SIB #389 - Does Gillet Test Assess Sacroiliac Motion?
The Study: Does the Gillet test assess sacroiliac motion or asymmetric one-legged stance strategies?
The Facts:
a. The authors wanted to see if the apparent movements of the iliac spine and the sacral base during the Gillet test were related to hip flexion and the palpation pressure the clinician used during the test.
b. The Gillet test is used to evaluate sacroiliac (SI) joint motion.
c. The Gillet test is commonly performed by the clinician putting one thumb on the posterior iliac spine (PSIS) with the other thumb being placed on the sacral base (SB) in the area of the second sacral tubercle.
d. The patient flexes their hip on the side that is being tested.
e. If the ilium rotates posterior and moves inferior then that is interpreted as the SI joint being moveable.
f. Interexaminer reliability studies related to the Gillet test range from good to poor.
g. In this study the examiner placed one thumb on the sacral base and the other thumb was placed on the PSIS. The thumbs were positioned so as to be parallel with the floor.
h.. Group A: (modest palpatory pressure was utilized.) In a group of subjects a picture was taken of the procedure with the subject at an initial base line of 0 degrees of hip flexion. The subject then flexed the hip on the side being tested to 10 degrees and another picture was taken.
i. Group B: (modest palpatory pressure was utilized.) In other subjects a picture was taken at 30 degrees of hip flexion. The leg was lowered and then flexed to 90 degrees where another picture was taken.
j. Group C: In a third group of subjects a picture was taken at 30 degrees and the examiner used modest palpatory pressure. Then the examiner increased the pressure with which the thumbs were applied to the sacral base and PSIS and the subject repeated the procedure and once again flexed their hip to 30 degrees and another picture was taken.
k. The authors concluded: “This study found that using relatively light palpatory pressure, with hip flexion ≤30°, the left PSIS appeared to move caudal and the right PSIS cephalad to the sacral base. For hip flexion =90°, both PSISs appeared to move cephalad to the sacral base. Firm palpatory pressure mostly abolished these apparent PSIS movements relative to the sacral base. The data suggest slight pelvic tilting, the result of asymmetric muscle activation patterns and tone, may account for all or part of the appearance of sacroiliac movement during Gillet testing.”
l. The authors also cautioned that there were a number of limitations in this study which “ought to mitigate against any tendency to immediately and completely reject the Gillet test; just as it was not appropriate to immediately accept its validity.”
Take Home:
“Slight pelvic tilting” during the one legged stance phase of the test “may account for all or part of the appearance of sacroiliac movement during Gillet testing.”
Reviewer's Comments:
First I liked the idea of using photography to quantify the movement. This allowed for the authors to see which direction the thumbs moved and how much they moved i.e. correlation and quantification. I thought the concept of utilizing less and more pressure in the test was quite inventive. We need to evaluate the procedures that we use in practice and I applaud the authors for performing this study.
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Cooperstein R, Truong F. Does the Gillet test assess sacroiliac motion or asymmetric one-legged stance strategies? J Can Chiropr Assoc. 2018 Aug;62(2):85-97.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/30305764
Link to Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173222/pdf/jcca-62-85.pdf