or not.
I don't know until you test it. Okay. So they, next thing they use 41 subjects. Again, they were students, the, the people performing the tests were two final year physiotherapy students. So. They were not even graduated yet. They were not actual physical therapy or athletic trainer professionals. They were students, which a lot of research out there is.
So again, like, there's nothing wrong with it being a student. But I'm gonna also say that's a yellow flag because the palpation skills of most new students and young professionals are very poor. And the anatomy there is a little challenging. For even the most seasoned pro professional, so 41 subjects, they were all students.
They, their average age was 23 years old, so they were all younger student population or older for students, but like, you know, babies, , not babies, you know what I mean? Adult babies of the 41 subjects, they threw three of them out, and then one of them did not show up for the return test the way they did the test.
So, the first thing that I noticed was they came in over a three week span, these patients, and you got tested one day. Um, I forget how many times they did the test, but they let the person go through ten repetitions on their own before they actually did the testing procedure. So, ten repetitions, then the test procedure on the right and on the left, and then four days later, they came back in and they did it again.
And both people, both researchers, tested it. So they compared the reliability between them and the reliability between those four days later. Okay? So, so, their final subject number was 37 people. And here I am again going, 37 people? You saw that the earlier studies did not very many people. In fact, the study in 1987 did 53 people, so more than you did.
But yet,
you could only get 40 people. Which Hey, again, I went through it in college. Like, it's hard. Recruiting subjects is hard. Especially when you have a short period of time that you need to get your research done in order to graduate on time and not spend a million dollars to stay in school to get all the subjects, right?
So it's like, I get it. I get why that happens. But also you have to remember that 37 subjects, all within 23 years old, plus or minus six months or two years even, Like that's not that many people. That's not a very good sample size. Even if we combine all these three studies, which we wouldn't because we would throw out the ones that use the old testing protocol, you know, like when we do a meta analysis, it's still not going to give us a ton of patients.
It's going to give us like, let's do the math. 37, 47, 48, 90, a hundred. We got maybe 115 people total in these four. Things like that's not very many people. And of course, when you run the statistical analysis, you, you run it to see if your subject number is appropriate enough to give you a appropriate amount of people to get some.
Significant data from but also like you can manipulate the data to make it work and often Things get published in journals that are not gold standard journals when they don't have very good subject numbers because gold standard journals are also like Hey looks great, but come back when you have more subjects and like the data is better.
So um
I say so a lot. I know this Side sidebar besides me saying so a lot when i'm listening to someone one of the things I say is like, oh, okay Oh, okay. And I'm like, I hear myself say it, and I'm like, stop saying that. Anyways. The thing I'm trying to tell you here is, yes, I see these studies. When the people come on my posts, the people being the ego based clinicians that think they know more than me and think I'm an idiot, and don't probably even read the caption very deeply.
Or don't believe that the model that they're currently using is wrong, which we got to start somewhere, right? That is where we're starting is we think the model we're in works and we're just used to media, mediocre results. There are the biggest comment I get is this test is unreliable. This test is unreliable.
This test is unreliable. Sometimes I write them back. Sometimes I don't, depends on what kind of mood I'm in. But I was like, Oh, you know what? Let's just film a podcast on it. Because maybe you're just nice and you haven't said that to me. Maybe you're a nice person and you don't say things on people's posts when you think you know better.
You just move on and ignore it. Chances are you like me. You know I'm smart. You're here because you think there's something to learn. You're here because you're curious and you believe that perhaps something is missing in this model and you're not satisfied with mediocre results or even good results.
But it's all relative how you describe good. I did a poll on Instagram the other day and we're like, what do you consider good results? Some people, it was seven out of 10, 70 percent was good. Like they could help seven at seven out of every 10 people. Some people was eight, some people was nine, no one. It was 10 and I'm here to tell you that good results should be 10 out of 10.
Or 9. 5 out of 10, as close to 10 as we can get. And it is possible. It's not only possible, but it happens on a regular basis, not just for me, but for my, the other clinicians that are gone through the LTAP level one and the mentorship program. And so, um, I also wanted to do this because it's like, yes, I, I get it.
Sometimes the research contradicts what we know works in our practice. And there's nothing wrong with that because then you go back to the research and you're like, well, how good was this research? Because maybe I'm getting different information because I'm like, I have a bigger population size, or I have better palpation skills, or I understand anatomy better, or like me, I'm using this test in a different model.
Now, now this is where I'm going to say, go back to that old episode and listen. One of the things that makes the SI joint so challenging. So the other thing, so. When I, I said at the beginning of this podcast, even I said, I, in this model that I, that I operate out of this whole organism approach, this approach to movement, and that includes the viscera, that includes the nervous system, the vascular system, the lymphatic system, that includes understanding how the organism autonomic nervous systems drive to survive.
When we look at the SI joint mobility test in this model, I actually would never expect it to be reliable. I would never expect my patient to come in four days after I examine them and get the same exact outcomes when it comes to the SI joint. And this is because the SI joint is what Jean Pierre Barrault calls a visceral joint.
It is a joint whose mobility Is checked when there is a strategic hyp-. Well, it's called a strategic hypomobility. The mobility of the joint is checked when the body is protecting or having tensions around visceral organs or the nervous system, it's going to affect the SI joint. The body does not grant us that mobility.
It is a way of protecting the organism. And so even within a session, I would not expect to get the same results. So what is that gonna do with the traditional inter relator and in inter and intra rater reliability? It's gonna say it's not reliable. 'cause all that study is saying is that when I do a test on somebody and I do it again, I'm getting to get the same result.
And when, and also when Joe Schmo, Joe does it next to me, he's gonna get that same result as me and inherently the way the SI joint acts. And the way that it can be limited from a hypomobility standpoint strategically, not structurally, means that it is constantly changing in response to what the body is feeling.
dealing with
and what the body is often dealing with is the drive to protect the vital organs and protect the nervous system and protect the whole organism. And the fundamental way it does to protect things, especially when they're cannot be protected by a hard frame is to limit mobility, is to change our output.
Our output is mobility, movements, pain, right? So I would never expect The SI joint mobility test, to be reliable, to be honest. And there's other, some other joints that I would kind of expect that too. But the difference between like in the shoulder and in the SI joint is the SI joint has very little movement.
So when it doesn't move, it's noticeable. But when my shoulder doesn't move, like who's to say that this is not moving or this is not moving or is not moving, just not moving. Right. Do you see how the nuance of it? changes, like no wonder there's such argument on the SI joint, right? It itself, especially in this model, tells us that it's just different.
So as you can tell, I'm super passionate about this because I don't want people to throw out this test from their practice because four studies from, as the, as my 14 year old niece would say, four studies from the last century. tells us it's unreliable? Somebody, one, do some new studies. Two, do them right.
Three, maybe we just need to write an article about how the joint is influenced by so much more than just the musculoskeletal structure of the ligaments and the bones and the tendons and the shape, the architecture. So that's it. Hope you found it helpful. Be on the lookout for next week's door's opening into the new free course, a mini course.
And also if you know you're in for the LTAP, join the wait list today and get access to that four day presale. It is from Wednesday, whatever that day is. What day is it? I got a calendar right here. Wednesday the 4th to Sunday, the 8th.
Hello! A little addendum. Was just linking all the research articles for you and I want to say that I did speak wrong to the, um, test that was done in 19, or the research article from 1985. It was in a better journal. It was in Physical Therapy, uh, the journal Physical Therapy, which is a little bit more reputable.
It was also performed by Uh, physical therapists that specialize in orthopedic physical therapy and have been trained in SI joint examination, which I'm still like, I'm still curious how many years of experience those testers had, but whatever. Um, it was eight testers. So, uh, we'll save that for another day of what I think about that, but, uh, they, they tested 13 different tests in 17 patients in two clinical settings and they found all of the tests.
So, um, the test results were poor reliability with less than 70 percent agreement. And, um, two of the tests were, but they relied on subjective information and it was more about pain, I believe, than it was mobility. So, this test, um, Better Journal, I like that. More seasoned clinicians like that still super low subjects.
So don't like that Too much testing things I believe looking at all 13 and then also it looks like they're focusing on pain more than mobility and Going back to what I already said, they use the Gillette's test with a straight leg So I still don't Love this test in general, but I did want to say that I spoke about it incorrectly earlier, and um, but it still has a lot of yellow flags for me.
Just not as many as the other. Oh look, it does have a full text. Look at that. We can read the whole article. Um, I'll link it in the show notes for sure. I'm linking all of these articles in the show notes.
Oh, I don't think it's free access though, so. It is in the Physical Therapy and Rehabilitation Journal. Which is associated with the APTA, so it's definitely a more reputable one, but it was from 1985, so they also used that old scoring system of statistical analysis for reliability, so lots of yellow flags still, but I'll link it all and you can read it yourself.